Primary Care Incident Reporting

1. Primary Care Incident Reporting Anne Greenley Head of Clinical Quality

2. Background The North of England Commissioning Support (NECS) Clinical Quality team worked on behalf of 13 Clinical Commissioning Groups (CCGs) in the north-east of England and Cumbria to implement a single standardised electronic incident reporting and management system across more than 470 GP practices representing 3.225 million registered patients spread over 15,339 km2.

3. Why? Intelligence Capture To build whole system picture

4. Overview NECS Review NHSE contractual relationship with Primary Care v CCG quality in Primary Care

5. Errors in primary care occur in about 1 to 2 per cent of all consultations’ Nationally there were an estimated 340 million GP consultations, in absolute terms, in 2013-14. So 6.8 million patients might have experienced an error over the last year. The NRLS is the largest repository of patient safety incidents in England and Wales. Since 2003, 11 million incidents have been reported. However, only 5,706 incidents were reported from general practice over the last year. It is likely that this reflects underreporting by GPs, and the reasons for this are complex. Change cannot be expected overnight – it has taken a decade for the patient safety movement to make significant gains in the acute setting. However, we need to explore the benefits of a unified mechanism of reporting and learning from errors. Marshall M. et al (2015) Don't let primary care patients slip through the nets; HSJ

7. SIRMS – Frontline Reporting • 1550+ GP practice users registered for 439 GP practices • System currently used by 330+ member practices across 13 CCGs – representing 2.46+ million patients. • 4100+incidents reported by GP Practices since January 2014.

8. Consistent Growth in Number of Reports and Number of GP Practices Reporting Reporting Levels

9. Trends and Themes Identified

10. Simplifying reporting NRLS Nationally the level of reporting of patient safety incidents from general practice is low in comparison to acute/secondary care. Reporting incidents to a national central system helps protect patients from avoidable harm by increasing opportunities for the NHS to learn when things go wrong. Incident reporting is also important at a local level as it supports commissioners, clinicians and the whole practice team to learn about the root cause of an incident and what can be done locally to keep patients safe from avoidable harm.

11. SIRMS – Commissioning Intelligence Reporting • Commissioning decisions must be based in part on local intelligence– ‘Commissioning’ Incidents/Issues & Intelligence. • Contract monitoring and management based in part on local intelligence from the Primary Care interface. • How do we monitor and manage clinical quality in providers? • Local, ‘coalface’ intelligence about what is the actually happening in healthcare organisations. • These issues can be used to identify the themes and trends within providers where there are failures in the systems and processes used to manage systems and clinical pathways.

12. SIRMS – Commissioning Intelligence Reporting Types of Commissioning Incidents and Issues - Referral issue - Waiting times - Cancellations - Test results - Communications - Admission problems - Choose & Book - Service unavailability - Breach of contract - Continued breach of contract - Penalty to contract applied - Prescribing/medication - Performance - PbR/Tariff issue - Discharge issue

13. SIRMS – Commissioning Intelligence Reporting Why report these issues? • Putting patients first – identifying issues in systems will lead to improvement in patient outcomes. • CCGs have a duty to monitor clinical quality in providers and get assurance that they are operating safely and effectively. • Can help CCG and member practices to drive up standards in primary care. • Clinical Quality intelligence can help commission safe & effective services from the outset. • Lessons learned that can be applied to other healthcare providers.

14. Making a difference: An example of what can be done to improve patient experience through incident reporting ….. DEXA scans – delays in reports Several incidents reported on SIRMS regarding delays of (in some cases) up to 3 months in the GPs receiving reports.  These incidents facilitated discussions between the CCG and Trust.  The Trust indicated that a surge in activity in had resulted in reported delays.  The Trust began a training programme of increasing the number of staff who are able to report.   Alternatives to clear the backlog were sought including a consultant who could come in to do the reporting. 

15. SIRMS – Practice Responsibilities • Completion of the initial SIRMS report form • Completion of the managers (incident review) form, including any root causes, lessons learned or outcomes if known. • Management and investigation of GP Practice primary care incidents (about own Practice) • If incident meets the definitions of a Serious Incident (SI) then this must be reported to the NHS England Area Team by the Practice.

16. SIRMS – NECS Responsibilities • Clinical Quality teams in Newburn, Durham, Tees and Cumbria review all incidents reported by GP Practices • Read & clear any primary care incidents. • If potential primary care SI is reported, contact Practice to advise discussion with NHS England Area Team. • Collate, analyse and identify themes and trends in incidents reported about providers. • Provide reports to CCGs on Provider themes & trends. • Provide reports to providers on issues reported about them. • Provide reports to Practices on incidents reported (if required)

17. SIRMS – CCG Responsibilities • Completion of the initial SIRMS report form for commissioning, contracting and clinical quality issues • Receiving reports from NECS on themes and trends in their provider organisations; • Raising issues with Providers through the QRG process; • Communication to Practices of issues raised with Providers and the actions taken as a result of Practice reports; • Working to support practices to improve quality in primary care where issues have been identified through reporting.

18. Benefits - Clinical Quality Reporting To CCG • Clear Evidence-based Intelligence – enables specific investigation of significant incidents with providers • Monthly Analysis Reports – feed into monthly patient safety meetings with providers • Practice Level Incident Data- supporting CCG practice visits

19. Benefits – to be realised through regular GP Practice Incident Reporting • Themes and Trends – detailed analysis will be possible with higher reporting rates - enabling the CCG to more effectively commission • Improvements in quality of care through more consistent Standards in Health Care • Improved Patient Safety through system intelligence

20. NECS Clinical Quality and CCG GP Practice Engagement

21. Summary • Incident reporting by GP practices about Providers has increased the availability of valuable clinical intelligence enabling the identification of high risk issues, themes and trends • This contributes to improvements in patient safety, patient experience and clinical effectiveness as issues can be identified and actioned to the benefit of patients.

22. Thank You for Listening Questions?