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Quality Specifications are a key component of NHS contracts between district health authorities and hospitals/services providing care. The perspective and methods of the Essex Quality Assurance Working Group are described, with emphasis on development of a framework within contracts to achieve high quality, appropriate, cost‐effective and consumer‐sensitive services. The objectives, structure and content of a range of quality specifications for services are discussed.

The past decade has seen an expansion of psychological treatments available to patients in the NHS. Research into the effectiveness of psychological treatments is also increasing, but this evidence is often not known or used by practitioners. This paper describes the development of a local clinical practice guideline from the research evidence to assist local GPs and psychological practitioners in selecting the most appropriate of three commonly available psychological treatments for adult patients — brief counselling, cognitive behaviour therapy, and psychodynamic psychotherapy. The steps of the guideline development process and difficulties encountered are outlined, and the local dissemination and implementation process described. A survey of GPs and practice counsellors conducted a month following distribution of the guideline found that most recipients reported it useful with many also reporting having used it already in clinical practice. The limitations as well as strengths of this local guideline development process are discussed.

SO THE Nissan Company of Kyoto has laid the foundation stone of its factory in Sunderland. An era, perhaps a new era in the history of the British Motorcar Industry is really on the way.