Improving Quality And Safety Progress In Implementing Clinical Governance In Primary Care
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Improving quality and safety - progress in implementing clinical governance in primary care
Author: Great Britain: Parliament: House of Commons: Committee of Public Accounts
language: en
Publisher: The Stationery Office
Release Date: 2007-09-13
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. The Department of Health introduced clinical governance, a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Primary Care Trusts (PCTs) are responsible for providing primary care services and commissioning services on behalf of their local health economy. This report examines the Department'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 PCTs. 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.
Improving quality and safety
Author: Great Britain: National Audit Office
language: en
Publisher: The Stationery Office
Release Date: 2007-01-11
Primary Care Trusts (PCTs) are responsible at the local NHS level for the statutory "duty of care", largely through implementing clinical governance. The concept of clinical governance aims to improve continuously the overall standard of clinical care; reduce variations in outcomes of, and access to, services; and ensure that local decisions are based on the most up to date evidence of what is known to be effective. The key principles of clinical governance are: a coherent approach to quality improvement, clear lines of accountability for clinical quality systems and effective processes for identifying and managing risk and addressing poor performance. Clinical governance, implemented effectively, can provide PCT Chief Executives with assurance that healthcare, whether provided directly or commissioned from other providers, is both safe and of good quality. This report finds that the organisational structures and processes for clinical governance have largely been put in place at PCT level. But progress in implementing the different components of clinical governance varies both within and between PCTs. More needs to be done to provide assurance about the performance of General Practitioners and the systems which protect the safety of patients. Key features of those PCTs that can demonstrate consistent improvements in quality include effective clinical leadership, maintaining the capacity to deliver services, ensuring the quality of the patient experience and improving services based on lessons from complaints and patient safety incidents. The higher performing PCTs are characterised by: availability and accessibility of information to support evidence-based medicine; all staff appraised against an agreed work and development programme; service users involved in service development; clear action plans developed in response to clinical risks; and underperformance by clinical staff addressed by clear management procedures.
The delays in administering the 2005 Single Payment Scheme in England
Author: Great Britain: Parliament: House of Commons: Committee of Public Accounts
language: en
Publisher: The Stationery Office
Release Date: 2007-09-06
The EU Single Payment Scheme replaced 11 previous subsidies to farmers based on agricultural production with one payment for land management. The European Commission gave some discretion to Member States over how to implement the scheme, and the Rural Payments Agency, which is responsible for administering the scheme in England, opted for the dynamic hybrid model which incorporates elements of previous entitlement and new regionalised area payments based on a flat rate per hectare. The Agency and Defra encountered severe problems in the implementation of the scheme in England, and by the end of March 2006, it had paid farmers only 15 per cent of the £1,515 million due, compared with its target of 96 per cent. This caused significant hardship to farmers and taxpayers will have to pay extra implementation costs. Defra has had to secure an extra £300 million to meet the potential cost of disallowance of expenditure by the European Commission arising on the problems in administering the scheme. Following on from a NAO report on this topic (HCP 1631, session 2005-06; ISBN 9780102943399 published in October 2006, as well as a report from the Environment, Food and Rural Affairs Select Committee (HCP 107-I, session 2006-07, ISBN 9780215033383) published in March 2007, this report by the Public Accounts Committee examines the impact of the payment delays on the farming sector, why implementation failed, the role of Defra and the changes being put in place to rectify the mistakes made. Lessons highlighted include: the Department made the scheme unnecessarily complex by choosing to adopt the most demanding implementation option; the Rural Payments Agency shed too many experienced staff at a key time; implementation of the project started before the scheme specification was finalised; and the IT system was introduced without adequate testing, a failure often seen with government IT projects.