Our paper aims to conceptualise a clinical governance framework and the tools it needs for the effective management of chronic diseases in the primary care setting, allowing to drive an effective change in healthcare services and thereby systematically improving their quality and safety.ДЇor the purposes of our analysis, we used the Chronic Care Model by Wagner et al 16 and Clinical Governance statement by Scally et al 17 for reference, carefully reviewing each of them and their various components.

14 Clinical governance for primary care, focusing on the management of chronic diseases, has specific features and relies on a network of different health professionals working together for their patientsвЂ™ benefit. 10вЂ“13 Until now, it has focused largely on in-hospital care, and met with significant difficulties when transferred to primary care. Clinical governance was first established in the UK, 9 and has been implemented in many different countries.

It encompasses the tools, methods and infrastructure devoted to assuring healthcare delivery, continuously improving the quality of the service and striving towards clinical excellence for patients. 8Д¬linical governance is an umbrella for the systematic administration and coordination of different processes having a direct impact on healthcare delivery, including the management of patients with chronic conditions. 7 With these pressures, primary care systems may have difficulty ensuring a coordinated approach, and the lack of clarity concerning their goals has led to divergent approaches, and a slow and often disjointed adoption of changes and improvements. 5 6 In fact, it is now widely recognised that the care and support needed to live with a long-term condition requires a radical re-design of services, by allowing patients to drive the care planning process and by developing a new management of care for people that is proactive, holistic, preventive and patient-centred as for example defined by the вЂHouse of CareвЂ™ model. 4 There is currently a growing interest in high-income countries to redesign healthcare organisations, focusing on practices that improve the quality of care and guarantee the equitable, timely and effective management of patients with chronic diseases. 1вЂ“3 As a consequence, the organisation and provision of primary care now faces new challenges (eg, polypharmacy, multimorbidity, fragmentation of care, frequent transitions of care, a need for strong integration and pressure from patients). The dramatic increase in the burden of chronic diseases in the last 20 years represents a primary concern for health services, and global health system sustainability demands a massive shift to primary care.

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