GP mythbuster 65: Effective clinical governance arrangements in GP practices

We consider a GP practice’s clinical governance arrangements when we make judgements about how effective and how well-led GP practices are.

What is clinical governance?

Clinical governance is a systematic approach to maintaining and improving the quality of patient care. It provides a framework for drawing together the different strands of quality improvement which includes clinical audit, clinical leadership, evidence-based practice and the dissemination of good practice, ideas and innovation and addressing poor clinical performance.

All healthcare providers should give clinical governance a high priority. It should be led by senior members of the practice who understand their responsibilities to improve the quality of care patients receive and are accountable for the quality of clinical practice provided by clinicians in the practice. All staff members should be involved.

In a good GP practice we expect to see that:

• Information about people’s care and treatment, and their outcomes is routinely collected and monitored. This includes assessments, diagnosis, referrals to other services and the management of people with chronic or long term conditions. This information is used to improve care.
• Quality improvement activities, including clinical audits, are carried out and involve all relevant staff.
• Participation in relevant local audits, and other monitoring activities, such as reviews of services, benchmarking, peer review and service accreditation.

In a good practice, accurate and up to date information about clinical effectiveness is used and is understood by staff. It is used to improve care and treatment and people’s outcomes and this improvement is checked and monitored.

The basis for effective clinical governance is having data and information about how well a GP practice is performing, and using this information systematically to identify how to improve the quality of care provided. Examples of information that can be gathered to support discussions on clinical governance include:

• Unexpected deaths
• New cancers and other life changing diagnoses
• Significant events  (both positive and negative – see GP mythbuster 3: Significant Event Analysis (SEA)
• Patient complaints
• Monitoring and adoption of best practice, eg NICE guidance and medicines alerts
• Patient feedback (both positive and negative) and survey results
• Prescribing performance
• QoF and Enhanced Service performance data
• Clinical audits findings
• Education and learning, and sharing learning within the practice.

Clinical governance and CQC inspections

Looking at clinical governance arrangements is a key aspect of our inspections of GP practices and it is relevant for a number of the key questions we use on our inspections (safe, effective, caring, responsive and well-led). In particular, it is included when we consider how effective and well-led GP practices are.  

See the key lines of enquiry we use on our inspections and the characteristics of an effective and a ‘well-led’ practice. A number of these key lines of enquiry are relevant to clinical governance.

Clinical governance arrangements are considered when we look at:

How effective a GP practice is:

How are people’s care and treatment monitored and how do they compare with other similar services?

• Is information about the outcomes of people’s care and treatment routinely collected and monitored, including assessment, diagnosis, referral to other services and the management of people’s long-term or chronic conditions, including those in the last 12 months of life?
• Does this information show that the intended outcomes for people are being achieved?
• How do outcomes for people in this service compare to other similar services and how have they changed over time?
• Are clinical audits carried out and all relevant staff involved?
• Is there participation in applicable local audits, national benchmarking, accreditation, peer review and research? How are findings used and what action is taken as a result to make improvements?
• Are staff involved in activities to monitor and improve people’s outcomes?

How well-led a GP practice is:

Do the governance arrangements ensure that responsibilities are clear and that quality, performance and risks are identified, understood and managed?

• Is there a holistic and comprehensive understanding or performance, which integrates the views of people with safety and quality information?
• Are there comprehensive assurance systems and performance measures which are reported and monitored, and is action taken to improve performance?
• Is there a systematic programme of clinical and internal audit which is used to monitor quality and systems to identify where action should be taken?

If we find that a GP practice does not have effective governance processes we will consider whether they are meeting the regulations which set out the fundamental standards of care. Regulation 17 focuses on good governance.