A national approach to patient safety in primary care

Our May 2012 newsletter highlighted the remarkable success of the Safety Improvement in Primary Care project, which promoted patient safety in general practices across four health boards in Scotland.

The project laid the groundwork for a new national programme which was launched in March 2013. National clinical lead, Dr Neil Houston, tells us more about how the Scottish Patient Safety Programme in Primary Care programme aims to transform safety culture in primary care.

Tell us about the project and what it achieved

We ran a breakthrough learning collaborative, with practices using trigger tools to identify patient safety incidents and completing safety climate surveys to prompt discussion and improve safety culture. We also developed tools to help practices improve the care of patients with heart failure and introduce reliable systems for prescribing, managing and monitoring high-risk drugs such as warfarin and methotrexate. We focused on these areas of primary care because they cause particularly high levels of ill health and pose risk of harm to patients.

Practices reported that patient care became safer and more reliable through more structured care, using guidelines more consistently and promoting patient education and self-management. Over 80% said that the programme had benefited their practice and 75% felt their safety culture had improved. The project led to more effective use of warfarin, with fewer patients being significantly outside the recommended therapeutic range. It also created more efficient working practices, improved team working, reduced staff stress levels and gave staff a clearer understanding of their roles.

What do you think made the project such as success?

I think it worked well because we focused on areas that primary care teams know are where patients can be harmed and care is suboptimal. It made sense to them and they wanted to improve in these areas. The tools spread organically to other health boards once people started to hear about their effectiveness. They were also adopted as GP teaching and appraisal resources.

Tell us about the national rollout of the project

The Scottish Patient Safety Programme in Primary Care programme is taking the tools and approaches that we developed into all 1,000 GP practices in Scotland. The three workstreams cover safety culture and leadership; safer medicines; and safe and reliable patient care at home and across the interface between primary and secondary care. It’s a ‘collaborative within a collaborative’ model – the central one is run by Healthcare Improvement Scotland and there are also local ones for each health board.

Every local health board collaborative has a GP as clinical lead, with those from the earlier project staying involved to provide continuity of knowledge and skills. Many health boards ran their first local learning sessions for practice staff during May and the rest will have done so by the end of June. There’s a community knowledge website for sharing resources and learning too – it includes patient stories, video clips, presentations and templates that people can adapt for their own use.

The rollout to GP practices is just the first stage of the national programme. Starting in summer 2013 we’ll be developing our plans to work with community pharmacy and nursing teams, and after the autumn we’ll be exploring the potential for involving other primary care professionals too.

What are you aiming to achieve on a national level?

The overall goal is to reduce avoidable harm in primary care and to achieve that, we want 95% of primary care teams to be developing their safety culture and achieving reliability in three high-risk areas by 2016. That includes completing and reflecting on annual safety climate surveys and bi-annual trigger tool reviews, the first of which have to be done by March 2014. The trigger tool and climate survey are actually part of the 2013/14 Quality Outcomes Framework for GPs in Scotland, so there’s a big incentive for practices to get on board quickly.

As well as measuring the use of care bundles and monitoring data on high-risk medicine, we’ll be aiming to track the effect that the programme has on hospital admissions.