Table 3.

Examples of clinical governance in a primary care group

Level	Quality problem	Possible solution: quality improvement process	Accountability—including accountability to patients
Individual healthcare professional	GP returning to work after prolonged absence—concerns about consultation competence	Arrange direct observation and assessment of consultation performance with provision of supportive feedback to identify practical approaches, enhance strengths, and correct weaknesses. Follow up as required	Clinical governor can report to the group that no further action is required. Patients can be reassured that a mechanism is in place to monitor and enhance clinical competence
Practice	Assessments of patient satisfaction show problems in securing appointments, complaints in relation to access, and difficulty getting through on the telephone	Evidence based audit of appointments process, rigorous analysis of problem; practical solutions identified and implemented. Further review planned after a reasonable interval	Agree with patients’ group the standards for appointments accessibility. Share audit results with patients’ group. Report to clinical governor and group board
Primary care group	A few health professionals and practice(s) refuse to participate in clinical governance activity, particularly audit. This is associated with evidence of problems in care, eg failure to reach clinical targets, patient complaints	Group clinical governance team visits the practice(s) to undertake detailed appraisal and identify obstacles to change. Comprehensive package of support offered, including team building, help with organisational development, and practical assistance in responding to the practice’s heavy workload	Report to group board and health authority. Persistent failure reported to relevant local or central organisations, eg local medical committee, regional office, or Commission for Health Improvement