Why is clinical governance necessary?

Clinical governance was introduced in the UK following a series of well publicized lapses in patient quality in the 1990s as part of a broader government agenda to improve the quality of care delivered to patients by the NHS. It is a set of processes that healthcare professionals are expected to work within in order to learn from the successes and failures of both their own practice and those of others and to promote an open culture where experiences are shared to promote best practice for their patients.

When was clinical governance introduced?

The NHS document A first class service: Quality in the new NHS (DH 1998) introduced the term ‘clinical governance’, stating that, ‘for the first time, the NHS will be required to adopt a structured and coherent approach to clinical quality, placing duties and expectations on local healthcare organisations as well as individuals. Effective clinical governance will make it clear that quality is everybody’s business’.

What is clinical governance?

The NHS publication, Clinical governance in the new NHS (1999) outlines four main components of clinical governance. These are:

The publication also provides examples of quality improvement activities, including:

Clinical governance should underpin the practice of all healthcare professionals as they strive for the best quality of care for their patients and continually seek improvement in their practice. Practicing good clinical governance ensures a consistent approach to decision-making, minimizes risk and ensures that patients are the priority and focus of the professional practice of pharmacists and all other healthcare professionals.

Creating standards for quality

Standards are set by clinical guidelines, such as National Service Frameworks (NSFs). These are documents that serve as a practical aid to the implementation of treatment and service guidelines in a specific therapeutic area. They are developed by groups of experts, which include healthcare professionals and patients, along with the support of NICE. With these, decisions to prescribe medicines can be based on the best available evidence (see Ch. 20).

Delivering quality

Quality health care should be delivered by well trained and motivated healthcare professionals who are well managed and are committed to life-long learning through CPD (see Ch. 6). NHS staff should communicate openly with other healthcare professionals and should be encouraged to share best practice.

Monitoring quality

Quality of care should be monitored both nationally and locally through a process of clinical audit (see Ch. 12), with clear policies aimed at managing risks with involvement of patients in an open and transparent health service. NHS staff should be regularly appraised on their performance and underperformance should be identified and remedied. The NHS document, An organisation with a memory (DH 2000) requires that mechanisms are introduced for ensuring that, when errors or service failures occur and lessons are identified, the necessary changes are put into practice so that a wider appreciation of the value of analysing and learning from errors becomes the norm.

 Patient and public involvement programme: including a patient satisfaction survey, displaying the results and acting upon them

 Clinical audit: to check whether a service has reached required standards

 Risk management programme: including use of approved patient incident reporting system

 Clinical effectiveness programme: e.g. using protocols for appropriate self-care advice

 Staffing and staff management programme: to include training and CPD

 Premises standards: to ensure good design and cleanliness

 Use of information: via access to effective IT links and appropriate reference sources.

Professional governance

Professional governance in pharmacy can be defined as:

Professional governance works in tandem with clinical governance, the aim of which is to:

Duty of care

Pharmacists have a duty of care to their patients and are required by law to ensure that the public is protected. The law would expect that pharmacists practise pharmacy to a level of competence expected by the profession, and indeed that practised by the ‘average pharmacist’. Pharmacists are expected to exercise reasonable care when supplying the public and patients with medicines and professional advice.

In their practice, pharmacists are subject to criminal law (e.g. The Human Medicines Regulations 2012; Misuse of Drugs Act), administrative law (e.g. contractual agreements), civil law and the standards laid down by the GPhC in various documents.

The majority of care within the health service is of a high standard but it is inevitable that errors do occur. The vast majority of these are relatively minor and easily rectified without serious consequences. Unless a pharmacist causes deliberate harm to a patient, it is unlikely that he or she would be subject to criminal charges; although, in 2009 a pharmacist was given a 3-month jail sentence suspended for 18-months, following a dispensing error. The charge was brought under the labelling regulations of the Medicines Act 1968.