On 26 September 2024, NHS England published its Primary care patient safety strategy, which describes the national and local commitments to improve patient safety in primary care. The document builds on cutting-edge research, including a 2020 study conducted by our team at the NIHR Greater Manchester Patient Safety Translational Research Centre (now the NIHR Greater Manchester Patient Safety Research Collaboration).

At the core of this strategy is our paper, ‘Incidence, Nature, and Causes of Avoidable Significant Harm in Primary Care in England: A Retrospective Case Note Review’. This research provided key insights on incidence of avoidable significant harm in primary care in England, as well as suggestions to mitigate risks and patient safety incidents.

The researchers found that “there is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms, followed by medication error and delays in making a referral once a referral decision had been made” (Avery et al, 2020). Furthermore, they suggested that improvements could be achieved by more efficient use of current information technology, better coordination and communication within teams, and stronger continuity of care both in terms of patient relationships and information sharing.

NHS Primary Care Patient Safety Strategy

Summary

Primary care – general practice, community pharmacy, optometry and dental services – delivers 90% of NHS interactions, face to face, by phone or online. The overwhelming majority of these are safe, but with between 20,000 and 30,000 incidents of avoidable significant harm identified in general practice in England per year, there is opportunity to continue to improve the safety of care in primary care. The NHS Primary care patient safety strategy describes the national and local commitments to improve patient safety in primary care, supporting all areas in this sector to fully implement the NHS Patient Safety Strategy.

The strategy focuses on:

1. developing a supportive, learning environment and just culture in primary care, with sharing across the system so that the services can continually improve
2. ensuring that the safety and wellbeing of patients and staff is central, and that our approach to managing safety is systematic and based on safety science and systems thinking
3. involving patients in the identification and co-design of primary care patient safety ambitions, opportunities and improvements

Given the capacity pressures in primary care and ICBs, this strategy seeks to continuously improve patient safety through existing processes and structures as much as possible, rather than adding work. The timeframes for the implementation of the local commitments are intentionally flexible to allow for the piloting of different approaches, and while this strategy is for all areas of primary care, some improvements will be implemented first in general practice and the successes and learning then used in the rollout to community pharmacy, optometry and dental services.

In summary:

• safety culture: participate in the NHS staff survey
• safety systems: complete patient safety syllabus training
• insight: register for and use the new incident recording (LFPSE) and incident response (PSIRF) systems
• involvement: identify patient safety leads and lay patient safety partners
• improvement: review and test patient safety improvements in diagnosis, medication, referrals, optometry and dental services

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