Table 2.

A model of clinical governance at different levels (1 to 4) in the development of primary care groups^*

Level of clinical governance3	Defining quality	Defining accountability	Defining quality improvement
Individual healthcare professionals	1 General Medical Council and United Kingdom Central Council for Nursing, Midwifery, and Health Visiting standards, GP’s terms of service	1 Information given to health authority about training received, complaints, and participation in audit. Persistent poor performance dealt with	1 Assessment and enhancement of consultation performance
	2 Criteria of consultation competence21	2 Summary of audit findings provided	2 Clinical audit
	3 Professional development, eg Royal College of General Practitioners fellowship by assessment	3 Relevant anonymised audits reported to patients	3 Personal appraisal with use of a limited range of implementation methods
	4 Patients’ views, evidence based practice	4 Patients involved in choosing audit topics/assessing performance	4 Personal development plans. Full range of implementation methods available
Practice teams	1 NICE annual topics	1 Publication to health authority of extent of practice accreditation	1 Multidisciplinary protocols in use
	2 Local NHS priorities–health improvement programme	2 Participation in audits	2 Multidisciplinary audit taking place
	3 Health needs assessment	3 Publication of results of clinical audits within health service	3 Practice professional development plan
	4 Patient involvement, evidence based practice	4 Relevant anonymised results of audits available to patients	4 Team has fully implemented continuous quality improvement, including systems to identify obstacles to change
Primary care group	1 One or two NICE, national service framework, or health improvement programme topics	1 Performance data reported to health authority. Persistently poorly performing teams and individuals assisted to improve	1 Findings of audits on topics fed back to practice teams and plans for improvement made
	2 More NICE, national service framework, and health improvement topics	2 Annual report on quality of care issued to Commission for Health Improvement and local health and social services	2 Audit findings compared with those of other groups; obstacles to improvement identified
	3 Comprehensive population health needs assessment, with explicit group objectives agreed	3 Annual quality report available to the public. Participation in accreditation schemes for groups	3 Wide range of methods used to overcome obstacles to change
	4 Patient involvement, systematic evidence based practice	4 Patient involvement in assessing quality of services	4 Comprehensive quality management system in place throughout the group

NICE=National Institute for Clinical Excellence. 

^*Activities in each cell of the model illustrate but do not define what should be expected of primary care groups at each stage of their development to trust status.