Table 1.

Examples of current quality improvement activities in primary care in relation to the principles of clinical governance⁶

Examples of current activities/organisations involved	Strengths	Weaknesses	Opportunities in governance
Quality improvement processes are in place and integrated
Clinical audit led by primary care audit groups (or equivalents)	High levels of participation by practices14	Quality of some audits could be improved	Integrate with evidence based practice and continuing professional development
	Can lead to demonstrable improvements in care	Audits often not linked to evidence14 or to continuing professional development	Use of a wider range of implementation methods3
			PCG-wide policy for clinical data recording
Evidence based practice, innovative practice, and research and development
Clinical effectiveness not actively managed16	Increasing examples of evidence based health care through guidelines17 and/or audit protocols18	Lack of local support and infrastructure	Systematise and actively manage evidence based practice in primary care groups
Research practice networks and individual research practices; university departments		Lack of training and skills in evidence based practice	Research practices/research groups
Professional development programmes
Hospital based teaching, pharmaceutical companies	Self directed learning groups	Not actively managed or systematic	Multidisciplinary practice professional development plan20
Departments of general practice/nursing, etc	Vocational training and trainers19	Failure of traditional continuing medical education to change practice5	Needs based or practice based life long learning
Practice based educational programmes	Clinical supervision (nursing)	Not needs based learning
	Systems for recertification being developed	Not multidisciplinary
Complaints, adverse events, and clinical risk reduction
Practice based complaints procedure	Resolution of complaints locally	Not actively managed or systematic	Integrate with other quality improvement processes, collation of data at primary care group level
Poor clinical performance
No requirement routinely to monitor clinical performance	Clinical supervision (nursing)	Often not actively managed or systematic	Actively manage a process to identify, support, and rectify poor performance at individual and team levels.
GMC/UKCC procedures; health authority procedures	Tool available to monitor and enhance performance21	Current procedures rely on extreme cases	Develop occupational health22

GMC=General Medical Council; UKCC=United Kingdom Central Council for Nursing, Midwifery, and Health Visiting; PCG=primary care group