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Department of Health guidance

See below for a list of quick-links the latest and/or most relevant guidance documents from the Department of Health:

Department of Health guidance

National service frameworks (NSFs)

NSFs are long term strategies for improving specific areas of care. They set national standards, identify key interventions and put in place agreed time scales for implementation. More information

Joint protocol for internal audit and clinical audit

The Department of Health provides guidance for Internal Auditors on working with Clinical Audit when assessing the clinical governance aspects of the Assurance Framework underpinning the Statement on Internal Control. More information

Involving patients and the public in healthcare

The Department of Health has carries out work to develop the proposals in the NHS Plan to create a patient-centred NHS - involving patients and the public. It describes progress and implementation so far, and sets out the proposals that require legislation for strengthening patient and public involvement. More information

Contracting and commissioning

This section contains information about the clinical audit requirements of the Department of Health Standard Contracts.

New contracts were published by the Department of Health in Annex D of the NHS Operating Framework.

The Department of Health has issued a standard contract for use between Primary Care and Acute Trusts. The Clinical Governance, Records and Audit (section 19) chapter of the contract requires the provider service to:

comply duties under Law (see clinical audit and legislation) to improve the quality of clinical services, including Department of Health guidance on clinical governance and Standards for Better Health
within 10 operational days of the co-ordinating commissioner's reasonable request, the Provider shall send the co-ordinating commissioner the results of any audit or services of a similar nature to the services carried out by the Provider
to implement all relevant recommendations of any appropriate clinical audit.

Quality and Outcomes framework

The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice.

The QOF contains five main components, known as domains. Each domain consists of a set of measures of achievement, known as indicators, against which practices score points according to their level of achievement:

clinical care: the domain consists of 80 indicators across 19 clinical areas (e.g. coronary heart disease, heart failure, hypertension)
organisational: the domain consists of 43 indicators across five organisational areas - records and information; information for patients; education and training; practice management and medicines management
patient experience: the domain consists of four indicators that relate to length of consultations and to patient surveys
additional services: the domain consists of eight indicators across four service areas which include cervical screening, child health surveillance, maternity services, contraceptive services
holistic care: the domain is a measure of the breadth of care across the clinical domain.

The QOF gives an indication of the overall achievement of a surgery through a points system. Practices aim to deliver high quality care across a range of areas for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of surgery workload and the prevalence of chronic conditions in the practice's local area.

To report the latest annual QOF points, The NHS Information Centre for Health and Social Care (NHS IC) has developed this online database to allow patients and public easy access to this useful data that indicates how well their surgery is doing. The NHS IC is working to make information more relevant and accessible to the public, regulators, health and social care professionals and policy makers, leading to improvements in knowledge and efficiency.

Further information on the results of the 2008/09 QOF can be found here.

A new strategy for the Quality and Outcomes Framework (QOF) was announced as part of the NHS Next Stage Review, including an independent and transparent process for developing and reviewing indicators. The Department has published a consultation document on how the process, to be led by NICE, should work, exploring views on the scope for flexibility for PCTs to set some indicators locally. Further information can be found here.

General dental services

The General Dental Services contract does not explicitly refer to clinical audit, however Part 16 (section 245) stipulates that the contractor shall comply with "such clinical governance arrangements as the PCT may establish".

Clinical governance arrangements are described as arrangements through which the Contractor endeavours to continuously improve the quality of its services and safeguard high standards of care by creating an environment in which clinical excellence can flourish. Clinical audit is considered to be a fundamental part of the clinical governance system. Further information about the General Dental Services Contract can be found here.

The National Health Service (General Dental Services) Amendment (No. 3) Regulations 2001 requires dentists to undertake at least 15 hours of clinical audit activities, and take reasonable steps to ensure that any assistant of his also undertakes such activities.

The regulations define "clinical audit activities", meaning activities which involve the systematic and critical analysis of the quality of dental care provided by the dentist, including the processes used for diagnosis, intervention and treatment and use of resources, and may include peer review by means of participation in meetings of a group of not less than 4 dentists where such a group considers the quality and performance of specific treatments and approaches to treatment. Click here to see a copy of the regulations.

The NHS Primary Care Contracting team have published a Clinical Governance Framework for Primary care Dental Services which recommends that:

all staff should be involved in identifying priorities for, and involved in, clinical audit or peer review
evidence of compliance with any locally agreed requirements for clinical audit and peer review
evidence that changes have been made where necessary, as a result of clinical audit or peer review.

The Clinical Governance Support Team published a Clinical Governance Resources Guide for Dentistry.

General medical services

The General Medical Services contract for General Practice does not explicitly refer to clinical audit, however Part 19 (section 488) of the contract refers to a "system clinical governance" which is a framework through which the Contractor endeavours continuously to improve the quality of its services and safeguard high standards of care by creating an environment in which clinical excellence can flourish. Clinical audit is considered to be a fundamental part of clinical governance system.

Section 488 of the contract stipulates "The Contractor shall have an effective system of clinical governance"

Further information on the General Medical Services Contract can be found here.

Future Regulation of Health and Social Care in England

In March 2008, the Department of Health published a consultation on the proposed standards required for registration with Care Quality Commission, the consultation closed in June 2008. The new standards will become effective from April 2010.

Further information is available here.

World Class Commissioning

Clinical audit underpins two of the eleven competencies required to achieve world class commissioning advocated by the Department of Health.

Further information about World Class Commissioning can be found here.

Competency 4 describes how through collaboration with clinicians organisations should lead continuous and meaningful engagement with clinicians to inform strategy, and drive quality, service design and resource utilisation.

The competency describes the processes and knowledge requirements of a commissioning organisation. These include:

building and supporting clinical engagement in strategic decision making and assuring clinical governance structures via PECs
working with clinical colleagues, such as PECs, along care pathways to spread best practice and rigorous standards to hold clinicians to account
working in partnership with clinicians along care pathways in commissioner and provider organisations to facilitate and harness front-line innovation and drive continuous quality improvement.

An example output of this competency evidence of regular and active dialogue with local clinicians, seeking their data and information needs in relation to clinical audit, supporting engagement that turns information into knowledge and action.

Competency 8 describes how through the promotion of improvement and innovation organisations should promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration.

The competency states that PCTs are the driver of a continuously improving NHS. They should seek innovation, knowledge and best practice, applying this locally to improve the quality and outcomes of commissioned services. In partnership with local clinicians, practice based commissioners and providers, they will specify required quality and outcomes, facilitating supplier and contractor innovation that delivers the best value. Through open and effective commissioning and decommissioning decisions, PCTs transform clinical and service configurations, meeting local needs and securing world class improvements in outcomes and quality.