This section describes my work in the area of threats to Patient Safety in Primary Care.
Background and rationale for work in this area
The majority of people who have contact with health care providers will receive high quality care but unfortunately for some people this care will actually harm them or be potentially harmful to them. The identification and reduction of harm has become a major priority for the NHS and although the main impetus has come from highly publicised adverse events in the secondary sector there is now an increased focus on primary care. Recent interest in the field of patient safety has tended to focus on care delivered in hospitals. However, the potential for safety problems in primary care is significant, not least because of the volume of patient contacts that take place, the complexity of the interactions and the level of uncertainty associated with providing care in the community setting. A recent review of patient safety in general practice which I carried out estimated that medical error occurs between five and 80 times per 100 000 consultations. Prescription errors were most common, occurring in about 11% of prescribing incidents, but communication and diagnostic errors were also important, as were interactions which took place across the primary/secondary care interface.
Despite the high prevalence and importance of patient safety in primary care, there has been little empirical research in the field. What has taken place has mostly been limited to the epidemiology and frequency of medical errors from the point of view of the physician.
The Department of Health has reviewed the extent and nature of adverse events in the NHS, with particular reference to how it may learn from such events to improve the quality of care that it provides. Most experience has been gained from secondary care where it can be expected that adverse events are more likely to occur in a complex organisational and technical environment. However, little is known about the situation in primary care where the majority of contacts with health care providers will occur.
The work that I do on patient safety sits firmly within the work on quality. It is our view that emphasising the importance of patient safety can act as an important trigger in improving the quality of healthcare both at the patient doctor interface and in the organisation of primary care. The way that this could be done in the primary care setting has not been explored and our research agenda will contribute directly to this by linking the outputs of the research on patient safety with the current work that we are doing on quality improvement.
Because research on improving patient safety is relatively underdeveloped within primary care, our strategy has concentrated on identifying researchers who have an interest in improving patient safety from a variety of backgrounds and building alliances with them. Our emphasis has been on building multidisciplinary alliances with practitioners from the wider health related disciplines (nursing, pharmacy and clinical medicine) and with researchers from psychology, engineering, management sciences and law and ethics. This is particularly important in the field of patient safety research because of the complex interaction between human factors, organisations and technology in the genesis of critical incidents in health care Understanding and implementing solutions related to patient safety requires significant input from all these disciplines. We have also developed important international collaborations. We are an important part of an international collaboration the LINNEAUS Collaboration. The LINNEAUS Collaboration received major funding from the European Union from 2008-2013 to develop a patient safety network in the EU.
Plans for Further Research
We have identified short term and long term priorities for work in the area of patient safety.
If you would like further information or wish to collaborate or study in this area, contact me.