Clinical governance in primary care: a literature review

A systematic review of the research literature published between 1999-2003 was carried out to review how primary care trust groups and primary care organisations were monitoring the implementation of clinical governance and the effects this may have on nursing.

Studies were limited to research papers with explicit methodology applicable to primary care trusts. The selection criteria, search procedures and methods of data extraction and analysis were formed at the outset.

A data extraction tool developed by Cormack was adapted as a guide to include nine areas of methodological appraisal in summary forms.

Initially 87 articles were identified from the search. When papers were omitted on the exclusion criteria seven studies remained.

Clinical governance is a notable example of co-ordinated policy development and the entire concept can be difficult to translate into the integrated and systematic approach to improving quality of care. Clinical governance requires changes at three levels: the individual health care professional, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams.

Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness. Whilst the sharing of information between practices is seen to be increasing with multi-professional study days occurring in some areas this in turn needs commitment for time and funding. The organisational and cultural environment within the trust as well as resource issues needs continuous attention if high quality governance is to become the norm.