Letters

Published: 17/10/2002, Volume II2, No.5827 Page 20 21

The National Institute for Clinical Excellence-endorsed definition of clinical audit is: 'a quality improvement process through systematic review of care against explicit criteria and the implementation of change.

Aspects of the structure, processes and outcomes of care are selected and systematically evaluated against explicit criteria.

Where indicated, changes are implemented at an individual team or service level and further monitoring is used to confirm improvement in healthcare delivery.' The Commission for Health Improvement review process also links clinical audit to quality improvement. Further, NICE's own review of national clinical audit projects led by the royal colleges indicated a wide variance in quality of such work.

The introduction of the national clinical audit support programme, therefore, is particularly interesting. It appears to compromise previous work to define and position clinical audit as quality improvement and seeks to liken it to performance management.

The following points contribute to this conclusion:

There is no indication that clinical audit staff have been consulted in the development of the programme. They will, no doubt, be doing the work.

It is being led by those who have either an debatable record in clinical audit (royal colleges) or those who merely provide n n one of many tools used by clinical audit.

It is far too late to have any reasonable impact on projects which are part of current national service frameworks, as all organisations have developed monitoring systems some time ago (or at least should have done).

It is patently not a 'collaboration' if some of those involved in clinical audit have been excluded in its development.

It is using the creation of a dataset and collection of data as a proxy for improving patient care.

This work has no understanding of the practicalities in conducting clinical audit in trusts.

Therefore NCASP is not: national (as most of its work has already been done); clinical audit (for the reasons outlined above) or supportive (in any way, as it will involve extra work for no local reason).

Martin Ferris On behalf of the national audit and governance group Sheffield South West primary care trust