To the Editor: It is refreshing to see quality initiatives like that of Mant et al,1 which examine issues of continuity across different territories. Use of a simple audit tool (minimum dataset) and methodology has worked well to illuminate what misleadingly appears to be a simple problem (ie, the two-way exchange of information between the hospital and general practitioner in relation to medication). Unfortunately, like many problems that appear straightforward and easily fixable, the reality is that this issue is far more complex to address. A lack of clinical governance has been made apparent in both the public hospitals and the Divisions of General Practice that participated. Clinical governance demands that organisations be accountable for standards and performance in relation to clinical care,2 and this is integral to addressing problems both internally and across the continuum of care.

Mant et al demonstrated that many hospitals had policies and strategies to accomplish the exchange of medication information,1 indicating that these procedures were thought to be achievable with current resources. Before this study, knowledge among staff of implementation was scant and confused, and there was no system of review to reveal existing problems. When problems were exposed and changes made, staff were not upskilled to incorporate the change into their practice (eg, junior doctors not completing the new discharge referral form). Similarly, the Divisions of General Practice did not resolve issues surrounding the production and distribution of business cards that they had agreed to undertake.

This study has determined a means to measure performance and has intervened to analyse problems and yield some improvements. However, if the organisations involved do not commit to develop clinical governance, the path towards continued improvement will be extremely slow (if at all) and the findings of this project made irrelevant.