CLINICAL AUDIT AND THE PURCHASER-PROVIDER INTERACTION - DIFFERENT ATTITUDES AND EXPECTATIONS IN THE UNITED-KINGDOM

Objectives-To explore and describe the views on clinical audit of heal thcare purchasers and providers, and in particular the interaction bet ween them, and hence to help the future development of an appropriate interaction between purchasers and providers. Design-Semistructured in terviews. Setting-Four purchaser and provider pairings in the former N orthern Region of the National Health Service (NHS) in England. Subjec ts-Chief executives, contracts managers, quality and audit leaders, di rectors of public health, consultants, general practitioners, audit su pport staff, and practice managers (total 42). Main measures-Attitudes on the present state and future development of clinical audit. Result s-Purchasers and providers shared common views on the purpose of clini cal audit, but there were important differences in their views on the level and appropriateness of involvement of health care purchasers, in tegration with present NHS structures and processes (including contrac ting and the internal market), priority setting for clinical audit, th e effects of clinical audit on service development and purchasing, cha nge in behaviour, and the sharing of information on the outcomes of cl inical audit. Conclusions--There are important differences in attitude s towards, and expectations of, clinical audit between health care pur chasers and providers, at least in part due to the limited contact bet ween them on audit to date. The nature of the relation and dialogue be tween purchasers and providers will be critical in determining whether clinical audit meets the differing aspirations of both groups, while achieving the ultimate goal of improving the quality of patient care.