-----Original Message-----
From: owen dempsey <[log in to unmask]>
To: GP UK <[log in to unmask]>
Date: 10 July 1998 07:15
Subject: clinical governance


>
>clinical governance for pcgs could have five strands, and these are to
>be discussed by the pcg
>
>1. policing of poor practice, by the HA, (prob no. crunching) process
>and penalties to be agreed by the pcg


I think this would be very counter-productive.  Clinical governance should
be about the pursuit of excellence own be professionally owned.  Let
performance review procedures be separate from clinical governance.  CHI
should be about trailing edge practice

>
>2. educational incentive monies for practices to demonstrate
>improvements according to the 'quality standards framework' perhaps
>administered via cme tutors, and developed by the LMC in conjunction
>with HA (used some of the criteria RCGP developed for fellowship ass. by
>practice)

I think clinical governance should be about promoting enthusiasm and the
motivation shouldn't be financial unless linking in to PGEA through personal
education plans.  I would worry that a quality standards framework would be
too prescriptive and wouldn't be owned by local GPs.
>
>
>3. joint working with secondary care to agree generic standards, and to
>develop speciality liaison groups
>
Should be part of PCG work somewhere and may be appropriate for clinical
governance.

>
>4. the development of maag to become a resource for the pcg to audit
>aspects
>of the care being purchased and for the input of the latest best
>evidence from
>NICE or other sources in to the Speciality Liaison Groups.

Sounds good

>
>5. For MAAGs to facilitate and to provide training for practices so that
>they can
>develop their own practice based pathways of care, that may or may not
>involve consultants or other clinicians, again with financial incentives
>as in 2.

This is something MAAGs should be doing anyway.

My hopes for clinical governance may sound hopelessly naive on this list but
here goes anyway.  It should be professionally led and about excellence.
When I came into practice in the 80s there were a number of groups of GPs
which looked at quality of practice e.g. young principals groups, college
groups, a small practice group.  There was no question of payment,
incentives or compulsion.  We were enthusiastic, self-motivated and set our
own agendas.  Whats more, across the country there were thousands of us.  So
what went wrong - a dictatorial 1990 contract, fundholding which encouraged
practice isolation business plans and paperwork.  Health Authorities who
felt they knew best what GPs should be doing.

In our locality there is a real desire to take control of the quality agenda
once again.  We can use CME tutors, MAAG etc as a resource.  NICE will
inform our discussions.  The trailing practices will be encouraged to join
in but we are no longer going to be dictated to about quality.  GPs innovate
best when working on their own ideas in their own way.  Clinical governance
will be a great boost to morale if GPs can take control of this agenda once
again.

If we recoil in the face of the threat then the threat will materialise and
the academics and managers will take over the agenda.

Thanks for the posting Owen.  I think we all need to share our ideas not
just on clinical governance but the setting up of PCGs generally.  Is there
scope for a PCG mailing list for those committed to the process of setting
up successful PCGs.

Martin Bradley
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