Audit activity is now widespread. There are a range of views about its prime purpose. Unless the audit programme has a clear purpose and direction, it will falter. As commissioning develops, there will be more explicit considerations of standards of care. Those standards will address both the processes of outcomes of care, focusing on effectiveness and appropriateness. They will best be generated by local agreement between purchasers, providers and clinicians, based on the knowledge available through research. Audit can provide a systematic appraisal of practice against such standards, while ensuring confidentiality for individual patients and clinicians. Property resourced, audit can play a valuable role directly linked to the commissioning process, which will ensure that the medical profession is fully engaged in the new dynamics of the NHS.
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