Is it feasible to apply clinical governance principles in operational primary care?

Clinical Governance Principles in Operational Primary Care. UK Civilian and military peacetime medical care is increasingly addressing the requirement for clinical governance. This has been defined as “A framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish”(1). It is supported by the four pillars of clinical effectiveness, prof-essional development, continuous quality improvement and risk management. Individuals and systems in both the NHS and military medical services are currently working towards the goals of Clinical Governance to improve patient care. The aim of this paper is to discuss clinical governance in operational military primary care. The core business of the Defence Medical Services is to support military operations. Military operations vary in their scope, risk and location and thus the range of medical skills required to support them can potentially be very different. Given these variables, is it feasible to implement Clinical Governance on operations? Whilst the overarching term of Clinical Governance is relatively new, many of its concepts are not. The training of personnel for their military medical task is not new, nor is the assessment of risk (both medical and operational). For example an operational medical assessment will in effect state the standard of care to be given, the systems to be used to deliver the care, the potential risks and options to reduce the risks, if possible. What has changed is the explicit requirement to meet peacetime civilian medical standards, if at all possible during operational deployments. This requirement is easier to meet in some theatres but extremely difficult in others. Specific difficulties that are not routinely encountered in civilian practice are the requirements for some medical facilities to move, often at short notice and having to support very small isolated detachments with their own integrated medical support.