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Multidisciplinary teamwork: key to clinical governance

Lynn Young
Community Health Adviser,RCN

Implementing clinical governance within all NHS organisations is an absolute given. It is an important part of the NHS Act 1999 and, in the light of a number of nasty healthcare scandals that have occurred in recent years, clinical governance has become the number one demand of Primary Care Trusts. However, it is proving to be tough going, as ensuring that we are all "doing the right thing" (a much simplified definition of clinical governance) takes inordinate time, financial resources, patience, tenacity and personal awareness.
Changing NHS structures and giving them new names is easy compared with challenging clinician behaviour and practice. After all, each time the UK is inflicted with a new political regime, the NHS has to cope with complete upheaval, regurgitating itself and coming out the other end, and often not in a position to provide any better care than the time before!
Clinical governance, however, has the potential to improve care, and nurses working in primary healthcare are in a strong position to act as catalysts to ensure a better deal for patients. We know that a large number of nurses have long taken the lead throughout the healthcare system in developing a culture of quality and best patient care. The great hope is that, as reform bites deeper into hospital and community health settings, nurses will have the capacity to continue this vital work.
Providing best patient care cannot be done by nurses simply working within their own discipline - the rallying call is for all stakeholders to pool their skills, expertise and energy and work in total harmony with one another to ensure that clinical governance is effective and visible.
With happy and multidisciplinary teamwork in mind it is high time that national organisations dropped their small differences and concentrated more on shared commonality. The RCN, RCGP and NHS Modernisation Agency plan to cooperate in terms of effort and resources so that they can play a much larger and hopefully more successful role in developing clinical governance in primary healthcare.
History is being made. The different disciplines are coming together in a way rarely experienced in earlier times, to help the often complex patient journey become less traumatic and more positive.
The reality of working on the quality agenda is, unfortunately, not all that we would like it to be. We have far too much evidence on the large number of clinicians who have bravely taken on a clinical governance lead and become thoroughly burnt out as a result, with understandable resignations prevailing.
Honesty is key during a time of hefty rhetoric and spin. Reform in itself cannot achieve better patient care. Care is provided by people, not structures, and clinicians need dedicated time out and resources to help ensure that they are able to provide the best possible practice in harmony with their colleagues.
Clinical governance has far to go and will fail to have the desired impact unless the workforce is given the help it deserves to provide the care that the public deserves. The RCN, RCGP and NHS Modernisation Agency should be equally determined to join forces and collaborate. The different organisations need to work within a spirit of optimism and perhaps even comradeship so they can publicly demonstrate that the rhetoric of "joined-up interagency working" can become a true reality, bringing palpable benefits to all.
While it is still early days, the plea to the politicians is that, for the time being at least, leave the structures alone and give the caregivers time and space to focus precious energy on simply improving care.