1.   Scottish Patient Safety Programme in Primary Care (SPSP – PC) Implementation & Spread Strategy 2013–2018

2. The Who, What and How?
Outline key elements of the SPSP – PC Implementation and Spread strategy, including:
Focus
Programme Aims
What are we spreading?
Rate of spread
Methodology
Infrastructure:
Contractual Levers
NHS Boards
Questions and Feedback 2

3. Focus Stage 1 General Medical Services Programme launch March 2013
Pharmacy and Nursing
Proto-typing and testing from autumn 2012
Stage 3
Dentistry
Exploratory work from autumn 2012
Stage 4
Optometry
Exploratory work from summer
Similar implementation and spread plans will require to be drawn up for the remaining stages (2–4) covering pharmacy and nursing, dentistry and optometry work streams when high risk areas have been identified and testing work undertaken 3

4. Programme Aims
To reduce the number of events which could cause avoidable harm to people from healthcare delivered in any primary care setting.
All NHS territorial boards and 95% of primary care clinical teams will be developing their safety culture and achieving reliability in 3 high-risk areas by 2018.

5. What are we spreading? 3 Workstreams: Safety Culture and Leadership
Safer Medicines
Safe and reliable patient care within practice and across the interface

6. Safety Culture and Leadership
Aim:  To develop a safety culture that engages with patients to support the delivery of safe and reliable care in primary care teams.
Increase awareness of safety issues within practice, through practice teams undertaking Safety Climate Survey’s.
Practices identify, reduce and learn from adverse events identified through trigger tool, SEA’s and adverse event reporting.
Safety walkrounds to ensure Safety in Primary Care is embedded within the NHS Board safety agenda.

7. Safer Medicines
Aim: To Provide Safe and Effective Medicines Management in Primary Care
Implement systems for reliable prescribing and monitoring of warfarin, methotrexate and azathioprine.
Practices have safe and reliable systems for medicines reconciliation following discharge.
Implement systems for safe and reliable insulin administration.
Implement systems to support reliable prescribing and monitoring of high risk medications in community pharmacy.
Use existing electronic data to support targeted application of clinical judgment to reduce high risk prescribing.

8. Safe and reliable patient care within practice and across the interface
Aim: To provide safe and reliable patient care across the interface and at home.
GP practices have safe and reliable systems for handling written communication received from external sources
Health Boards and GP practices have safe and reliable results handling systems
Reduce harm from pressure ulcers
Reduce harm from falls
Reduce incidence of catheter-associated urinary tract infection

9. Measurement Framework
Process measures
7 agreed sets of process measures which are outlined in the change packages.
Outcome measures
2013
% INRs: < 1.5 and >5
Laboratory use
2014
Admission rates for patients on specific drugs?
Co -Prescribing rates.
Overall measurement
Collecting and aggregating data at NHS board level:
NHS Lothian

10. Rate of Spread:
Not all at once
Menu
Build over time
Practices and boards prioritise

11. Methodology – collaborative within a collaborative
Each NHS Board will deliver collaborative learning events and participate in a national collaborative and attend national learning events.
National Learning Sessions
NHS Board Learning Sessions
Collaborative Interactive Workshops (Awareness raising) Oct–Dec 2012
Learning Session 1 & Formal launch (2 days) by Cabinet Secretary – mid Mar 2013
Local Learning Session (1 day) May 2013
Learning Session 2 (1 day) Sep–early Nov 2013
Local Learning Session (1/2 day) Nov 2013
Learning Session 4 (1 day) Apr 2014
Local Learning Session (1 day) May 2014

13. Successful implementation needs . . .
Commitment of Boards, HIS and SGHD
Build on the professionalism of front line staff
Prioritised within existing and adapted contracts
Alignment with GP Appraisal and Revalidation

14. SGHD and HIS
Health Boards
GP Practices

15. Healthcare Improvement Scotland will provide:
National Leadership and Influence
Tools
Guidance
National collaborative
Expertise
Support

16. Boards need to provide …
Executive buy in and championing
To Prioritise this programme
Dedicated programme management, clinical leadership and QI support to:
Run the collaborative
Build knowledge and skills
Support practices

17. What’s in it for boards? Fewer adverse events Fewer Admissions
Safe effective prescribing
Fewer Falls/ UTIs/Pressure ulcers
Improved Interface working – SPSP
Engagement with Primary care

18. Adverse events in primary care in NHS Scotland cause:
39,000 Admissions pa
21,000 pa admissions are drug side effect related
14,000 pa preventable
6,500 from Warfarin, NSAIDS, Diuretic, Anti-platelets alone
Based on 327,000 acute medical emergency admissions 2010/11 - ISD
Howard et al Br J pharmacology 2006
Howard et al qshc 2003

19. Innovation Adoption Curve
This is best highlighted in Roger’s Innovation Adoption Curve,
There is no point in trying to get clinician by-in from the masses. Convince the innovators and early adopters and optimise them. . 19

20. What’s in it for Clinicians
Doing the best for your patients Working better as a team More confidence in your systems Less things going wrong Less stress More Efficient Better Interface working

23. Revalidation Safety core to revalidation and GMC guidance
Bundles, Trigger Tool and Climate Survey
evidence for GP appraisal

24. Enhanced Service - 5 years
To support Improvement in key areas of the programme
Attending Collaborative Learning Event
Data collection and improvement 1 high risk process per annum
Trigger Tool Review (25 records biannually)
Safety Climate Survey annually
Safety as Core in Scottish Focussed Contract

25. Alignment Productive General Practice
Medical Defence organisations – MDDUS
GP training
Prescribing initiatives

26. Frustrations/celebrations
PGP Tools
Getting Started
Creating the team
Raising awareness
Engage Team
Attend Collaborative
PGP Tools
Using Data
Process mapping
Frustrations/celebrations
Process reliability
PDSA
Collect Warfarin
Data
Care Unreliable

27. And for Patients…
Better Informed Better Understanding More in control of health Actively engaged in improving services More confident in systems More reliable care Less chance of being harmed/ admitted Better QOL

31. Why wouldn’t we?

32. Discussion What challenges do you anticipate?
What benefits do you see?
How does this align with:
Current board objectives and activities?
Questions?