How does a primary care trust measure the performance of its GPs? Some things are relatively easily counted: operations, visits to the clinician. It is harder to count things that really matter, such as standards of care, the competence of the clinician, training, and the outcome for the patient. Paul Jennings explains

The first system Walsall teaching PCT developed for this was the clinical governance toolkit, based on the seven pillars of clinical governance. Although intellectually rigorous it never won the hearts of clinicians. The product was a thick folder that was not used by anyone except for reference at performance-measurement times.

Faced with this tricky issue and increasing pressure to regulate its own suppliers, the PCT came up with the clinical governance workbook.

Initially, this tool was created to deal with the management of the general medical services contract but has expanded into other areas of primary care, including the quality and outcomes framework and non-clinical components of the GMS contract. It has also expanded into including Standards for Better Health and other core standards. Most recently, it has included elements of patient experience and public involvement.

Working on a simple Excel spreadsheet, practices indicate whether they have achieved, or are aspiring or not to a particular standard. For each standard, evidence is required. The evidence is put into the spreadsheet as, for instance, copies of a policy or the notes of a meeting. The system is also set up with hyperlinks that can take the reader to source material on the internet.

The system is moderated by the PCT to check evidence validity. Evidence is used to evaluate quality and by individual practices to see how they are getting on with QOF attainment.

Security on the system ensures that only one person at the PCT has access to all reports and individual practices can only see their own. After requests from clinicians the scheme has been successfully extended to the PCT's own provider arm, where similar levels of security ensure that departments can see only their own information.

This security is essential in fostering confidence in users who would undoubtedly be anxious if they thought all their peers could view and assess their performance. I suspect this reticence will lessen. Across the primary care and provider services the system now has nearly 300 users.

Compared with our previous approach the benefits of the clinical governance workbook are:

  • better monitoring of clinical suppliers both by commissioners and by the suppliers themselves;

  • the ability to generate reports, for individual practices and for whole services, which can be used to manage performance and identify trends;

  • automated links and hyperlinks that keep the whole system real-time;

  • links to the QOF that enable the practice and the PCT to monitor QOF data relatively painlessly;

  • hundreds of frontline clinicians involved in evidence submission;

  • no dusty files sitting ignored on the shelves and no trees destroyed.