Study suggests there is confusion over monitoring of patient safety in primary care

Monitoring of safety and quality issues in primary care may be lacking, according to a small study.

Researchers carried out a study involving interviews with 21 primary care workers in North West London, including GPs, practice managers and other non-clinical staff. It explored how such workers monitor patient safety.

The results of the study, published in BMJ Open, suggest that monitoring of safety and quality issues in primary care could be made better so that staff are able to make improvements to their practices, based on their awareness of potential problems.

There was a lack of clarity among participants over what to report or monitor - what actually constitutes a patient safety issue. Broadly speaking, it concerns avoidable errors in healthcare that can cause harm to patients.

Participants described being overwhelmed with complicated data which lacked any meaningful analyses about safety and quality. There was also a lack of clarity over which patient safety events are expected to be reported or monitored. Participants reported uncertainty on whose responsibility it was to act on patient safety information or concerns. Several participants were unclear about which issues relating to patient safety needed to be reported or whether it was even relevant to general practice. Some said that they had little time to devote to considering patient safety issues, because of heavy workloads.

Lead researcher Professor Paul Aylin, from the School of Public Health at Imperial College London, said: "GPs and other primary care workers, including practice managers and other non-clinical staff, need to know when things go wrong so that they are able to act to improve patient care.

"Clinical staff do make mistakes - they are human, after all. In this small study, we weren't looking at whether poor reporting is leading to patterns of harm to patients. But in general, in order to improve any kind of service you need to understand what can go wrong and why, and how to prevent problems occurring again.

"Our study was small and it only looked at primary care workers in North West London, but it does raise some interesting questions about how safety is monitored and how monitoring can be used to ensure continuous improvement of what is already an excellent primary healthcare system in the UK."

The research suggests that the problems are not just centred on what goes on within the GP surgery. There are difficulties that arise when discharge letters come back to the GP once a patient leaves hospital. These may be too brief and there are not systems in place to flag a potential problem. Similar communication problems were identified following referral to district nursing services.

Professor Aylin said: "There appears to be a need for clearer information in the form of specific guidelines, policies and procedures with regard to who monitors patient safety in primary care, what is monitored and how it should be monitored. This requires a joined-up approach, across the NHS."