Explain what is meant by the term ‘clinical governance’ AND discuss the implications and impact of clinical governance on practicing pharmacists and pharmacy services.
Throughout the world, societies are striving to determine how best to organise their health systems and deliver services. Increasingly, there is recognition that the development and evaluation of new therapies and diagnostic tools is only part of the answer to better health care(1). Clinical governance first began to appear in the NHS vocabulary after Labour came to power in the 1977 and was one of the foundation stones of the NHS planning blueprint. The NHS plan was published in 2000 and the policy has underpinned the governments raft of reforms ever since (2). The department of health’s clinical governance support team defines clinical governance as: “A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care can flourish” (3). When major reforms of health care and social services were introduced in the 1990 in the NHS and Community care act the government put quality on the agenda for the first time. The reforms were based on two white papers: Working for patients (department of health 1989a), with its focus on the NHS, and Caring for people (Department of health 1989b), which addressed care in the community. These aspects collectively contribute to the idea of clinical governance (4).
The standards of clinical governance were set nationally by the National Institute of Clinical Excellence (NICE), which were agreed by wide consultation and use of research into effectiveness and cost effectiveness of clinical practices. National Service Frameworks (NSF) also set standards. A key element of good clinical governance is work to deliver the standards set by NSFs and the NICE(5). Principles of clinical governance extend to all NHS services; including community pharmacists who have an important contribution to make to the development of a coherent strategy for assuring and improving service provision across the local health community. Most community pharmacies have undertaken a significant level of clinical governance activity. This includes the use of standard operating procedures; such as recording, reporting and learning from adverse incidents; participation in continuing professional development and clinical audit; and assessing patient satisfaction(6). The development of clinical governance of community pharmacy services is supported and encouraged by Primary Care Organizations (PCOs)(6).
Clinical governance can be broken down into a series of smaller processes, which when brought together, can help assess the quality of services provided to patients in the NHS. There are key components of clinical governance which have implications on practicing pharmacists and pharmacy services. These components are: Patient and public involvement, clinical audit, risk management, clinical effectiveness, staff management, education, training, continuity professional and personal development (CPD), accountability and research and development (7).
One of the core concepts of clinical governance is that the patient or client should be the centre of their healthcare experience (8). Patient and public involvement is an important implementation in clinical governance as it allows patients/clients knowledge and expertise about their health and well-being, which can be used in partnership with experts’ professional knowledge to provide effective quality care. Structures and processes are needed to facilitate professionals and patients to work together in order to achieve positive outcome to a patient (8). This has shown to have impacts on pharmacists in England and Wales as they are encouraged to undertake annual patient satisfaction surveys which are then reviewed and changes are then...
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