User involvement in clinical governance.
OBJECTIVE
To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation.


METHODS
Qualitative data comprising semi-structured interviews, reviews of documentary evidence and relevant literature.


METHODS
Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status.


METHODS
Key stakeholders including Lay Board members (n = 12), Chief Executives (CEs) (n = 12), Clinical Governance Leads (CG leads) (n = 14), Mental Health Leads (MH leads) (n = 9), Board Chairs (n = 2) and one Executive Committee Lead.


RESULTS
Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs.


CONCLUSIONS
Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself.
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. susan.pickard@man.ac.uk
Susan
S
Pickard
Martin
M
Marshall
Anne
A
Rogers
Rod
R
Sheaff
Bonnie
B
Sibbald
Stephen
S
Campbell
Shirley
S
Halliwell
Martin
M
Roland
D003256:Community Participation; D009313:National Health Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011639:Public Opinion; D006113:United Kingdom