Aims and Method To determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle. Results Consultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects

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... n subsequent use of the CPA register. Clinical Implications Health service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.