The aim of this study was to explore the views of Primary Care Organisation (PCO) clinical governance leads on the implementation and development of clinical governance within primary care in the south west region. A grounded theory study using focus groups, research interviews and negotiated feedback reports was designed for use in the primary care setting. The subjects were a purposeful sample of 16 PCG-level clinical governance leads. Four main categories emerged from the data. These included: (1) defining clinical governance; (2) the process of implementing clinical governance; (3) positive aspects of clinical governance; and (4) concerns about delivering clinical governance. At the time of collecting the data (approximately 1 year after the introduction of clinical governance), there was evidence of a culture in primary care where clinicians valued efforts to improve the quality of patient care and enjoyed their own involvement in decision-making at a grass-roots level. However, whilst the concept of clinical governance was received with enthusiasm, the delivery of clinical governance faced challenges. These challenges included the paucity of ear-marked funding, the speed of implementation, the volume of work, and the impact on the clinical governance lead's relationships at home and at work and on his/her emotional wellbeing.