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Clinical governance is a posh term for merging management and clinical processes, says Mark Davies, who predicts a new hybrid on board

The reforms are upon us. Primary care groups, clinical governance, the National Institute for Clinical Excellence, the Commission for Health Improvement - not forgetting national service frameworks.

Quite a change. But the last lot of reforms did teach us a bit more about what makes good healthcare. We know now that resources matter. Health budgets do not grow on trees. Drawing a line on resource use is painful but necessary, soothed only by an honest look at what might make a service better: efficiency which makes the most of existing resources, and effectiveness to translate these resources into 'value for money' healthcare.

We also know that local services need good management. As part of the drive to efficiency and effectiveness, services must be actively co-ordinated and led. We know that open market principles can be far more destructive than productive.

The new reforms claim to have recognised all these problems and provided a solution. The road to the promised land of healthcare is clinical governance. This has been borrowed, like much else in the public sector, from the private sector. All aspects of quality assurance, such as performance monitoring and risk management, are built into the strategy.

At a local level, clinical governance will ensure we are delivering prime healthcare by building quality assurance packages into service development. This will, in turn, be realised by local service infrastructures designed to cater for clinical governance. This is most obvious in the specifications for the new PCGs and primary care trusts. Clinical governance in local services will itself be shaped by shiny new NICE. Templates for local services' profile and performance will be developed via national service frameworks, currently in production. CHI will be on hand to make sure local services are behaving themselves and adhering to the guidelines. What will happen next?

A key factor is the changing relationship between the roles of manager and clinician. At the start of the previous reforms in the early 1990s, the manager and the clinician were poles apart. The true casualty was local services, with fall-out affecting both patients and staff. Under the new reforms, this relationship has become somewhat blurred. Resource issues are now part of everyday clinical practice, as clinical issues are in day-to-day management practice.

The logical conclusion of this process is merger. At the end of the day, clinical governance is a posh term for merging the management and clinical processes. Actually, 'service governance' would have been a better term. Instead of management decisions and clinical decisions, we will have services decisions. Instead of management and clinical research we will have service research. And instead of managers and clinicians we will have a hybrid of the two - 'servicians'. Proto-servicians, currently known as clinician- managers, are already being bred in the form of medical directors and nurse managers. Other types of servician will include information systems and human resources specialists.

As clinical governance grows, so will the infrastructure to support it. Service frameworks will be shaped by evidence-based development. As PCGs become established, the same structures will be applied to secondary and tertiary care. Secondary care groups will take over the roles of acute and district general hospital-based trusts. For ultra-specialist services, tertiary care groups will be formed, to focus on patient groups beyond the capabilities of PCGs and SCGs. As these care groups will share the same structures, inter-care services agreements will become simpler.

The people inhabiting these new care groups, and eventually care trusts, will be the servicians. As the infrastructures of the care groups become clearer, servicians will specialise in areas such as strategy-setting, finance, information systems and clinician specialties. Everyone will be concerned with the overall service, even though individuals will be focusing on specific areas of the service. People working in local services will be aware of how their roles integrate into the service as a whole.

Gone will be the old slogan 'patient-centred care'. What matters is 'people- centred care'. This means staff and patients will be equally valued, working together to create an efficient, equitable and effective service for the future.

Perhaps then the government will go away and reform something else.