Can medical audit be implemented by 1991?

The Government's proposals for the reform of the National Health Service' have met with a mixed response. Amidst the controversy one item has received widespread support. Increasingly it is recognized that medical audit is an essential component of high quality clinical practice, and the United Kingdom can no longer lag behind countries such as the United States, Australia and the Netherlands2 in this important area. Audit is the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient.' Professional leadership of audit is central to the government's approach. A system ofpeer review is proposed, with evaluation of the quality of care using a specialized knowledge of current medical practice. Every doctor will participate in regular medical audit. Although individual results will remain confidential, general results will be available to managers. It is accepted that several pre-conditions are necessary for medical audit to take place. These include access to medical records, adequate information, secretarial support, and the provision of time which will not then be available for other clinical work. The time-scale for implementing audit is tight. It is envisaged that every Health Authority will have implemented a comprehensive audit programme by April 1991. The establishment of a district medical audit advisory committee is a principle requirement. The committee will be required to produce a forward programme for developing audit and reviewing clinical practice in each subsequent year as well as a report on the previous years results. The proposals in the forward programme must be agreed with the District General Manager. If necessary, managers will be able to initiate an external audit which would take the form of an external peer review or a joint professional and managerial appraisal. Medical audit has developed in pockets throughout the country3 but it is not widespread. Although professional bodies such as the Royal Colleges have subsequently promoted it,4 many clinicians are uncertain about how to get started. If they are to implement audit by 1991 they must start to plan their programmes now. This paper discusses some of the issues which must be tackled to achieve this target.