Purpose and Background: The introduction of clinical governance made NHS organisations accountable for the monitoring and continuous improvement of the quality of patient care at all levels, across all services. Implementation of evidence-based practice and provision of an adequate infrastructure to support it is a major component and at local level, clinicians in all NHS organisations are required to participate fully in audit. The following describes the second phase* of a study investigating the dissemination and utilisation of an audit toolkit for the UK acute low back pain guideline through clinical governance routes.

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Phase I Results Were Previously Reported At SBPR

Methods: structured telephone interviews were conducted with 50 clinical governance leads and 22 clinical audit leads in 72 primary care trusts (pcts). the qualitative data were analysed using a framework approach involving identification of issues, concepts and themes and the construction of a theoretical perspective for the main categories. these were cross-validated by the original interviewer checking for dissonance.

Results: Six categories were identified: priorities; capacity and resources; loss of quality support groups; organisational issues; local environment and lack of audit strategies. the results suggest that low back pain is still a considerable problem but has lost its priority status at both government and local levels, largely due to the introduction of national service frameworks (nsfs) and to inadequate resourcing. primary care has a huge agenda that is seen as being grossly under-resourced with respondents reporting difficulty in meeting nsf requirements. many localities had not generated or finalised audit strategies while gp autonomy and poor communication between the gps and pcts were identified as barriers to the implementation of audit processes in primary care.

Conclusion: Presently, implementation of evidence-based healthcare for non-priority areas seems not to be feasible through clinical governance routes. without nsf status, the likelihood of seeing clinical audit used to assure evidence-based primary care for low back pain seems remote.