Clinical governance

Reception and care-navigation teams use the toolkit to decide, often mid-call, whether something is urgent, which service fits and who the patient should see. That only works if the wording on each card is right for your practice and has been checked by a clinician. This page sets out who is responsible for what, and how the checking fits together. For the step-by-step review work, see the Clinical reviewer guide.

The same framework works for a single practice, a multi-site practice or a PCN.

Who is responsible for what

Agree these roles before you start setting up, and write down who holds each one.

Clinical lead

Usually a GP, ANP or clinical pharmacist. The clinical lead:

• reviews and approves card wording, including AI-drafted wording and smart visuals
• checks high-risk buttons and highlighted phrases make sense for your practice
• makes sure local pathways, restrictions and escalation routes are correct
• leads periodic review of the library
• signs off major changes, such as a new appointment model

Anyone who approves cards needs a Practice admin account at your practice. Standard accounts can’t open Clinical Review. See Roles and permissions.

Practice or PCN admin lead

Often the practice manager. The admin lead:

• adds and edits cards, and customises shared cards for local use
• drafts updates when services or arrangements change
• turns reception feedback into changes
• manages staff accounts and roles
• arranges review time with the clinical lead and keeps the queue short

Reception and care-navigation team

Staff:

• follow the approved guidance on each card
• tell the admin lead when an instruction is unclear, out of date or missing, using Suggest an improvement on the card
• report patterns that worry them, such as repeated confusion over the same symptom

The governance loop

Every card your practice uses has a review status of its own:

In outline:

1. The admin lead creates or edits a card, or runs AI customisation. The card goes to Pending.
2. The clinical lead checks it in Clinical Review, edits it if needed and approves it, or requests changes.
3. Requested changes are made, and the final wording goes back to the reviewer for approval.
4. When the wording or local arrangements change again, the card returns to Pending and the loop starts again.

The how-to is in the Clinical reviewer guide: what to check on every card, working through the queue and AI drafts and smart visuals.

What sends a card back to Pending

• Any edit your practice makes to a card’s content: instructions, brief instruction, important notice, age-group variants or images.
• Applying AI improved wording, whether or not you edited it first.
• Saving AI customisation wording.
• Saving an AI smart visual for the card. Removing one doesn’t.
• Creating a new card.

There is no setting to skip review. Central updates to shared cards by the Signposting Toolkit team don’t reset your approvals, so watch the release notes and re-check cards they mention.

Review status is not visibility

New cards start switched off, so staff don’t see them until someone switches them on. Disabling a card is not approval and doesn’t clear its review status. While any switched-on card is waiting, everyone at the practice sees a notice on the signposting home page.

Age groups

If your practice uses age bands, the Under 5, 5–17 and Adult versions of a symptom are separate cards, each reviewed on its own. If your practice uses one card for all ages, the reviewer checks that the single card covers every age safely, including babies and young children. See What to check on every card.

Local variation

Practices differ in their clinicians, skill mix, appointment types, local services, arrangements for children, and safeguarding and escalation policies. The shared library is a starting point. Your practice adapts it by:

• customising shared cards for your practice (other practices aren’t affected)
• adding cards of your own for local pathways
• hiding shared cards that don’t apply to you
• adding highlight rules and buttons that match your appointment book

Every change to a card’s wording goes through the same review loop, so the live library reflects how your practice actually works. Hiding a card, reverting it to the shared wording, and highlights and buttons don’t change its review status. See Cards.

Periodic review

Review the whole library at least once a year, and sooner when:

• local pathways or services change
• your workforce or skill mix changes
• national guidance changes (for example NICE or NHS England)
• reception feedback shows confusion or ambiguity
• the release notes announce changes to shared cards you use

Clinical Review helps you find the work: filter by status, sort by Most recently changed, and use the counts to see what is still waiting. See Periodic review for how to run one.

Several sites and PCNs

Each practice in the toolkit is separate: it has its own cards, review queue, highlights, buttons and staff list. Practices don’t see each other’s content.

Common arrangements:

• Each practice governs itself, with its own clinical lead and admin lead.
• A PCN governance group agrees shared wording, and each practice’s clinical lead approves it for their practice.
• One team works across several practices. Give the team an account at each practice, with the role they need there. Approval is recorded per practice, so a card approved at one practice is still Pending at another until someone approves it there.

Before approving, check the practice name at the top of the screen, especially if you work at more than one. See Team and access.

The audit trail

The toolkit records:

• Card history: each change to a card’s wording, with who made it and when. AI-drafted wording is labelled with the AI model that produced it, even if someone edited it before applying.
• Clinical review: who last reviewed each card, when, and any review note. Earlier decisions made before AI customisation are kept alongside the card in Clinical Review.
• Practice Handbook: changes appear on the handbook’s Audit tab, including saved and removed smart visuals.
• Accounts: sign-ins, new accounts, membership and role changes and password resets.

Practices can see review details and the handbook audit tab in the app. The card history and account records are held by the Signposting Toolkit team; ask us if you need them for an investigation. See Data and security.

Clinical safety concerns

If a card looks clinically unsafe:

1. Take it out of use straight away: in Clinical Review, choose Request changes and disable, then check it shows as disabled.
2. Tell your clinical lead.
3. If the problem is in shared wording, or you think other practices could be affected, email contact@signpostingtool.co.uk without waiting.

For general questions about the toolkit, use the same address, or send a bug report from Suggest a feature in the menu. See Sending feedback.

Related: Using AI safely · Roles and permissions