- The NHS reforms placed a requirement on all doctors to improve the quality, effectiveness and efficiency of medical practice by undertaking a regular programme of audit. Through a case study of the introduction of medical audit support staff, this publication documents how this process has been accomplished to date. It indicates ways to improve the organisation, management, planning and follow-up. It describes examples of successful audit projects, the factors contributing towards their success and the resulting changes. It analyses the major issues emerging for medical audit support staff. The authors conclude that the success of audit is being held back by a lack of common agreement as to its scope and objectives. The report emphasises the need for debate among clinicians, managers and policy makers about the future direction of audit.