Clinical Audit in the NHS internal market: from peer review to external monitoring
| Date | 01 April 1998 |
| Published date | 01 April 1998 |
| DOI | 10.1177/095207679801300204 |
| Subject Matter | Articles |
Clinical
Audit
in
the
NHS
internal
market:
from
peer
review
to
external
monitoring
Mark
Exworthy
Institute
for
Health
Policy
Studies,
University
of
Southampton
Abstract
Relations
between
managers
and
professionals
in
the
public
sector
have
often
centred
on
the
control
of
work
performance.
Work
performance
strategies
and
techniques
have
been
transformed
by
recent
public
sector
policies
involving
managerialisation
and
quasi-markets.
In
particular,
the
clinical
audit
programme
in
the
National
Health
Service
has
traditionally
been
the
preserve
of
professionals,
mainly
doctors
but
managers
and
purchasers
have
become
more
involved
recently.
Based
on
an
empirical
study,
this
paper
explores
the
ways
in
which
Health
Authorities
were
approaching
their
responsibilities,
the
consequences
of
such
strategies
for
purchasers
and
providers,
and
the
implica-
tions
for
professional-managerial
relations.
The
paper
concludes
that
purchasers
have
not
made
substantial
progress
in
assessing
work
performance
because
of
professional
resistance
and
the
non-threatening
environment
fostered
by
some
purchasers.
Clinical
Audit
(CA)
is
a
means
by
which
health
care
professionals
demonstrate
the
effectiveness
of
health
care
through
meeting
standards
and
also
develop
the
quality
of
care
delivered
(Joint
Centre
for
Education
in
Medicine,
1992).
Furthermore,
CA
is
symbolic
of
the
changing
nature
of
relations
between
health
care
professionals
(clinicians)
and
managers
(Dent,
1993).
Some
managers
have
seen
CA
results
as
a
source
of
information
about
professionals'
work
perfor-
mance
which
may
be
used
to
manage
the
organisation
and
professionalised
labour.
Managerial
involvement
in
CA
has
thus
not
always
been
accepted
by
professionals.
These
relations
have
been
complicated
by
the
introduction
of
the
internal
market
in
the
National
Health
Service
(NHS).
Professional-managerial
relations
have
been
overlain
by
the
purchaser
and
provider
system
of
the
internal
market.
This
article
examines
the
move
of
CA
from
a
peer
review
process
to
external
monitoring.
The
first
section
sets
the
context
in
which
CA
now
operates,
viz.
one
Public
Policy
and
Administration
Volume
13
No.
2
Summer
1998
40
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