NHS England Clinical audits and registries guide published

2 Feb 2026

This week, NHS England published Clinical audits and registries: A best practice guide, which is aimed at both owners and administrators of new and existing health care audits and registries, including NHS England.

This guidance sets out a unified approach for commissioning and overseeing clinical audits and registries across the NHS in England, and within the audit and registry community. Its objectives are to “support audits and registries owners and commissioners to work in partnership with NHS England”, and act as a “reference tool for those participating in the process”. More specifically, it states that “its primary aim is to ensure systems deliver timely, actionable insights that support clinical decision-making, enhance patient safety, improve healthcare quality and reduce inequalities in access and outcomes.”

The guide sets out the sources of clinical audits and registries that NHS England supports, and this includes the National Clinical Audits and Patient Outcomes Programme (NCAPOP), as one of “those clinical audits that are directly or indirectly funded and commissioned by NHS England’s Medical Directorate via the Healthcare Quality Improvement Partnership (HQIP)”. It outlines the key considerations for the NCAPOP and other NHS England-commissioned sources, namely:

• Compliance with NHS England’s statutory responsibilities
• Joined-up approach to clinical leadership and governance
• Appropriate data use and analysis
• Data and analytics infrastructure to streamline information governance
• Clarify responsibilities for ensuring detection of unwarranted variation and outliers
• Clear process for commissioning and decommissioning audits and registries.

In relation to defining and managing outliers, this guide cites HQIP’s Outlier management for national clinical audits as an example that “sets out the definition and statistical process used to identify alarms and alerts. It includes the need to identify positive outliers to celebrate clinical excellence and include non-participation as an outlier flag.” It also mentions the HQIP-hosted National Joint Registry (NJR) as an example that “adopts a more intensive ‘accountability and transparency’ model.”

The guide recognises that clinical audits and registries are a key part of a wider NHS quality management system and how they support quality improvement (QI), and includes many HQIP-commissioned programmes as examples:

• National Cancer Audit Collaborating Centre (NATCAN), which “develops explicit QI goals…to improve the results of all forms of cancer care, as well as patient experience during diagnosis and treatment”
• Cardiovascular Disease Prevention Audit (CVDPREVENT)’s data and improvement tool, which “provides open access to the data, with clear, actionable insights for those tasked with improving cardiovascular health in England”
• The Sentinel Stroke National Audit Programme (SSNAP), which “measures the quality and organisation of stroke care in the NHS across England, Wales and Northern Ireland”
• National Audit of Eating Disorders (NAED), where “services will receive QI support from an NAED QI expert and coach, offering help in project design and QI methods through resources, online training workshops and webinars”
• National Clinical Audit of Psychosis (NCAP), which “consists of enhanced and core programmes of QI support based on the outcomes of the audit. NCAP Quality Improvement“.

This document goes on to outline the roles and responsibilities for frontline clinicians and managers, healthcare providers, regional commissioners and ICBs, and NHS England. It also sets standards for working in partnership with others across the sector, including patients, parents, carers and the public, who should be involved in the “design, implementation and evaluation of clinical audits and registries”.

While the guide states that it “does not set out the future direction for audits and registries or how commitments arising from the 10 Year Health Plan and the Dash Review of Patient Safety across the Health and Care landscape will be implemented”, it does say that it is “aligned to the aims of both the 10 Year Health Plan and Quality Strategy”.

Read the guide in full: www.england.nhs.uk/long-read/clinical-audits-registries-best-practice-guide

Notes: 1) While focused on England, the guide acknowledges the cross-border relevance of many audits and registries, including those involving Wales, other devolved nations, crown dependencies and international collaborations. 2) It is a dynamic working document which may be amended to align with evolving needs and the new quality strategy. The guide will be regularly reviewed and updated by NHS England in partnership with colleagues from the audits and registries community.

Further resources from HQIP

• Discover more about how HQIP supports organisations to use clinical audit and healthcare data to drive improvement – from strategy development to implementation or training
• Guidance and other resources to support improvement
• Reports and infographics
• Benchmarked results, searchable by project name, trust, hospital or unit