Almost all the old primary care trusts had put in place clinical governance structures and processes but fewer had actually made sure they were working, a report from the National Audit Office says today.

The report - which looked at PCTs before the 2006 reorganisation - says that implementation of clinical governance has been patchy. It found a clear link between clinical governance and overall performance. The best-performing PCTs were those that had, for example, displayed clinical leadership and improved services based on lessons from complaints and safety incidents.

Lower-performing PCTs were those with the weakest clinical governance, for example a system for reporting patient safety incidents that was not used by GPs and therefore was incapable of giving the PCT any information.

In its first look at clinical governance in primary care since the concept was introduced in 1998, the NAO found that 82 per cent of PCTs said clinical governance had benefited patient care. Some 20 per cent said it had delivered savings, for example by reducing the number of patient safety incidents.

The least well-developed aspect of clinical governance overall was public and patient involvement. The NAO has prepared individual reports on PCT performance which will be sent out to PCTs this week.

Karen Taylor, head of health value for money at the NAO, said the picture had been clouded by the reorganisation but added: 'The only way to evaluate progress is to say this is the position you inherited and ask what have you done to address it.'

For more information visit www.nao.org.uk