Two clinical auditors left a run-down clinical service and set up a firm to inject their profession with some much-needed rigour. Stuart Shepherd reports

Two clinical auditors left a run-down clinical service and set up a firm to inject their profession with some much-needed rigour. Stuart Shepherd reports

Clinical audit is not a sexy topic. Even its most fervent advocates will tell you as much. It can appear to be data collecting for data's sake and it has no regulatory body. Its organisational status has also declined over the past decade, with many of the standalone audit groups that emerged in the early 1990s being absorbed into generic clinical governance teams.

More recently, the switch from administrative and clerical grading to Agenda for Change saw a significant number of practitioners lose out financially.

In such a climate, however, the experience of two auditors has been a spur to action and those negative images may be about to change.

Leicestershire Primary Care Audit Group (PCAG) former manager Stephen Ashmore and his deputy Tracy Ruthven have left the NHS to set up the independent Clinical Audit Support Centre (CASC). This new service aims to provide training and consultation, to cultivate professional standards and inject what they believe is some much-needed dynamism into clinical audit, a discipline that should in their view be all about transformation and development.

One of the main spheres of work for CASC will be running courses for audit staff accredited through adult learning body the Open College Network .

'Most individuals working in the discipline don't have any nationally recognised audit qualifications,' says Stephen.

'It has always struck us as the biggest irony that people performing clinical audit are examining quality assurance without being able to provide any for their own work. We want to support them with good-quality materials to deliver time-effective audits of a high standard that really contribute to improvements in patient care.'

Providing services to clinical audit staff in itself represents something of a move away from the more direct work that PCAG had been doing with GPs and practices to monitor the efficacy of interventions in coronary heart disease and other long-term conditions.

The pair also plan to offer training packages, tailor-made projects and online clinical audit support to community professionals. This would be building on national services they developed through links with organisations such as the Community Practitioners' and Health Visitors' Association and the College of Pharmacy Practice.

The work that went into nurturing this emerging national profile has its origins in Stephen and Tracy's time heading the Leicestershire PCAG team. The combined effects of AfC and reconfiguration, however, started to jeopardise that early success.

'To make the switch to AfC, most audit professionals had to go through a job assessment questionnaire,' says Tracy. 'The outcome of that wasn't good for many of my colleagues or myself.

'I was transferred to band 6, which represented a pay cut of more than 10 per cent. Given my qualifications - I had just completed a master's degree in managing quality in healthcare - that didn't seem like good news.'

Two of the team soon left and a vacancy freeze quickly followed in a discipline already beset with recruitment difficulties. Stephen's position as manager soon became equally untenable; there were simply not enough people to run a functional team.

'Not surprisingly, those people facing drops in salary of anything up to 25 per cent looked to go back to the disciplines they had come from, such as nursing,' he says. 'Being unable to recruit new staff made it impossible to manage the team.'

Faced with the prospect of working in an under-resourced service that looked set to take on an increasingly local focus, Stephen and Tracy decided to leave. Their business was launched in September this year.

It seems an opportune time for such a venture; the role of audit in both patient outcomes monitoring and meeting core and developmental standards for better health is increasingly important.

In his keynote address at a recent conference, NHS clinical governance support team clinical audit development director Graham Copeland told delegates that, according to the best estimates,£750m is spent annually on clinical audit.

Most importantly, perhaps, the market that CASC is looking to break into will be aiming to improve on recent performance.

'If you look at clinical governance reviews, most organisations came out poorly in relation to their audit systems and delivery,' says Stephen. 'Research papers conclude that audits are only achieving small improvements.'

Stephen's first-hand experience tends to support these findings. 'By their own admission, some of the staff who used to attend our external PCAG training days would recognise that the audits they were performing weren't always up to scratch.'

In setting up on their own, Stephen and Tracy know life could get tough if their services do not come up to scratch, but they relish the opportunity to build on their professional knowledge and be in charge of their own destiny.

'We are looking forward to the autonomy and advantages that come with running our own business and being able to direct our work across a national platform without having to depend on local service level agreements,' says Tracy. 'We will be able to work alongside NHS audit staff colleagues in a way that we believe offers an alternative to more traditional models.'