• risk management
• community health
• audit

• CHI, Commission for Health Improvement
• CHT, congenital hypothyroidism
• CNST, Clinical Negligence Scheme for Trusts
• DDH, developmental dysplasia of the hip
• GP, general practitioner
• HACCP, Hazard Analysis Critical Control Point
• NHSLA, National Health Service Litigation Authority
• NPSA, National Patient Safety Agency
• PCHR, Personal Child Health Record
• PKU, phenylketonuria
• RM, risk management
• TB, tuberculosis
• TBM, tuberculous meningitis

The widespread acceptance of clinical governance as a tool for improving the quality of health care delivery means that consultant community paediatricians share responsibility for setting and maintaining standards of practice in the community. One aspect of developing a high quality of care is risk management (RM), which has been defined as “the process of reducing or eliminating losses due to accident or misadventure”.¹ An essential feature of RM within clinical governance is that individual practitioners assume responsibility for their part in reducing and eliminating risk. The overall aim is to improve the quality of care, by identifying and reducing risks that might result in damage to a patient or healthcare professional, or result in complaints and litigation. There are three aspects of RM:

• Setting up systems that monitor practice, identify weaknesses and adverse incidents, and allow analysis of mistakes and omissions before harm, complaints, and litigation occur. It is important that “near misses” are included in this category.

• Analysis of complaints received to derive lessons that may be learnt to improve quality of care.

• Managing litigation.

The aims of this paper are to suggest what systems might be needed to minimise risk and raise quality, and to suggest areas where trusts should focus their RM activities. The focus is on preventive care programmes and we will not discuss “vaccine damage”, child protection, or aspects of professional practice, which involve the same principles and hazards in a community setting as in any other area of clinical work.

The concept of RM has been applied most commonly to “high risk” areas such as obstetrics, orthopaedics and accident & emergency medicine. By comparison, community child health is a low risk activity. The NHS Litigation Authority (NHSLA) operates a Clinical Negligence Scheme for Trusts (CNST), but …