Review

Access to audit

USER INVOLVEMENT IN MEDICAL AUDIT
Nikki Joule
Greater London Association of Community Health Councils, 1992, £7

The requirement in the 1989 white paper Working for Patients that all doctors be involved in auditing their practice has given medical audit a strong push up medical and managerial agendas. This report from GLACHC on the potential for - but current lack of - user and community access to the audit process will begin to place the issue on political agendas too.

Indeed, as the report was published the DoH set up a new national body to advise it on audit issues, including the development of guidelines on involving patients.

The GLACHC report analyses the results of two small surveys on the views of professionals and CHCs about user involvement in medical audit. Predictably, the responses show minimal participation in any stage of the audit cycle, though in general district and FHSA audit committees seemed to welcome the eventual involvement of health service users although, as one committee member put it, ‘we are still working hard to get doctorsinvolved in audit!’

The report highlights a range of issues, notably the tension between audit as an internal, professional activity and audit as a tool by which managers or purchasers - or indeed the community - can improve service quality. But the suggestion, at one point, that audit could identify ‘unnecessary, as well as harmful, practices’ seems wide of the mark, and confuses audit with clinical and health services research.

In focusing narrowly on medical (doctor only) audit, the report neglects the wider, and potentially more fertile, field of multidisciplinary clinical audit, which is surely the way forward if the ultimate aim is to improve overall standards of care. Nonetheless, this is a useful, well-argued and forward-looking contribution to the debate.