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Clinical governance information for appraisal

GMC’s Supporting information for appraisal and revalidation. The standard definition of clinical governance is “A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (1).” The definition now extends to all settings in which health care takes place and it clearly follows that responsibility for safety and quality of care is shared by everyone in the organisations which commission and provide health care.

Clinical governance refers to the systems and processes that underpin safe and effective care. It encompasses the safe introduction of advances in technology, medications, techniques and models of care and the phasing out of outmoded ones. It encompasses systems to prevent, recognise and (where possible) rectify harm to patients where something has gone wrong, or something has nearly gone wrong, or a situation has been identified where something is likely to go wrong if nothing changes. It encompasses the sharing of information that will improve care and prevent harm on other occasions and in other health care settings.

In its publication Supporting information for appraisal and revalidation, the GMC requires doctors to participate in quality improvement or clinical audit relevant to their work, to evaluate and reflect on the outcomes, to take action and to evaluate the resulting change.  It also requires doctors to record significant events which have involved them and discuss these at appraisal. A significant event is defined as “any unintended or unexpected event, which could or did lead to harm of one or more patients.”

Health care organisations should have their own systems for recording and acting on significant incidents, and there are also requirements for certain types of incident to be reported to national organisations (for instance, significant events involving medical devices should be reported to the Medicines and Healthcare products Regulatory Agency).

Organisations should assist doctors by providing clinical governance information to assist doctors in preparing for appraisal. This may include data on activity and outcomes, the outcome of investigations of significant incidents, complaints and compliments. Responsible officers may sometimes require doctors to bring specific items of clinical governance information to their appraisal.

The sub-specialty sections of this site provide information about significant events which may be particularly relevant to these areas of clinical practice. The College document Quality, safety and clinical governance in ophthalmology: an overview, provides additional information about significant events in ophthalmology and the regulatory processes which underpin safe care in ophthalmology.

The College promotes the Safer Surgery initiative promoted by the World Health Organisation and the National Patient Safety Agency (NPSA) and has developed a preoperative checklist for cataract surgery jointly with the NPSA.

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