Risks to patients in primary care need to be scrutinised

The extent of the risk to patient safety in primary care is unknown and badly in need of more scrutiny, MPs have heard.

Although patient safety has been on the hospital agenda for several years it is not clear to what extent it is embedded in NHS primary care services, expert witnesses told MPs on the parliamentary health select committee as part of its inquiry into patient safety.

Aneez Esmail, professor of general practice at the University of Manchester, who has led research in this area, gave evidence to the committee, which asked him about safety culture in the NHS.

“In terms of patient safety, it’s something that has been left off the agenda in primary care. The work hasn’t been done like it has in the secondary care sector,” said Professor Esmail.

“We understand how big a problem it is, but we haven’t concentrated on it enough, and we don’t have very good means of measuring or identifying specifics or putting numbers on it. My research work shows there is willingness to do things about it, but our knowledge base is very limited and restricted.”

MPs asked whether the witnesses thought that there was awareness that patient safety in primary care was a problem.

Professor Esmail replied, “All the big agencies, such as the National Patient Safety Agency, are beginning to understand that there is a whole amount of work to be done in primary care and are beginning to focus their attention on it. Research money is becoming available to work in this area.”

MPs asked whether progress had been made since the Department of Health’s report An Organisation with a Memory was published in 2000, which looked at adverse events in the NHS and started a drive to improve patient safety (BMJ 2000;320:1692, doi:10.1136/bmj.320.7251.1692/g).

Alison Holmes, director of infection prevention and control at Imperial College Healthcare NHS Trust, London, also giving evidence, said, “Progress has been made. The stage was set for us to make these changes and develop an organisational model.

“The local organisation model is about embedding infection prevention and control within the very fabric of the organisation. The model we have developed and worked on has had a significant impact.”

MPs asked about the overuse of antibiotics and whether this happened in most hospitals.

Dr Holmes said, “There is collateral damage with antibiotics—they can cause side effects. We need to understand our patterns of antibiotic prescribing to get a handle on it and establish the relation with Clostridium difficile.

“That level of understanding would really help us in targeting and choosing what best antibiotics to use. Antibiotics are valuable, and we must use them immediately when we need them, but we must use them incredibly carefully.”

Fellow witness Matt Griffiths, visiting professor of prescribing and drugs management at the University of Northampton, said, “I think patient safety is taken extremely seriously in the NHS, but there are so many facets to it.

“Sometimes practitioners can get swamped by the amount of messages coming to them from different directorates saying you must do this or that.”

The inquiry continues.