1. Is Primary Care Safe? HAPIA Conference 2014 Peter Walsh

2. 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

3. 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).

4. 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 incidents per day
(Sanders and Esmail; Fam Pract. 2003; 20:231-6).

5. Are GPs reporting enough?

6. What do GPs report?
Table 9: Reported incident types by general practice by quarter, Apr Mar 2014
Number of incidents
Incident type
Apr Jun 2013
Jul Sep 2013
Oct Dec 2013
Jan 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

7. 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.

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

9. 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.

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

11. Thank you! Any questions?
CONTACT:
@AvMAuk