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PCNs can help promote safety culture and share initiatives

NHS should focus on strategies that maximise the frequency of things going right – not on blame

Louise Prime

Thursday, 04 July 2019

Primary care networks (PCNs) present an opportunity to promote a safety culture and focus on continuous quality improvement and patient safety in primary care, according to NHS Improvement’s new NHS Patient Safety Strategy, and it believes that by learning from each other and sharing data PCNs could also “shine a light on areas for improvement across primary, community and secondary care”. It is urging primary care to adopt and disseminate the best of the secondary care patient safety initiatives where they are evidence based, and test those that lack evidence. And it is calling for the NHS in general to act against the blame culture, and instead focus on strategies that “maximise the frequency of things going right”

NHS Improvement pointed out that the vast majority of people already receive safe primary care, with only a tiny fraction of the two million reported patient safety incidents coming from primary care; where there are problems, the most common are difficulties making the right diagnosis, delays in referring patients to hospitals and prescribing errors. Following its strategy’s publication earlier this week Dr Nikita Kanani, NHS England and NHS Improvement’s medical director of primary care, has set out changes that she said will underpin safety improvement in primary care.


She argued that the development of integrated care pathways, with patients moving seamlessly between primary, community and secondary care services, is “an opportunity for local systems to develop sensitive clinical governance with clear lines of accountability and safer care”. She also suggested that there are further opportunities from new ways of working for healthcare professionals, for example, “extensivists” — GPs or physicians working primarily in the community but able to follow their patients into hospital – that can reduce admissions and length of stay.

Dr Kanani added that digital strategies could contribute to improved patient safety in primary care, for example: reduced delays in referrals through better administration; more effective management and continuity of care of patients with multimorbidity; better communication between healthcare professionals and patients, and between primary and secondary care; and reduced medication errors thanks to integration and connection of GPs and community pharmacies through electronic prescribing.

She also referred to problems relating to the dissemination and implementation of Patient Safety Alerts in primary care, and promised that NHS Improvement will work with PCNs “to explore how they can engage primary care providers in alert implementation”.

The strategy, published jointly by NHS England and NHS Improvement and led by Dr Aidan Fowler, sets out their vision for the NHS overall to continuously improve patient safety and the role of a safety culture to deliver it. They argued that sharing safety insights and empowering staff and patients with the skills, confidence and mechanisms to improve safety could save almost 1,000 extra lives and £100m in care costs each year from 2023/24 – with the potential to reduce claims provision by around £750m per year by 2025.

The report’s authors said: “Blame is a natural and easy response to error. It allows the cause of mistakes to be boiled down to individual incompetence, carelessness or recklessness and asserts that the problem is the individual. Blame relies on two myths. First, the perfection myth: that if we try hard, we will not make any errors. Second, the punishment myth: if we punish people when they make errors, they will not make them again.

“Too often blame is disguised within otherwise valid approaches to improvement such as training and reflection… A ‘systems’ approach to error considers all relevant factors and means our pursuit of safety focuses on strategies that maximise the frequency of things going right.”

NHS Providers welcomed the strategy’s publication, and head of policy Amber Jabbal commented: “To achieve the ambitions of this strategy, there must be a culture shift within the NHS, moving away from blame, to one which is transparent and support learning from the causes of incidents.

“It is right that NHS staff across all levels are given the training, expertise and resources needed to fully embed an effective safety culture and spot the risks of patient harm when they occur. Staff and trusts must also have the support and resource they require to adopt the digital solutions which will play a key role in delivering these aims.”

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