Clinical Governance

If you asked ten different people what clinical governance is, you would likely receive ten different responses. Clinical governance is to do with the quality issues of providing a service - this is not a new concept for pharmacy, perhaps just some of the terminology and recording procedures are new.

The Department of Health 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"

Practically speaking clinical governance is about formalising practices that most pharmacists already undertake today. Clinical governance is about setting standards and improving upon them. Standards in terms of physical premises - is the pharmacy wheelchair and pram accessible? Standards in terms of written procedures - does the pharmacy have a written policy to follow when a drug is recalled? Standards in training and development - are the pharmacists and staff continuing to receive professional training?

At present participation in clinical governance arrangements is voluntary for community pharmacy. As a way of improving standards, clinical governance should not be looked upon as a form of inspection. Standards of services within pharmacies are already high, but what pharmacies are perhaps not that familiar with is the formal assessment of these services and documenting the fact that service levels are being met. Clinical governance can provide a way to help pharmacists demonstrate that they are delivering their service to a high standard and it can also be seen as a tool to help identify if any improvements need to be made.

Primary Care Trusts (PCTs), local divisions of the NHS, have been tasked to assess the current standards of clinical governance locally, and this will include pharmacies. Many PCTs have formulated plans to roll out clinical governance and some have included it as a service level requirement for those pharmacists who are interested in providing additional professional services from their pharmacy premises.

PCTs must report their progress to the Commission for Health Improvement (CHI), and its successor organisation the Commission for Healthcare Audit and Inspection (CHAI). CHI undertakes clinical governance reviews of NHS organisations to advise on quality improvement and as part of an exercise to star rate these organisations.

As part of its activities, CHI reviews community pharmacy clinical governance arrangements within a PCT, primarily through a survey that is conducted with community pharmacies.

There are seven pillars that CHI considers:

• Patient & public involvement
• Managing risks
• Clinical audit
• Use of clinical information
• Staffing & staff management
• Education, training and continuing professional development
• Clinical effectiveness

The exact contract language is still under negotiation. However, it is likely that community pharmacists and PCTs will continue to work together to determine local implementations of clinical governance best practice.

Relationship to Medicines Management

As medicines management services develop, then so too will the formalisation of these services, and this will lead to nationally recognised service specifications that include elements of clinical governance. Elements of clinical governance are already included in many PCT service level agreements, for example, smoking cessation and provision of advice to care homes.

Community pharmacists who engage in medicines management services through PCTs can expect guidance from PCTs on clinical governance issues. All PCTs have appointed a clinical governance lead and many PCTs will have a community pharmacy clinical governance facilitator in post. If you do not know who your facilitator is, contact your local PCT.

Until there is a nationally recognised service model, any community pharmacist engaging directly in service provision with either a PCT or GP practice will have to consider developing a service specification (also referred to as a service level agreement) in partnership with the PCT/practice. This specification should include clinical governance.

If you have further questions on clinical governance or would like more detailed information, contact your local PCT's clinical governance facilitator or your Local Pharmaceutical Committee secretary.

Read More on Clinical Governance:

Clinical Governance in Community Pharmacy - Guidelines on Good Practice for the NHS

A Vision for Pharmacy in the New NHS

Beyond the Baseline - the role of clinical governance facilitators working with community pharmacists