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Recent criticism of some aspects of current practice within the NHS has placed the role of clinical audit increasingly under the spotlight. In a recent publication, the National Institute for Clinical Excellence states that “the time has come for everyone in the NHS to take clinical audit very seriously”. This article considers the intimate link between clinical audit and clinical governance, a philosophy that has not yet been universally adopted. It describes the key principles of risk management within the context of clinical audit, and examines the audit burden imposed on primary and secondary care by assessors, National Service Frameworks and regulatory bodies. It discusses the challenges risk managers face in adopting a systematic review of care that seeks to avoid harm to patients, while improving outcomes and care standards.

Clinical audit departments will have to demonstrate more “business‐like” procedures such as rigorous project management in order to meet the demands of clinical governance. Addenbrooke’s NHS Trust Clinical Audit Department has developed a method of objectively estimating how long a clinical audit will take and therefore its resource implications. This information also allows accurate planning of a rolling programme and will assist in the adjustment of this programme according to organisational requirements.

The quality of clinical care is a fundamental issue for both providers and recipients. It seems logical for the parties to collaborate. Increasing understanding of each other's values and perceived needs with commitment to incorporating both users' and clinicians' unique perspectives on clinical quality and effectiveness is a new venture which will further contribute to improving the quality of health care in the NHS.

Clinical Audit has reached a crucial point in its development. In this article, we report the results of a multi‐professional consensus conference held to consider the likely direction of Clinical Audit in the future. In a structured exercise, small groups identified four priority areas: integration of Clinical Audit with research and development, clinical effectiveness and evidence‐based medicine; development of audit methodologies; emphasis on multi‐professional approaches; and incorporation of Clinical Audit into purhasers' and providers' business planning cycles. Reconfigured groups then formulated specific recommendations in each priority area, to be addressed to clinicians, provider managers, purchasers, and the DoH/NHS Executive. Recommendations were validated by all conference practicipants post‐hoc.

To formulate an effective teaching prog ramme in the principles of clinical effectiveness for junior doctors, with simultaneous participation in a clinical audit project during their six‐month period of employment.

Accident and Emergency (A&E) Senior House Officers (SHOs) were educated in the principles of clinical effectiveness through a structured five‐session approach whilst they concurrently performed their clinical audit project. Throughout the process the A&E SHOs were supported by the Clinical Effectiveness Unit and the A&E Consultant overseeing departmental audit.

The structured teaching programme resulted in a good understanding of the clinical effectiveness process amongst the A&E SHOs, as demonstrated by their ability to perform a clinical audit project which ultimately improved practice.

This study has involved the construction and assessment of a teaching framework for junior doctors. The conclusions have been drawn on the basis of objective measures such as the completion of a clinical audit project which successfully improved practice. Thus, the publications of the findings may be considered in the category of a research paper. However, the authors accept that the assessment of a teaching programme's success and its portability to other departments or institutions can be highly subjective.

With appropriate guidance and support, junior doctors are able to perform meaningful clinical effectiveness exercises at an early stage in their careers and within the constraints of short periods of employment. The structured teaching approach could be considered as a template which other institutions may wish to adopt to educate their own juniors.

Despite the increasing importance of clinical audit in modern practice, the authors are not aware of any published teaching programmes which provide junior doctors with the necessary understanding of and skills required to take part in the clinical effectiveness process.

The purpose of this paper is to undertake a survey of the level and quality of service user involvement in clinical audit in NHS trusts currently, in order to identify perceived drivers and barriers, and factors to increase meaningful involvement.

A cross‐sectional descriptive survey was conducted with clinical audit leads in NHS trusts in two Strategic Health Authority regions (South East Coast and London).

There has been an increase in the presence of relevant policies and structures related to user involvement in clinical audit since previous research a decade ago. However, similar barriers are identified and the role of users is still mainly providing feedback, with little meaningful involvement in the audit cycle, and few examples of improvements to clinical care.

An organisational culture of user involvement needs to continue to be developed in the NHS generally, and the rationale and benefits of this need to be fully understood by all health professionals. Support needs to be provided at a national and trust level.

Previous research on this topic was conducted ten years ago and there is no evidence to demonstrate how practice has changed since. This paper provides contemporary evidence regarding the implementation of user involvement in clinical audit.

In 1989, a programme of clinical audit was introduced throughout the UK National Health Service (NHS), in an attempt to improve care through the application of quality methodology to clinical issues. However, the role of clinical audit in the new NHS “internal market” is unclear. Reviews evidence on the development of audit and concludes that it has operated largely in isolation, under professional control. Central policy is now advocating greater purchaser and provider management involvement in audit, enabling feedback from and to service provision and management decisions. Where there are constructive local relationships the opening up of audit should be beneficial, but these do not always exist. Discusses a range of models for the interaction of clinical audit with wider NHS management systems. Recommends a split system of professionally controlled background audit and collaborative shared audits to balance conflicting goals.

A postal questionnaire survey of junior doctors’ views was conducted in a large acute hospital in the south‐east of England, amongst 146 junior medical staff recorded as being employed by the Trust across 21 specialities. It profiled their level of participation in audit and the quality of current audit programmes within their specialities and assessed their knowledge and understanding of clinical governance. Our findings suggest: a high level of involvement in activities labelled audit, but that these activities did not necessarily conform to robust audit methodologies; that junior doctors’ professional attitudes towards clinical audit are influenced by negative experience of undertaking audit within their specialities; and that there was a variety of understanding about the principles and meaning of clinical governance. It concluded that the conditions for coherent strategy aimed at promoting effective audit programmes which could support the use of clinical audit as a tool for continuous professional development are not yet in place across the Trust.

Many different activities have been defined for the effective use of clinical audit. Proposes a method of linking the practice and outcome of audit with the Trust business people, setting out criteria methodology and background following a two‐year research study.

The purpose of this study was to identify the priorities for evaluation and development using the perceptions of a sample of participants in clinical audit in Scotland. Semi‐structured interviews were held in four health board areas. The study indicated that the priorities for evaluation were: 1) the validity of the measures used in audit; 2) communications — both top‐down, bottom‐up, and across units and professions; 3) the systematic approach to planning programmes and projects; 4) implementation of change; 5) showing the improvement in patient care by closing the audit loop.