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The Ambulance Service Association National Clinical Effectiveness Project

Regional Group Structure
Discussion paper


Published by the Ambulance Service Association National Clinical Effectiveness Project


Role of Regional Clinical Audit Groups
Recommendations and Action
Map - Stage 1 – 6 regional groups in England
Map – Stage 2 – 4 regional groups in England

Progress to October 1999


ASA Clinical Effectiveness Project - Proposal for Regional Group Formation


It was one of the aims of both the ASA/JCALC Clinical Audit Committee and the Northern & Yorkshire Regional Ambulance Clinical Audit Project to set up regionally based audit groups for ambulance services. Until recently the Northern & Yorkshire Group and the South East Ambulance Clinical Audit Group (SEACAG) were the only regions of the UK to have established clinical audit groups, the former through direct project funding and the latter through a desire to collaborate and share experiences.

With the inception of the ASA’s National Clinical Effectiveness Project in December 1998 it was deemed necessary to establish a network of regional groups through which clinical audit could be developed.

It is also an objective of the ASA Clinical Effectiveness Project to promote regional groups in order to encourage collaboration, comparison and for establishing useful forums through which local and regional voices could then be heard at a national level. Similarly, nationally raised issues could more readily be fed back to the regional groups and to a local level.

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This proposal for regional clinical audit groups centres on the issues of


These concepts are by no coincidence also discussed in depth in the NHS document First Class Service and the Audit Commission’s Life in the Fast Lane, both promoting collaboration, sharing of best practice and strengthening clinical audit/ effectiveness at both a local and national level.

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Each of the proposed regional clinical audit groups already has at least one representative on the ASA/JCALC Clinical Effectiveness Committee. Regional groups match as closely as possible the NHS Regions and also incorporate the proposed Trust mergers either about to become formalised or being discussed.

Although these proposed regional groups do not exactly match the ASA regional groups, the representation of committee members is mirrored. In other words each ASA region is represented on the Clinical Effectiveness Committee through these proposed regional clinical audit groups.

In each case the regional groups are formed within England. Northern Ireland, Scotland and Wales remain as ‘regions’ in their own right. Similarly the ‘island’ services have not been allocated a specific region. It is proposed that all of the services included above would be free to join whichever regional group they felt would provide most benefit. For example, the Scottish Ambulance Service may could collaborate with the Northern & Yorkshire Regional Clinical Audit Group.

The Welsh Ambulance Service presents a unique situation in that it constitutes of three internal regions. These internal regions meet regularly to co-ordinate clinical audit within Wales as a whole. There is then the further possibility of each internal region collaborating with it’s nearest neighbour. For example, North Wales may wish to collaborate with the services in the north west of England, Mid Wales with the Midlands group, and South Wales with the south west services.

This proposal concentrates of the structure of the regional clinical audit groups within England. A two stage regional clinical audit group structure is proposed here.

Stage 1 - Build from the existing groups, establish the larger groups and smaller ‘peripheral’ groups

Stage 2 - Incorporate ‘peripheral’ groups into main group structure

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Role of Regional Clinical Audit Groups

Role of groups* (*see article on SEACAG in Candour, Ambulance UK Vol.14, no.2)

Regional collaboration and comparison
National collaboration and comparison

Role of project manager

Facilitate group formation
Visit groups regularly to co-ordinate, advise, listen, feedback etc.

Local opinion can be discussed at a regional forum. The regional consensus can then be tabled at a national level through the regional representatives on the ASA/JCALC Clinical Effectiveness Committee. Similarly, any initiatives to come from the committee can be introduced through the regional representatives to the regional groups and down to action at a local level.

Each regional group would also act as a focal point for training, workshops etc. surrounding audit and effectiveness issues. Visits from experts to give lectures or provide training could easily be facilitated through such a forum. With the proposed regional group formation given here virtually matching the boundaries of the new NHS Regions there is also scope for such bodies to represent the views of the wider NHS at group meetings and to aid in the facilitation of collaborative work.

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Recommendations and Action

  • Each regional representative from the ASA/JCLAC Clinical Effectiveness Committee to discuss these proposals with the ambulance services in their regions.
  • Regional representatives to confirm their preferred option for the regional structure of clinical audit groups with comments, to the ASA Clinical Effectiveness Project Manager before Friday 30 April 1999.
  • ASA Clinical Effectiveness Project Manager to circulate to all UK ambulance services the agreed structure for regional clinical audit groups.
  • Agree dates and venues for the inaugural meetings of the regional clinical groups (where they do not already exist) at which the ASA Clinical Effectiveness Project Manager will attend.


A First Class Service, Department of Health
A Life in the Fast Lane, Audit Commission
South East Ambulance Clinical Audit Group (SEACAG), Candour Issue 2, Ambulance UK Vol.14 no.1.

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Stage 1: Six regional clinical audit groups within England.

Key to Maps of Regional Groups (Bold denotes ASA/JCALC CEC representation)

South East Ambulances Clinical Audit Group

  • Kent, Essex, Sussex, Surrey, East Anglia, Beds & Herts, Two Shires, London, Royal Berkshire

South West Ambulances Clinical Audit Group

  • Westcountry, Avon, Gloucester, Wiltshire, Oxfordshire, Hampshire, Dorset
  • West Midlands Regional Clinical Audit Group

  • West Midlands, Hereford & Worcester, Shropshire, Warwickshire, Staffordshire
  • East Midlands Regional Clinical Audit Group

  • Nottinghamshire, Derbyshire, Leicestershire, Lincolnshire
  • North West Ambulances Clinical Audit Group

  • Lancashire, Merseyside, Greater Manchester
  • Northern And Yorkshire Clinical Audit Group

  • Cleveland, Humberside, North Yorkshire, Durham, Northumbria, West Yorkshire, Cumbria, South Yorkshire
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    Stage 2: Four regional groups within England.

    Key to Maps of Regional Groups (Bold denotes ASA/JCALC CEC representation)

    A Northern Clinical Audit Group to include:

    • North East , Tees East & North Yorkshire, Cumbria, Lancashire, West Yorkshire, Merseyside, Greater Manchester and South Yorkshire.

    A Midlands Clinical Audit Group to include:

    • Shropshire, East Midlands, West Midlands, Warwickshire, Staffordshire and Hereford & Worcester.

    A South West Clinical Audit Group to include:

    • WestCountry, Dorset, Avon, Wiltshire, and Gloucestershire,.

    A South East Clinical Audit Group to include:

    • East Anglia, Two Shires, Beds & Herts, Essex, Royal Berkshire, London, Surrey, Sussex, Oxfordshire, Hampshire and Kent.

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    Progress to October 1999:

    • The Northern & Yorkshire regional group was re-established in combination with a regional clinical governance working group. Meetings have been held in August and October 1999.
    • SEACAG has continued to meet regularly and is currently working on a regional collaborative cardiac arrest audit.
    • A West Midlands regional group has been formed, although its’ remit is to discuss issues concerning clinical governance, incorporating clinical audit and clinical effectiveness but not addressing them independently. The first meeting was held in March 1999, with subsequent meetings in June and September 1999.
    • A South West regional group was established with its first meeting in October 1999.
    • Contact has been made with a regional accident & emergency clinical audit co-ordinator in the Greater Manchester area who also has links into Lancashire and Mersey. Through this link a North West regional group will be developed which will then be asked to collaborate closely with the Northern & Yorkshire group.
    • Due to mergers in the east midlands area there are now only two NHS ambulance services in the area. Rather than establish a small group moves are underway to get the two services in the east midlands to collaborate closely wit those services in the west midlands.

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