Principles to govern clinical governance

Clinical governance--a new NHS concept that seeks, through clinical guidelines and national service frameworks, to encourage and enforce compliance with nationally-devised evidence based clinical policies--has manifold and complex implications. This paper reasons that clinical governance is actually a means to promote excellent practice of a particular kind and that non-compliance does not necessarily equate to bad practice. Therefore, separate means must be utilized to address bad practice. The paper proposes and supports in turn a series of principles to ensure that the potential benefits of clinical governance are maximized and the potential harms are diminished. A similar set of principles is proposed to help govern the management of bad practice. The complementary conclusions of the reasoning are that a) doctors should willingly embrace clinical governance and b) the NHS should not rigidly enforce it. However, as clinical governance restricts clinical freedom and patient choice it is important that ethical principles, such as those proposed, are followed in order to avoid or manage some unhappy conflicts.