Clinical governance in primary care Edited by Tim Van Zwanenberg and Jamie Harrison Radcliffe Medical Press 224 pages £21.50

Clinical governance was first coined as a term in the 1997 NHS white paper The New NHS: modern, dependable. Chief medical officer Professor Liam Donaldson reminds us of this in his opening chapter, which gives some of the genesis of clinical governance, but he is too modest to acknowledge the authorship of the term which many have ascribed to him.

It is, in its own way, quite brilliant. It meant, as Humpty Dumpty would have said, 'Just what I mean it to mean'. That is, while it carried many resonances and suggested an approach to the clinical world which drew from corporate governance and financial governance, it remained for the Department of Health and others to define it more fully.

Nearly two years later much more is clear.

Primary care group boards are now in place, chief executives appointed and second-in-line and even third-in-line posts are beginning to take on their roles.

To what extent can this book help? I would suggest that it is likely to be of great benefit to PCGs and those involved in supporting and helping them to establish governance arrangements. The notion of governance, and clinical governance in particular, is a difficult one and does need localising in the environment of primary care.

There have previously been a number of publications, but this book brings together the whole range of issues associated with governance in a way that can only be helpful.

The book makes a clear statement by the very order of its chapters; having set the scene with the chief medical officer and the chapter by the editor and regional nurse director of Northern and Yorkshire, the book moves straight to the patient perspective written by Marianne Rigge, director of the College of Health. Clinical governance is about patients' perceptions of the NHS, patients' perceptions of the care delivered to them, and the centrality of patient quality in governance arrangements.

From there the book moves through clinical effectiveness, particularly evidence-based practice, through notions of risk management and complaints, personal and professional development and some speculative chapters around the future.

I came across a number of quotations that I`ve not seen before: I particularly enjoyed: 'When people cease to complain, they cease to think' (Napoleon I).

The chapters are brisk and highly structured, averaging about 10 pages. Each chapter has a simple summary of two or three sentences at the beginning and a series of practical points and references at the end. In between the text is broken up with boxes, check lists and helpful headings and sub headings.

The visual quality cannot be overemphasised - this is a very easy book to pick up and put down and has many valuable items. I particularly enjoyed the structure of Mike Pringle's chapter as well as the insights it offered. Entitled 'Significant event auditing, ' he starts: 'We all enjoy a good discussion about a patient.'

How true this is, but what he then makes clear with two simple cases is the learning that we can derive from such discussions and ways to make that learning more structured and more routine. What this chapter teaches, as do others, is neatly summed up by my favourite quotation: 'We are what we repeatedly do; excellence, then, is not an act but a habit' (Aristotle).

This book could help more of us to adopt the habit of excellence, and should be essential reading for those thoughtfully developing PCGs.

Tim Scott is senior fellow, British Association of Medical Managers.