Increasingly, complex healthcare is being delivered ‘outside of the hospital’s walls’. Examples include chemotherapy and antibiotic treatments being provided in the patient’s home or at a community based ambulatory care center.  Since the Covid pandemic there has been a significant increase in the provision of ‘out of hospital’ services such as ‘virtual wards’, ‘virtual’ emergency departments, and ‘hospital in the home’. There has also been a rapid rise in clinical consultations via telehealth, including post discharge follow ups. Primary care practices and community care centers have also seen an increase in the complexity of care that they are providing, especially with the challenges of gaining admission of patients to hospital, and the additional responsibility for complex care being provided in the community. Increasingly there are greater community, government, and professional expectations that evidence of practical implementation of high standards of safety and quality, occurs in all health care settings. Therefore, ensuring that an effective clinical governance framework, including robust processes for ensuring accountability for clinical governance, is in place for ‘out of hospital settings’ is important.