GP Feedback Aug 2017– Jan 2018 Oxfordshire For more information, contact the GP Feedback Team via email: occg.gpfeedback@nhs.net Oxfordshire Clinical Commissioning Group   Purpose of GP feedback Incident reporting continues apace, we receive on average 35 pieces per week. It provides us with clear, concise, patient specific information that we can use to address issues of quality and performance with our providers. We will give you an Update Report every 6 months so that you know what your colleagues are saying, and what we are doing about it. Thank you for your ongoing use of DATIX to share your experiences and suggestions for quality improvement. Good News! Changes made as a result of your feedback: “PCSE are not altering recall dates for cervical cytology after colposcopy” - NHSE response "We have escalated this with the Quality Assurance Team. PCSE have been investigating the issue. PCSE have plans in place to transform the cervical screening administrative support that they provide. This includes development to the way colposcopy 'discharge lists' are managed. The new process will be automated to provide a more robust transfer of data. Details are provided in the PCSE newsletter from October https://pcse.england.nhs.uk/news/2017/october/cervical-screening-bulletin/ “There was a delay in actioning ultrasound results by the Gynae-Oncology Team” - When clinicians view and take responsibility for results on the OUH’s EPR system, the result is “endorsed”, and rates of endorsement are monitored by OUH/OCCG. As a result of this GP feedback, there is now a process in place in the Gynae-Oncology team to improve this. The junior doctor will display endorsement rates at the MDT, which encourages prompt endorsement and management of results by colleagues. Gynae –Oncology are now showing significant and sustained improvement regarding result endorsement rates. OCCG are working with OUH to share learning across the Trust. “We are receiving requests to supply antibiotics for children with tonsillitis who have been seen in children's A&E but given only a small supply of medicine ” - Discussion with Consultant Nurse in ED, staff reminded to give entire course. Stocklist updated and increased number of TTO packs available. A&E Pharmacist to prepare a patient information leaflet on how to reconstitute subsequent bottles (cannot be done in A&E as contents will expire before course due to end). Reminder to supply full course will be included in A&E staff newsletter.

“The rheumatology advice line doesn’t seem to exist anymore” “The rheumatology advice line doesn’t seem to exist anymore”. - The Rheumatology helpline has been re-opened in a new format to promote more appropriate use of this service. “Endoscopy patients appear to still being given a leaflet that tells them to come to see their GP for results in 2 weeks” - Leaflet updated - no longer says get results from GP. “DEXA Reports seem to have stopped including helpful information, but instead directs GPs to the NICE guidelines. I would hope that these reports might resume giving practical advice in future” – OUH response: “Due to recent GP feedback, GP DEXA reports were streamlined in order to make advice more reader friendly, and also to ensure that the GPs had more input in their patient's treatment pathway. Therefore the report was shortened with a link to the relevant NICE guidelines, in order for GPs to use this for advice. Upon review of the information, we have decided to include some suggestions and investigations which will be informative for the patient's treatment pathway. The link to the NICE guidelines will, however, remain for those who wish to use this for more detailed information and alternative options.” “Patients who have had a procedure organised by gastroenterology are being told to see their GP for the results” – The gastroenterology department are drafting a form to be completed by the clinician in consultation with the patient - this will indicate exactly what they have been given to take away with them (blood form, x-ray form etc.) or what test will be scheduled, and then what action they need to take (hand in the form at reception, wait for a letter etc.). Following your feedback, the team have added a section to the form detailing how the patient should expect to receive the results after any procedure or scan (letter from us, or discuss in next OPA). We hope this will clarify things for the patients and avoid wasting GP appointments. Thank you for your helpful feedback. When providing DATIX Feedback, please provide the patients NHS number, when possible, as this allows investigators to look at the details for each case. Ideally the feedback you send is passed directly onto the provider. Before we are able to do this we occasionally need to edit comments. Please keep your submissions polite and courteous at all times. DATIX is designed to identify systemic safety and quality concerns, rather than to solve individual patient/clinician problems. DATIX does not replace the need for GP practices to contact the provider directly if there are specific clinical issues, for example to request a second opinion from a hospital clinician.

Action being taken from themes The OCCG GP Feedback Team Delayed discharge summaries – Currently, around 80% of discharge summaries are sent before or within 24 hours of discharge. We will continue to work with the OUH to improve compliance. Duplication of letters - The OUH Trust have successfully completed testing a new algorithm to ensure that only true updates to outbound electronic documents get sent from the Trust’s electronic patient record. In analysing the cause of the problem, the OUH found that the vast majority of duplicates were due to post discharge activity, re-triggering identical summaries. The change made, essentially works out whether the only difference in the document is the date/time, and if all else is identical now blocks the outbound message. There has continued to be a steady stream of reports regarding duplicates despite this change – which are now thought to be due to user error/training need – please continue to DATIX these, but there is no longer any need to send to examples to Dr Altman, as you may have been doing over the last few months. We will continue to work with OUH to address this issue, which we realise is frustrating, inefficient and could lead to patient safety issues. Management of test results - Currently, around 85% of tests requested by OUH clinicians are “endorsed” via the electronic patient record (EPR), meaning there is an audit trail showing that someone has seen the result. This issue is ongoing and work continues via the CRM/QRM to review progress with an expected trajectory to improve further. There is significant drive from the OUH to improve performance, and work to encourage clinicians who work infrequently at OUH to review patient results. Performance is monitored at specialty level and result endorsement levels are now on public display within the hospital. The OCCG GP Feedback Team Dr Andy Valentine. Clinical Director of Quality at OCCG and Deputy Locality Clinical Director for Oxford City at OCCG. Amanda Poor. Patient Safety Support Officer. Victoria Harte. Senior Quality Improvement Manager (Patient Safety) All contactable regarding GP feedback through occg.gpfeedback@nhs.net