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5 Questions Every Practice Should Answer to Assess its Clinical Governance and CQC Readiness.

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You may remember a few weeks ago we examined the six signs of good governance in the GP practice. In that article we briefly touched on clinical governance when we highlighted the process of a clinical audit. In this article, we look at the five questions a practice needs to answer when assessing its performance in clinical governance.

1.What are the key functions of clinical governance?

If you think of clinical governance as a frame-worked approach to ensure that standards of patient care are not only maintained but improved, then it can be seen that there are four distinct areas that the governance will cover:

-The clinical audit


-Evidence based practice

-Sharing of best practice, ideas, and innovation to improve clinical performance

As with practice governance, clinical governance should be led by senior members of the practice but should engage all employees.

2.How do you ensure good clinical governance?

There are four key elements that will qualify good clinical governance:

1) Senior members of staff understand their roles and responsibility to aid the improvement of the quality of care provided to patients

2) Systems and procedures are in place to gather information about care and treatment given, and to monitor that care and treatment. The information that will be monitored will include patient assessments, diagnosis, referrals, and the management of patients with long-term and chronic conditions

3) Activities are in place to support the improvement of clinical care (this includes clinical audits). These activities should be thoughtfully designed and involve all relevant employees

4) The practice should also involve itself in local activities, such as audits, service reviews, and service accreditation

3.What does the CQC look for during inspections?

The CQC will look for evidence that a GP practice is competent across the four areas of clinical governance and that its governance framework supports the four key elements of clinical governance. You can expect that the CQC will want to see evidence that:

-Information about clinical activities is accurate and up-to-date, and that it is presented in a way that allows staff to understand its relevance and use

-There are procedures and processes in place that enables this information to be used to improve patient care and treatment

-Improvement in outcomes is both measured and monitored, and shows that intended outcomes are being achieved

-Clinical audits are carried out

-The practice is involved in local audits and national benchmarking, as well as accreditation and peer reviews

-All information gathered at the practice, local, and national level is used to improve performance

The CQC will expect to see evidence that all relevant members of staff are involved in the processes of clinical improvement.

4.Information is power: what clinical information should you be monitoring?

The CQC considers that the collection, monitoring, and understanding of clinical information is the number one key element to ensure improvement of clinical services. The type of information that you will need to use includes (but is not limited to):

-Unexpected deaths

-New cancers and other life changing diagnoses

-Significant events

-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

5.Is your practice well led?

In order for the clinical governance framework to be effective, a GP practice will need to be well-led. Policies and procedures should ensure that all roles and responsibilities are identified and understood, and the CQC will inspect for evidence that practice leadership takes a holistic approach to performance and understanding. The views of people should be integrated with safety and quality information, while systems are in place to impel the actions required to improve performance.

Download our one page resource on ‘five leadership qualities the CQC wants to see in your practice’ as a starting point to ensure your leadership empowers clinical governance in the practice.

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