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Can external control drive clinical standards? In the meantime we have clinical governance. What this actually means, how it is meant to operate, and whether governance guidelines will become yardsticks for judging performance also remain open. But at least it sounds like a good thing, and one glib but hopefully sensible answer is that clinical governance might ensure “uniform standards” across heterogenous NHS practices, reassure the public and, in any case, it seems here to stay—at least for the moment.
It still baffles me as to what differences there are between excellent clinical practice and practice by clinical governance—presumably the latter is not meant to be quite as good, but will do. There seems to be a clamour for “ acceptable” standards and this handbook, from a group of eminent UK general practitioners, fills a gap for primary care. The authors are members of the Primary Care Society for Gastroenterology, an organisation that has made significant contributions in knocking down barriers between primary and secondary care and has advocated cogent seamless care. The publication covers a series of problems from dyspepsia to colon cancer and includes an interesting section on horizon scanning, an example of new NHS speak, evidence that the authors have their ear to the ground, shifting though it may be.
It would be deluding to assume that all we know about gastroenterology, and that which matters to patient care can be compressed into 94 pages, but there is sufficient to keep governance types well busy. The information is well accessible but this is, of course, not a textbook. The chapter on stomas begins “A stoma is an artificial opening of the bowel on to the external skin”, sheer gold dust to the doctor who forgot to attend the surgery lectures or to the non-clinical manager now anticipating being in charge of ensuring we do our jobs properly and services are commissioned effectively. There are one or two omissions—for example, the lack of mention of varices as a cause of acute bleeding—but each chapter does have a section on health economics for those hopefully traversing the quagmire of costs, effectiveness, care, and quality. Word has it that this book is selling well; the authors have got that aspect of health economics correct and timely.
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