Safety changes 'neglected by GPs'

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Reforms to improve the quality and safety of NHS care are not hitting home in GP surgeries, says a report from the National Audit Office.

It says many have not implemented 'clinical governance' systems found elsewhere in the health service.

Edward Leigh MP, chairman of the House of Commons Public Accounts Committee, said the current shake-up of primary care trusts should address this.

Health Minister Lord Hunt said a new 'quality framework' for GPs would help.

This once again shows that patient safety is still too far down the NHS agenda Edward Leigh MPChairman, House of Commons Public Accounts Committee

Clinical governance was first introduced in 1998 as a way to drive improvements in the care offered by hospitals, GP practices and pharmacies.

Learning from mistakes

It was a formal framework for many of the things the NHS was already supposed to be doing.

These included learning from mistakes and complaints, keeping up to date with 'best practice' in other parts of the health service, spotting and dealing with risks to patients and staff and improving facilities to improve the 'patient experience'.

Emphasis was placed on the importance of involving patients and the public in making decisions about changes in services.

CLINICAL GOVERNANCE Spotting potential risks to patients and staffChecking how good your work isInvolving patients and the public in decisionsImproving the 'patient experience'Learning lessons from complaints and mistakes

The NAO report looked at how clinical governance was working in primary care - inside primary care trusts, GP surgeries and pharmacies.

While it found that primary care trusts - which are more directly influenced by strategic health authorities, had made substantial progress, a different picture emerged in frontline services, particularly those independent of direct NHS control, such as GPs.

No reporting

In a survey of GPs, three quarters admitted that they did not report "adverse incidents" - events which either did or might have caused harm to patients - to the National Patient Safety Agency, a central plank of clinical governance.

We are constantly assessed by the primary care trust for the safety and quality of services we deliver Dr Laurence BuckmanBritish Medical Association GPs Committee

Sir John Bourn, head of the National Audit Office, said: "Good clinical governance is essential if patients and the public are to have greater confidence in the NHS.

"Whilst Primary Care Trusts have made good progress in getting structures and processes in place, there has been less progress in actually implementing the fundamental components of clinical governance, particularly patient and public involvement."

Mr Leigh said: "Many primary care organisations have demonstrated limited progress in implementing the Department of Health's clinical governance agenda.

"This once again shows that patient safety is still too far down the NHS agenda.

"Most NHS organisations that provide or commission primary healthcare services have systems and processes in place to give assurance that the services provided by GPs, pharmacists and others are safe and of good quality.

"But that is a fat lot of good when they all too often fail to apply these systems and processes in practice."

He added: "I am particularly disappointed that least progress has been in the area of patient and public involvement, in both designing services and decisions about care."

Across England the number of primary care trusts is being cut, and the NAO says that the new larger trusts should take the opportunity to implement clinical governance more effectively.

However, Dr Laurence Buckman, a GP and member of the British Medical Association's GPs Committee, said that although many GPs still did not understand what clinical governance was, they understood the need for safety and quality.

He said: "We are constantly assessed by the primary care trust for the safety and quality of services we deliver - if we don't give a decent service, we don't get as much money.

"It's simply that the structure of clinical governance that works elsewhere in the NHS doesn't work in GP surgeries."

'Safe and effective

Health Minister Lord Hunt said that patient safety was a 'key priority'.

"The vast majority of NHS patients receive safe and effective care and the majority of incidents that are reported result in no harm to patients.

"The Department of Health welcomes the NAO's finding that clinical governance in PCTs has delivered clear benefits to the quality of patient care, with reporting systems in place and changes being made in the light of reports of any incidents.

"We recognise that the biggest challenge for PCTs is in engaging clinical staff such as GPs, independent providers and the public in improving patient safety even further.

"We are currently developing a quality framework to help them do so."