David Hunter (Live from Leeds, 1 April) points out that clinical governance creates a dilemma for public health medicine. As a member of the Faculty of Public Health Medicine he will have received in the past few days a draft position paper from the faculty entitled Clinical Governance, Self-Regulation and Revalidation in Public Health Medicine for consultation.
Prompted by General Medical Council proposals on revalidation for registered medical practitioners, the board of the faculty has (some might say, at long last, and despite David Hunter's doubts) dared pose the question: 'What is the clinical role of public health medicine?' Now is a good time to acknowledge this question publicly. After lengthy discussion, the faculty acknowledged formally and publicly in 1990 the importance of multidisciplinary public health by establishing honorary membership for colleagues with backgrounds other than medicine. David Hunter was one of the early honorary members and his questions are therefore highly pertinent.
The faculty and its members contributed to the Calman review of the public health function and have continued to promote multidisciplinary practice, training and assessment - the FPHM diploma examination is now open to all-comers. By the beginning of 2000 there will be - with the support of the Department of Health - an agreed set of national standards for public health practice, pushed forward by a multidisciplinary group, including the faculty.1
At the same time the faculty's new standards committee will be producing a parallel set of clinical standards for the practice of public health medicine. Many of the standards will relate to precisely the area David Hunter emphasises - the 'clinical quality' role - involving many aspects of the clinical governance agenda. Other clinical standards will include activities such as communicable disease control. This is not an easy task, and a critique from multidisciplinary public health is part of the process. To be fair, if appraisal of senior hospital doctors (as proposed by the British Medical Association 2) is to involve non-clinical as well as clinical roles, and team as well as individual performance, similar criteria are to be expected for public health physicians.
The faculty and the discipline of public health medicine are now irrevocably committed to auditing the work of public health physicians, an activity necessarily preceded by setting standards for tasks which require clinical training and experience. The fact that multidisciplinary standard setting will be happening simultaneously with clinical standard setting should provide appropriate ways forward from the crossroads which David Hunter describes so clearly.
Professor Stuart Donnan
Faculty of Public Health Medicine
1 Feasibility study of the case for national standards for specialist practice in public health. www.his.path.cam.ac.uk/phealth/fphm.htm
2 Appraisal for Senior Hospital Doctors: statement from the central consultants and specialists committee. British Medical Association, 1998.