Is Primary Care Safe? HAPIA Conference 2014 Peter Walsh

WHAT IS AvMA? The independent charity for patient safety and justice Provides advice and support to individuals affected by a medical accident Works in partnership with NHS, health professionals, Gov’t departments and lawyers Core participant in Mid Staffordshire public inquiry and main driver for Duty of Candour

Scale – general practice 85 percent of contacts with the National Health Service take place in primary care; there are 300 million general practice appointments and over 900 million prescription items dispensed each year. This means that nearly 750,000 patients consult their GP each day and 1.6 million people visit a pharmacy daily (1.2 million for health reasons).

Number of incidents? It has been estimated that there are between 5-80 safety incidents per 100,000 consultations, which in the UK would translate to between 37-600 incidents per day (Sanders and Esmail; Fam Pract. 2003; 20:231-6).

Are GPs reporting enough?

What do GPs report? Table 9: Reported incident types by general practice by quarter, Apr 2013 - Mar 2014   Number of incidents Incident type Apr 2013 - Jun 2013 Jul 2013 - Sep 2013 Oct 2013 - Dec 2013 Jan 2014 - Mar 2014 TOTAL ENGLAND Implementation of care and ongoing monitoring / review 276 236 213 217 942 Documentation (including electronic & paper records, identification and drug charts) 142 101 64 61 368 Medication 86 103 110 363 Clinical assessment (including diagnosis, scans, tests, assessments) 126 89 63 51 329 Consent, communication, confidentiality 56 57 62 238 Access, admission, transfer, discharge (including missing patient) 53 74 46 234 Treatment, procedure 43 42 34 41 160 Infrastructure (including staffing, facilities, environment) 35 29 30 128 Patient accident 33 27 23 116 Disruptive, aggressive behaviour (includes patient-to-patient) 9 22 8 5 44 Medical device / equipment 12 10 38 Self-harming behaviour 4 3 2 17 Infection Control Incident 15 Patient abuse (by staff / third party) 7 1 14 Other 186 Total 916 859 740 677 3,192

CQC on GPs & dentists Our biggest concern is about safety and safeguarding Almost one in five GP practices did not meet at least one of the standards of safety (although the impact on patients was mostly minor). Among dental practices, one in 13 did not meet at least one of the safety and safeguarding standards.

Out of hours GP services CQC, State of Care, 2013-14 “Most of the out-of-hours services we inspected were safe, effective, caring, responsive and well-led. “

Out of hours: CQC found some Did not have safe mechanisms for storing and checking the stocks of medicines held   Did not have appropriate recruitment processes. Did not have adequate systems for checking and monitoring equipment, including oxygen and emergency medicines. Did not inform patients how they could make complaints.

Regulation and accountability Why no action on non-reporting practices? Patient Safety Alerts and general practice Time to end the independent practitioner model?

Thank you! Any questions? CONTACT: www.avma.org.uk advice@avma.org.uk Twitter: @PeterWalshAvMA @AvMAuk