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Forging links: evolving attitudes of clinical governance leads in general practice

Andy Meal, Julia Hippisley-Cox, Alison Wynn, Mike Pringle, Ruth Cater

Background Clinical governance was introduced by the British government in 1998 at the same time as the creation, in England, oforganisations to deliver it in primary care – primary care groups. It was acknowledged, however, that individual general practices and primary care teams would actually deliver many of the requirements of clinical governance on the ground.Because of this, the opinions and attitudes of staff at practice level, particularly the clinical governance leads in the practices, are important for the delivery of the clinicalgovernanceagenda.Objective To investigate the views of practice clinical governance leads on their role in relation to the delivery of clinical governance.Design A qualitative study using two sets of semistructured interviews, one year apart.Setting Nineteen general practices from19 primary care organisations (PCOs) within Trent Region.Participants Key informants nominated by each of the participating practices as being their clinical governance lead. Sixteen practices nominated general practitioners (GPs) (in one of these, two GPs shared the role), one practice nominated a practicenurse co-ordinator, and another nominated both a practice nurse and practice manager to be interviewed. The remaining practice nominated a GP, practice manager and two practice nurses to be interviewed.Results Attitudes of our informants to clinical governance are positive. There is an ongoing commitment to quality as clinical governance is being implemented at practice level. This is in spite of some initial reluctance by our informants to take onthe role of clinical governance lead, and uncertainty about what the role would entail. In the Ž rst interviews there was a feeling that being clinical governance lead would involve a practice-centred approach, continuing existing practice qualityinitiatives such as clinical audit. One year later attitudes had evolved. Quality was still seen as important, but now more of our informants saw their role extending beyond the practice, in particular to a link role between themselves, their PCOand other practices.Conclusions Clinical governance is being implemented in a positive climate in primary care, with an ongoing commitment to quality that predates the advent of clinical governance. The role of the practice clinical governance lead has evolved fromapractice-centred approach to one that is more outward looking, as evidenced by a link role between practices and PCOs. We suggest that this role could facilitate many aspects of clinical governance, and as such it should be encouraged by PCOs, more specifically by enabling protected time for clinical governance work in practices.