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Background: Internal quality control (IQC) has a long and well-established role in clinical biochemistry laboratories. However, despite the duration of use, and the publication of several articles detailing best practice, the implementation and use of IQC vary significantly between institutions. Consequently, the North Thames Audit and Quality Assurance Group undertook a region-wide audit of current IQC practice in 2006., Methods: On aspects of IQC testing, interpretation and laboratory processes, 54 laboratories in the region were audited., Results: Audit data showed significant variability in all aspects of practice, including IQC frequency, use of appropriate material, statistical processing and grades of staff involved., Conclusions: Some of the variation in practice may affect the effectiveness of laboratory IQC, and thus the adequacy of a laboratory to monitor system performance. Consequently, a set of proposed regional standards have been developed and disseminated, prior to re-audit at a future date.