Clinical Governance

Published on: 10th July 2013 | Updated on: 15th May 2024

Schedule 4 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 set out the ‘Terms of Service of NHS pharmacists in four parts.  Part 2 are the Essential services, Part 3 are the Hours of opening provisions, and Part 4 set out the other terms of service, which includes Clinical Governance.  Adherence with the clinical governance requirements is thus a part of the terms of service.

The clinical governance requirements of the community pharmacy contractual framework (CPCF) cover a range of quality related issues detailed below.

Guidance for pharmacy contractors

The Community Pharmacy England/NHS Employers guidance summarises the CPCF clinical governance requirements:

Community Pharmacy England and NHS Employers guidance for pharmacy contractors on clinical governance (all references to PCTs in this document should now be interpreted at relating to the local NHS England team)

The clinical governance approved particulars define specific requirements which are set out in the Terms of Service.

Clinical Governance Service Specification (note – this service specification was published in 2004 and has not been subsequently updated. The Community Pharmacy England/NHS Employers guidance provides an up to date source of information on the CPCF’s clinical governance requirements)

Changes agreed to the community pharmacy contractual framework in September 2014 included amendment of the clinical audit and patient safety incident reporting requirements. Further information on the amended requirements can be found in Community Pharmacy England Briefing 015/14: Changes to Contractual Requirements 2014/15.

Related resources


Business continuity & emergency planning

CPPQ (patient satisfaction survey)

Complaints procedures

Practice leaflet requirements

Patient safety incident reporting

Raising concerns (Whistle-blowing)

Chaperone policy

Community Pharmacy England briefing on Chaperone Policies – this guidance document summarises the Chaperone Guidance issued by the National Clinical Governance Support Team. It is not mandatory to have in place a chaperone policy, but pharmacy contractors may wish to consider the adoption of a policy in order to protect patients and staff.

Clinical governance lead

Outline job description for a clinical governance lead (Microsoft Word) – each pharmacy is required to have a clinical governance lead, to act as the main contact on clinical governance matters between the pharmacy and the local NHS England team.


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