Accepted date: 25 November 2003
Clinical governance leads in primary care trusts play a crucial role in embedding the pursuit of excellence within their healthcare organisation. They are often the Ã…Â½ first point of contact for any issue relating to general practitioner appraisal, poor performance, quality and standards, be they clinical or organisational. However, for many clinical governance leads their job seems daunting, with no clear boundary around their roles and responsibilities, and no clarity about their own personal development such that they can acquire the skills and competencies for their work. Using the NHS Knowledge and Skills Framework and reÃ…Â½fined by stakeholder consultation this document sets out a framework for primary care trusts’ clinical governance leads. It attempts to deÃ…Â½ ne the core activities, skills required and support needed to meet these activities. These can be used to compose a template for a job description and person speciÃ…Â½ cation for a competent clinical governance lead.
clinical governance leads, framework, job description, person specification
Clinical governance is a framework through which NHS organisations are accountable for continuously improving the quality of their services, safeguarding high standards by creating an environment in which excellence in clinical care will flourish. The Commission for Health Improvement (CHI) defines clinical governance as a ‘system of steps and procedures . . . to ensure that patients receive the highest quality care’.
While there is evidence that the concept of clinical governance is received by primary care with enthusiasm, the delivery of clinical governance faces challenges. These challenges include the paucity of earmarked Funding, the speed of change, and the volume of work for clinical governance leads. The work of the clinical governance lead has varied depending on the needs of the organisation, configuration of the clinical governance structure, designation of the lead (e.g. medical, nursing, pharmacist) and other local factors.
Clinical governance leads have experienced dif- ficulties during the development of their role; for example, they have not always been clear about their level of responsibility for the development of clinical governance within their own organisation, the ambiguity of their role and the long-term uncertainty. The early lack of direction for the role of clinical governance leads has served to create a sense of powerlessness among some, forcing many to resign their position. However, this uncertainty also encouraged local flexibility and facilitated organic growth of the process.
To help define more clearly the roles and responsibilities of the clinical governance leads the NHS Clinical Governance Support Team held a stakeholder event and published a draft framework for consultation on their website. Attendees at the stakeholder event were made up of primary care trust (PCT) and strategic health authority clinical governance leads, PCT professional executive committee chairs and members, clinicians fromnursing and general practice and others, to reflect the broad church of primary care clinical governance. The stakeholder event was chaired and facilitated by the Director of Primary Care for the NHS Clinical Governance Support Team.
The aims of the consultation process were to:
• define the core attributes of the clinical governance lead
• define the roles and responsibilities of the clinical governance lead
• map the roles and responsibilities against the NHS Knowledge and Skills Framework.
Fundamental to the roleof a clinical governance lead is to champion a culture of high quality care across the PCT. This means instilling within the organisation the shared beliefs and values of clinical governance as outlined in Box 1 such that this may in turn influence the norms, attitudes, and behaviours of the members of the PCT.
Table 1 highlights the attributes of good clinical governance and the role that clinical governance leads have in relation to achieving these.
The NHS Knowledge and Skills Framework has been designed to determine the pay progression for all employees within the NHS.7 It is made up of dimensions, six core and 16 specific to particular jobs. It is designed to identify the knowledge and skills that individuals require for particular posts and help guide the development of individuals.
Each dimension is accompanied by a ‘descriptor’, which give successively more advanced levels of knowledge and skills and/or increasing complexity of application to the demands of the work.
The knowledge and skills defined for clinical governance leads, outlined in Table 2, are drawn fromthe NHS Knowledge and Skills Framework.7 The examples given can be used to develop the job description template.
The NHS Knowledge and Skills Framework seems an appropriate tool for describing the roles of a clinical governance lead, with the main additional ‘specific’ areas being communication, leadership skills and talent to e¡ect change and influence people. In addition to clarity of roles and responsibilities, other factors must be present such that a clinical governance lead can function e¡ectively. These include professional support from the PCT chief executive and training, which includes leadership and change management as well as the practical aspects of the post. Other factors include e¡ective communication systems between primary care and secondary care, a multiprofessional team approach with management support, access to timely clinical information, clearer guidance on the levers available to clinical governance leads and teams and finally access to evidence-based information. With these in place, clinical governance leads will be equipped for the next challenges facing them in supporting the implementation of the quality and outcome framework of the new General Medical Service contract. Clinical governance has moved a long way since the concept was first introduced into NHS practice and helped to focus clinicians’ minds on clinical quality. Future developments must now be involved providing the leads withmore clearly defined roles and responsibilities and expanding their roles to involve embedding quality and governance in the whole commissioning process.
USEFUL WEBSITES FOR EVIDENCE-BASED CARE
• www.jr2.ox.ac.uk/bandolier/: journal presenting evidence-based information around health.
• www.cochrane.org: prepares, promotes and publishes evidence-based reviews on aspects of health and social care.
• www.le.ac.uk/cgrdu: Clinical GovernanceResearch and Development Unit, University of Leicester.
• www.nice.org.uk: systematic reviews on areas of common clinical practice.