An explanation of the impact of clinical governance on primary care in Liverpool
Contact - Dr. Siobhan McQuillan e-mail:s.mcquillan@liv.ac.uk tel: 0151 794 4552
Academic Lead(s)
Dr. J Robinson
Researchers
Dr. S McQuillan, Susan Beaton
Project Status
Completed October 2004
Funding
Alt Valley PCT £10k
Aim
1. To explore the impact of the implementation of clinical governance in individual primary health care teams (PHCT)
2. To determine what is being done by those involved in clinical governance activities
3. To identify the demands of clinical governance on PHCTs
4. To identify the perceived needs of PHCTs in relation to clinical governance
Method
The multidisciplinary research was conducted using qualitative methods. Activity logs of clinical governance activity were completed by members of five PHCTs, and followed up by semi-structured interviews. Two focus group discussions were arranged with patients registered with Liverpool GPs. Each participating PHCT received a report and feedback session, and patients were sent a summary of the research findings.
Results
5 PHCTs participated in the study (10 nurses, 12 administrators and 9 GPS completed 31 activity logs and 18 participants were interviewed).
Participants regarded clinical governance to be team event which has increased awareness of the need to improve services. Contacts with patients were the most frequently reported CG activity followed by professional development exercises. Improved team working and communication within teams was considered to be important. An increased workload was reflected by all participants with lack of time considered to be the main issue affecting service delivery. Inappropriate use of skills within a team resulted in frustration and inefficiencies. Educational activities and whole team learning events were identified as being important. Improvement in computer systems and increased use of e-mail communication was highlighted. There was general concern about time spent chasing information from secondary care and that secondary care had a poor understanding of primary care. Additional concerns included the need for improved working with other organisations such as social services; better information and education to be available for patients; and improved facilities within primary care.
A total of 14 patients participated in the 2 focus groups. There was unanimous agreement that “getting past the receptionist” is the most difficult hurdle patients have to cross in order to access medical care and that the time waiting for an appointment is an additional barrier to access. The overall culture of primary care was not seen to be conducive to shared decision making and GPs were seen as powerful with staff and patients having the least power. Patients wanted to be fully informed about whom was responsible and accountable for their care and wanted GPs themselves to deal with complaints of a clinical nature. The need for improvements in confidentiality, particularly in reception areas and in communication between health professionals and patients were highlighted. A wide range of services available form primary care, such as phlebotomy, x-rays and ECGs was considered to be important.
Conclusions
This exploration of clinical governance activity in Liverpool highlights the importance of team working, good communication and collaboration to the delivery of clinical governance locally. It is important that the key areas of good communication, teambuilding and team learning are not forgotten or lack emphasis in the delivery of the clinical governance agenda as failure to do so risks the fundamental building blocks on which the delivery of good health care depends. It remains a challenge for PCTs to develop a culture within primary care in which quality improvement becomes a shared undertaking for all those involved in the patients pathway of care.
Reports
McQuillan S, Robinson J, Beaton S. An exploration of the Impact of clinical governance on Primary care in Liverpool. Report submitted to North Liverpool PCT and MPCRD Consortium. October 2004.