Improving quality and safety - progress in implementing clinical governance in primary care: lessons for the new Primary Care Trusts
Publication of 47th Report, 2006-07
Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:
“Too many primary care organizations are paying lip service to the principles of the Department of Health’s clinical governance agenda. Given that the central aim of the agenda is accountability for improving service quality and patient safety, that’s a poor state of affairs.
“The lines of communication between the Primary Care Trusts, on the one hand, and their GPs and other healthcare contractors, on the other, are defective. The PCTs must get the message across that clinical governance systems and processes must be applied on a day to day basis to drive up standards of quality and safety. They are not just a set of principles on paper - something to be piously nodded through at management meetings and forgotten.
“How can we be confident in the NHS’s ability to share learning locally and nationally about what can go wrong in healthcare when only a tiny proportion of GPs (four per cent) routinely report patient safety events and incidents to the National Patient Safety Agency?
“Clinical governance must result in real improvements to the quality of services to patients and to levels of patient safety. Patients want to be listened to by PCTs when the latter are making decisions on commissioning services. And PCTs need to show patients what effect their views have had.”
Mr Leigh was speaking as the Committee published its 47th Report of this Session which examined the Department of Health’s progress in implementing clinical governance in primary care; the lessons learned; and the risks that will need to be managed if quality and safety are to be embedded in the new Primary Care Trusts (PCTs). The Committee had taken evidence from the Chief Executive of the NHS, the Deputy Chief Medical Officer and the NHS Director General of Commissioning.
Following serious concerns about clinical and organisational failures in the NHS during the 1990s (such as Alder Hey, the Bristol Royal Infirmary and Shipman), the Government identified the need for a more systematic approach to improving quality and safety in healthcare. In response, the Department of Health introduced a ten year programme to improve the overall standard of clinical care. Its centrepiece is clinical governance; a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.
The Health Act 1999 (and 2003) introduced a statutory ‘duty of quality’ for services commissioned and provided by all NHS Trusts, for which trust Chief Executives are accountable. The Department expects this duty of quality to be discharged, at trust level, through the implementation of clinical governance. The Health Act 1999 also gave the Department the authority to establish Primary Care Trusts which are responsible for providing primary care services and commissioning services on behalf of their local health economy. In all some 303 PCTs were established between 2001 and 2002.
In July 2005, the Department identified the need for significant organisational change to enable primary care to respond more effectively to key national initiatives such as patient choice, payment by results and practice-based commissioning. The Department therefore announced that the number of PCTs would be reduced and reconfigured to 152, with effect from 1 October 2006.
The Committee found that clinical governance is not as well established in primary care as in secondary care, largely because of the complexity of PCTs role in both commissioning and providing care; and the independence of contractors delivering healthcare, particularly General Practitioners (GPs). Primary care has also been slower in adopting a structured approach to quality and safety, evident for example in the lack of compliance with national systems reporting of clinical incidents. There is a lack of clarity between PCTs and their contractors as regards accountability for ensuring quality and safety, and scope for greater involvement of patients and the public in ensuring that primary care services are safe and of high quality.