CLINICAL
GOVERNANCE
Dr Rachel McEnery GP trainer
Kilmeny Group Medical Practice
Aims and Objectives
 To understand the role and significance of Clinical
Governance in General Practice
 Highlight potential areas that may come up in your AKT
 Inspire you to become Clinical Governance leads in your
future practice!
Agenda
 Introduction
 What is Clinical Governance?
 Small group work looking at cases, SEAs or Audits
 Discussion
Clinical Governance - Definition
 ‘a framework through which NHS organisations are
accountable for continuously improving the quality of their
services and safeguarding high standards of care by creating
an environment in which excellence in clinical care will
flourish’
Scally and Donaldson 1998
Clinical Governance – History
 1997: The New NHS – modern, dependable
 1998: A First Class Service: Quality in the New NHS
 GMC: Duties of a Doctor and Good Medical Practice
 RCGP: Good Medical Practice for General Practitioners
 2008: Lord Darzi High Quality Care For All – NHS next stage
review
Clinical Governance Structure
 Individual
 Practice
 PCT
 SHA
 DoH
 Independent regulators CQC and Monitor
 National Quality Board
 RCGP
 GMC
7 Pillars of Clinical Governance
1. C……….. E……….. & R………..
2. A….
3. R… M………
4. E…….. & T……..
5. P…… & P….. I………
6. U…. I…….. & I.
7. S……. & S……. M………
Health organisations also need L………, T… W…, A………….
and a C…… of openness for Clinical Governance to be
effective.
7 Pillars of Clinical Governance
1. Clinical Effectiveness and Research
2. Audit
3. Risk Management
4. Education and Training
5. Patient and Public Involvement
6. Using Information and IT
7. Staffing and Staff Management
Health organisations also need Leadership, Team work,
Accountability and a Culture of openness for Clinical
Governance to be effective.
 Clinical Governance key components video
Leadership
 Establish direction or vision
 Persuade people to share
the vision
 Communication/listening
skills
 Innovate
 Responsibility, respect,
integrity, authority
 Ability to inspire and motivate
 Ability to interpret data
 Good and fair judgement
 High standards
Accountability
 Answerability
 Responsibility
 Blameworthiness
 Liability
Culture
 No blame
 Patient first
 Safety
 Desire for quality
improvement
 Openness
 Learning
 Education and reflection
 Supportive
Clinical Effectiveness and
Research
 The Right person doing:
 The Right thing (evidence
based practice)
 In the Right way (skills and
competence)
 At the Right time (providing
treatment or services when
the patient needs them)
 In the Right place (location
of treatment/services)
 With the Right result (clinical
effectiveness/maximising
health gain)
Audit
 Aim of the audit process is
to ensure that clinical
practice is continuously
monitored and that
deficiencies in relation to
set standards of care are
remedied
 At practice and national
levels
Education and Training
 CPD
 Appraisal and Revalidation
Patient and Public Involvement
 Patient and public feedback to
improve services, for
development of services and
monitoring treatment outcomes
 PALS
 LINKs
 Local feedback questionnaires
 Patient participation groups
 Patient satisfaction surveys local
and national
 Suggestion boxes
 Lay members on interview
panels, complaints hearings and
trust boards
Using Information and IT
 Patient data is accurate and
up to date
 Data protection
 QOF
Staffing and Staff Management
 Appropriate recruitment and
management of staff
 Organising a programme of
education, training and
appraisal of all in the service
to motivate and develop staff
and encourage retention.
 Systems to identify poor
performance
 Implementation of strategies
to correct poor performance
Risk Management
 2 stage process
1.
2.








Risk Assessment
Risk Management
Includes infection control
Reporting of incidents via SEA
Promote a blame free culture
www.nhstaps.org.uk
www.npsa.nhs.uk
www.nrls.npsa.nhs.uk
MaPSAF
Primary care trigger tool
Risk Management
 Risk management video - Bodies series 1
Risk Management
 What key elements of
Clinical Governance were
and were not demonstrated
here?
 What should have
happened?
Small Group Work
 Discussing Audits, SEA or cases.
Conclusions
 Nothing new
 Opportunities and threats
 Can support us
 Might make us feel better!