Patient safety: is your GP practice providing safe care?

It’s one of the key questions the care quality commission (CQC) asks during inspection – is your GP practice providing safe care? To provide safe healthcare for patients is the end goal of every practice – but how can you ensure you’re hitting the safety mark? We explore

According to the BMA’s 2017 report, General practice in the UK, there was an estimated 15% increase in the number of GP appointments undertaken every year in England between 2011 and 2014 – the most recent number standing at 340 million.

Every day, practice staff – GPs, nurses, practice managers, healthcare assistants, reception staff – provide outstanding healthcare to their patients. However, according to the RCGP, best estimates suggest that between two and three per cent of consultations result in a patient safety incident which is defined as, ‘Any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving NHS-funded healthcare’.

Further, a study published in the BMJ – How safe is primary care? A systematic review – says that one in 25 patient-safety incidents will result in severe harm – for example, shorter life-expectancy, permanent injury, major loss of function or death.

What does this mean? According to guidance published by the RCGP, a GP working six sessions per/week, with an estimated 25 interactions per session, could be involved in seven to eight severe incidents a year.

What happens in the case of such an incident? How can you lower risk?

What is a patient safety incident?

There is a diverse range of incidents that fall under the definition of ‘patient safety incident’. Some common ones might include:

miscommunication with patients;
difficulty accessing clinical services;
unavailable records;
inaccurate medical records;
delayed referrals;
poor information transfer between healthcare providers;
missed or delayed diagnosis or assessment of care;
prescription errors;
malfunctioning or unavailable medical equipment

The National Reporting and Learning Service (NRLS)

The NRLS works with health organisations and royal colleges to improve reporting of patient safety incidents. All incident reports are submitted to a national database which was designed by the National Patient Safety Agency based on international experience and best practice. Collating this information provides an opportunity to ensure that learning from patient safety incidents is shared across the country and is intended to protect patients by raising awareness.

All patient safety incidents – whether they result in harm or not – should be reported through the NRLS. This can be done via NHS England’s general practice specific eform which are used to spot emerging incident-trends, or anything that might be of particular concern.

What happens after a patient safety incident report is made?

Once submitted to the NRLS, and entered into the national database, each patient safety incident report is analysed by national patient safety experts to spot trends, specific incidents of concern or emerging risks to patient safety.

If a trigger incident, or group of incidents of particular concern, is identified action will be taken to help address the identified issues/risks through the provision of advice and guidance. This will be disseminated across the NHS – as a patient safety alert, for example – so as to ensure that lessons learned in one part of the country are shared elsewhere.

‘Although you may not receive any formal feedback on an individual incident you report, you can be assured that, by feeding into a national system, you are making a difference to the bigger picture of patient safety,’ the NHS says.

Why report a patient safety incident?

Your patient safety report should describe clearly and concisely what happened – including the conditions and steps that led to the situation. The importance of this at practice level is that, for example, reflection on patient safety incidents can flag strengths and weaknesses in your practice and drive enhanced professional development and positive changes, as well as providing an opportunity for significant event analyses (SEA) – also known as a significant event review or audit – which can be used to improve practice and processes.

If an incident occurs, or nearly occurs, it is up to the practice to understand the mitigating factors that could have contributed to a patient safety incident – this will inform the design of interventions or the restructuring of processes to avoid future issues. Your patient safety report can provide a sound basis on which to build an improvement plan.

Assessing patient safety

There are plenty of valuable resources available online to support practices in their quest for optimum patient safety. The RCGP’s patient safety tool kit provides a structured approach to assessing the different aspects of patient safety and how you can ensure that you are meeting them – covering safe systems, safety culture, communication, patient reported problems, diagnostic safety and prescribing safety, for example.

Seven steps to safety

The NHS provides a useful, seven-step best practice guide for general practices to implement to safeguard their patients, as set out in Seven steps to patient safety in primary care. The steps have been developed to ensure that, if followed, should something go wrong, the right action is taken and that clinical governance standards, accreditation processes and contractual requirements are met.

The seven steps are as follows:

Step 1: build a safety culture

Step 2: lead and support your practice team

Step 3: integrate your risk management activity

Step 4: promote reporting

Step 5: involve and communicate with patients and the public

Step 6: learn and share safety lessons

Step 7: implement solutions to prevent harm

So, where does patient safety stand in your practice?

Resources

NHS England Guide for general practice staff on reporting patient safety incidents to the National Reporting and Learning System

NHS guidance on patient safety in general practice