Audit is generally subsumed under the heading 'clinical governance' - a term which is familiar to the profession and less of an imposition on their time as it once seemed to be. Clinical governance will probably turn out to have the single most important influence on how clinicians work inside and outside the NHS in the years to come. It is unlikely that any other aspect of government intervention will have a greater impact on the lives and working habits of those in healthcare.
Clinical governance has to do with the delivery of high quality clinical services and audit procedures are an integral part of this process. It makes clinical quality an integral part of the NHS governance framework. Clinical Governance has had a higher profile following the problems associated with heart surgery in Bristol, and apparent failures in cervical screening programmes. Public safety is a key aim.
Health professionals will continue to have the right of exercising individual clinical judgement and the Royal Colleges and the statutory bodies will continue in their role for professional self-regulation. Participation in clinical governance will become a requirement of practice in the NHS, and should be equally applicable to private work.
The main purpose of clinical governance is to support clinical staff in improving quality of care, it will also ensure that wherever possible poor clinical performance is detected and acted upon. It does not replace an optometrist’s clinical decision making; independent clinical judgement is retained and considered vital. The aim of clinical governance is to put systems in place within which this judgement is exercised so as to reduce the possibility of poor performance and to ensure that wherever possible problems are remedied before they get out of hand. Much of this will relate to the organisation and management of clinical services rather than to individual clinical decisions.
In optometry the following are all aspects of clinical governance:
Examples of audit are in the links below:
The audit framework document which was produced by the College of Optometrists guides practitioners through the audit process and is still relevant today.
The audit of the Manchester-based glaucoma referral refinement scheme was published by Eye (2003), 17, 21-26.
The audit of the cataract direct referrals scheme was produced by Cambridgeshire LOC in 2003.
The audit by the former North Charnwood PCG of a GP ophthalmic referrals to optometrists' scheme, which was published in December 2003.
