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Communication skills are essential business tools, as well as a prerequisite for management of global economic organisations and effective government in complex societies. Communication underpins Western values and ensures that, through feedback processes, organisations appreciate the different value sets that can impact upon the success or failure of policies and enterprises. In order to gain the greatest benefit from effective communication, greater emphasis needs to be placed on the academic teaching of the skill involved, as part of and together with greater efforts to promote the reputation of professional communicators.

The purpose of this article is to assess the impact of recent changes to out‐of‐hours primary care services.

The changes to out‐of‐hours primary care services since the introduction of the new GP contract in 2004 are considered. A recent survey of out‐of‐hours providers helps to give a view of how these organisations have diversified. An analysis of recent claims and complaints handled by the Medical Protection Society highlights the risks of this new approach.

There have been significant changes in the way that out‐of‐hours care is delivered and this has led to a number of emerging risks. In particular, problems with communication skills are the most frequently occurring factor in out‐of‐hours incidents.

Quality standards currently focus on working practices, rather than soft skills such as communication. Training for out‐of‐hours providers in these skills is essential, particularly where children are concerned.

The paper highlights the areas of risk which contribute to substandard out‐of‐hours care.

The paper's aim is to consider the value of medicolegal telephone help‐lines for doctors.

This is a brief review as to how members of a medical protection organisation use a medicolegal telephone help‐line by analysing 100 random calls during a two week period in March 2008. The range of themes and concerns are compared with annual figures from 2007. Recommendations with regard to the need for national advice are considered.

The nature of the service provided gives doctors an additional opportunity to explore matters of concern. Doctors appear to need guidance to support decision making in a variety of ways where a clinical or professional situation needs resolving within an appropriate ethical and legal framework.

Health care organizations should reflect on what if any additional ethical / medicolegal training is required for their employees to assist in difficult professional decisions. There appears to be a significant need for doctors to be able to access independent telephone advice and the use of such services may need to be encouraged.

The paper highlights the benefit for health professionals to have access to independent, objective advice and discussions to support ethical decision making.

A clinical governance project is set up following the delayed diagnosis of two children with life‐threatening conditions (osteomyelitis and Ewing's sarcoma). They attended A&E with a simple limp. The aim is to improve the management of this very common presentation. With this purpose, a series of algorithms was created and then its use with a prospective study assessed

The study was carried out for nine months. A total of 113 children were included in it. Some 65 per cent were diagnosed, treated and followed up by the A&E department exclusively. Only 15 per cent required hospital admission. No hip aspirations were required to diagnose septic arthritis, as the exclusion of this condition was based on the four predicting factors (pyrexia, raised WCC, raised PV and CRP and fluid in the hip joint demonstrated by hip ultrasound).

It is believed that the management of this group of children is greatly improved.

The protocol presented in this study is cost‐effective as unnecessary hospital admissions are avoided, fewer patients are referred to specialised clinics and appropriate use of the radiology service is made out of hours. Diagnosis and treatment of serious conditions such as septic arthritis, or Perthe's disease, does not get delayed.

The purpose of this article is to assess important recent guidelines on resuscitation, published in December 2005.

The guidelines are put into the context of other attempts to standardise CPR practice. An analysis of recent claims and complaints handled by the Medical Protection Society and problems reported to the National Patient Safety Agency, broadens the discussion.

A number of issues of concern arose – the competence of health professionals, recognising the deterioration of patients, communication of Do Not Attempt Resuscitation decisions, and equipment failings. Strengthening training, better monitoring and performance management are important in addressing these issues.

Health professionals have a good opportunity to avail themselves of the new CPR guidelines; it is in the public interest to try and achieve these standards.

The paper highlights the continuing risks in providing substandard resuscitation.

The purpose of this research is to ascertain whether there has been a change in the outcome of critically ill pregnant women from the indigent South African population from a clearly defined region in Pretoria, after the introduction of new management protocols supported by regular audit and feedback.

A comparison of outcome of all women with severe acute maternal morbidity or maternal deaths was made between 1997/1998 (original protocol) and 2002/2004 (new protocol) was performed.

It was found that there was a significant increase in the prevalence of critically ill pregnant women between 1997/1998 (8.40/1,000 births) and 2002/2004 (10.22/1,000 births; p<0.014), but a reduction in the MMR 133.2/100,000 births to 104.9/100,000 births (Odds Ratio 0.79, 95 Confidence Intervals 0.51 and 1.2) and in the mortality index from 15.9 per cent to 10.3 per cent (Odds Ratio 0.61, 95 per cent Confidence intervals 0.39 and 0.96). The pattern of primary obstetric causes of critically ill pregnant women has remained unchanged during the study period, but the prevalence of each disease category increased. The average number of dysfunctional organ systems per patient declined from 1.41 in 1997/1998 to 1.19 in 2002/2004. There were significant reductions in the number of critically ill pregnant women with renal dysfunction, metabolic dysfunction and cerebral dysfunction. The number of patient related, administrative related and medical personnel avoidable factors all decreased.

The new protocols, audit and feedback have been associated with a reduction in the number of preventable and manageable complications experienced by critically ill pregnant women over the past five years.

The purpose of this article is to assess important changes made to the vaccines used for childhood and adolescent immunisation in August 2004. These changes resulted in a number of patient safety incidents.

The changes are reviewed for the way that risk assessment and risk management were used in their development. An analysis of recent claims and complaints handled by the Medical Protection Society is then used to broaden the debate.

The August 2004 changes to the childhood vaccination programme contained unnecessary and avoidable risks of patient safety incidents, which could have been avoided if existing advice had been followed. Errors continue to be seen in the administration of childhood immunisation in primary care. These are driven both by systems and human factors.

This paper will be of use to those working in primary care who wish to ensure that childhood and adolescent immunisations are carried out correctly.

The paper highlights risk‐management issues that are relevant to childhood and adolescent immunisation.

The purpose of this article is to assess the new NHS code of practice on records management, published in March 2006.

The guidelines are put into the context of good practice, and changes to the way that medical practice is being delivered. Recent MPS experience of complaints and claims is also used to inform the analysis.

The code of practice includes much that is useful, in particular reviewing the legislation on the subject and providing more detailed retention schedules than the previous guidance. However, there are also some omissions, and some areas where more detail would have been helpful.

Health professionals can take advantage of the new code of practice to refresh their knowledge and, if they have responsibility, review the records management within their own organisation.

The paper highlights the continuing risks of substandard records management.

The purpose of this paper is to show how the Turning Point Initiative to improve the health of populations by improving the USA public health system has many lessons on collaboration for governance systems.

The article synthesizes published literature outlining the results of a Robert Wood Johnson Foundation/W.K. Kellogg Foundation grant program to 21 USA states and 43 communities and relationships to administrative practice.

Turning Point's creation of a formalized network of public health partners across the USA has led to innovations in collaboration, increased system capacity, and alternative structures for improving health.

Turning Point's efficacy in community health system improvement can be mirrored in clinical governance. A major potential for improvement in clinical delivery systems is available by re‐thinking key partners, organizational structures, and system administrative capacity.