1. GP Feedback August 2018 Oxfordshire
For more information, contact the GP Feedback Team via
Oxfordshire
Clinical Commissioning Group
Purpose of GP feedback
Incident reporting continues, we receive on average 35 pieces per week. It provides us with 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 with updates about what we are doing about it.
Thank you for your ongoing use of DATIX to share your experiences and suggestions for quality improvement.
POTASSIUM LEVELS
We received feedback regarding concerns caused by receiving blood results showing high potassium levels where this is due to haemolysis. After discussion with the OUH, changes made as a result of your feedback are shown below. More detail available on the GP Bulletin. From late February 2018, the lab stopped reporting potassium in specimens where there is haemolysis, or obvious EDTA contamination (usually with a low calcium).
1. Haemolysis
Haemolysis significantly increases the plasma concentration of potassium, phosphate, AST and LDH. In the past, results have been reported even though haemolysis is present, but with a comment to highlight haemolysis. To reduce clinical risk, it is proposed not reporting these results if samples are grossly haemolysed and where the results could be misinterpreted.
2. Potassium-EDTA contamination
Potassium-EDTA is used for full blood count tubes. It contains potassium and chelates other metals. It therefore increases the apparent concentration of potassium, and reduces calcium, magnesium, iron and ALP (because magnesium is required for its action).
Most specimens affected by these two issues come from acute areas of the hospital, and the rate is much lower in primary care. However, a Datix was received from primary care, suggesting an example where results had been interpreted as genuine.
Since the change was made, reports will simply be ‘starred’ indicating that no result was given and a comment such as “Severe haemolysis”, “Sample delayed”, “Suspected EDTA contamination” will be added.
If you specifically need a potassium result, this needs to be stated on the ICE request form and the lab will let you know if it was unobtainable, so that the sample can be repeated.
If you have any comments or queries, please address them to Dr. Brian Shine at the OUH.

2. GP Feedback August 2018 Oxfordshire
For more information, contact the GP Feedback Team via
Oxfordshire
Clinical Commissioning Group
Duplicate letters – update We received lots of DATIX feedback, especially earlier in the year, regarding duplicate documentation being sent to Primary Care. Following the successful implementation of a “duplicate checker” to the Electronic Patient Record at OUH, the volume of duplicates due to IT glitches has reduced significantly. The CCG and OUH are aware that there are still duplicates being sent out and we will continue to work on this issue. The causes of the remaining duplicates seem to be, among other things: Providers other than the OUH. Human factors, leading to some departments still manually sending out second copies of correspondence directly. Antibiotic prescribing for children with tonsillitis; full course not being prescribed. You sent lots of feedback regarding this situation whereby patients were diagnosed in ED with tonsillitis, but were being given an incomplete course of antibiotics, and being advised to attend primary care for the rest. We liaised with our colleagues at the OUH, and found that this was being done as a result of concerns regarding reconstitution of liquid antibiotics/fridge-life of reconstituted antibiotic. A multi-specialist discussion, informed by new NICE guidance for sore throat allowed an agreement that has led to a change in policy. Altering the course length for antibiotics for tonsillitis to 7 days (one bottle) was implemented, allowing the full re-constituted course to be prescribed and issued by the hospital. Please do send further feedback if you have any further examples.
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. D ATIX 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.

3. The OCCG GP Feedback Team
August 2018
For more information, contact the GP Feedback Team via
Oxfordshire
Clinical Commissioning Group
MED3 We are seeing an increasing number of reported incidents of patients not being given a MED3, or being given a MED3 for an incomplete period of time. The issue has been raised with the Deputy Medical Director and all Clinical Directors at the OUH, as well as each department responsible for the incident(s). We are hopeful this will lead to change, and we will continue to monitor this. Healthshare/Berkshire Pathology Services/Physiological Measurements Ltd (PML) We have received significant amounts of feedback regarding newer providers. In particular, Healthshare, Berkshire Surry Pathology Services, and Phsycological Measurements Ltd. We have fed your comments and clinical incidents back to the organisations, and also to the commissioners responsible for these contracts. The issues raised will continue to shape services as the respective contracts go forward. Please continue to send your feedback when problems occur so that we can investigate and challenge as appropriate. CAMHS The new CAMHS contract began in 2017 with Oxford Health as the provider. The contract model is new and innovative, and there are on-going challenges regarding waiting times. The Single Point of Access for CAMHS started earlier this year as part of this new model, allowing self-referral for patients. As new aspects of the service come on-stream, we would be keen to hear your experiences both good and bad, as this can help to shape services. Please continue to use DATIX to share examples of clinical care
The OCCG GP Feedback Team
Amanda Poor. Patient Safety Support Officer
Victoria Harte. Senior Quality Improvement Manager (Patient Safety)
Dr Andy Valentine. Clinical Director of Quality at OCCG and Deputy Locality Clinical Director for Oxford City
All contactable regarding GP feedback through