Developing, testing and implementing the NSPCR Patient Safety Toolkit in general practices in England

• To produce an operational definition of safe general practice;

• To identify tools for assessing the safety of general practices and obtain consensus on their use in the Patient Safety Toolkit;

• To test these tools in a sample of general practices;

• To investigate the implementation of the Toolkit.

Brief overview of the project

Stage 1 (Developing the Patient Safety Toolkit) will involve:

a) Undertaking two focused systematic literature reviews to identify:

    i) Tools, and associated outcome measures, used to assess aspects of patient safety in general practices;

    ii) Qualitative studies on the experience of patients and/or health professionals of patient safety in general practice.

b) Conducting a survey of international general practice organisations to identify any additional tools for assessing patient safety;

c) Conducting interviews with UK and international experts to explore the attributes of safe general practice;

d) Creating a conceptual framework of the key attributes of safe general practice;

e) Obtaining consensus on the attributes of safe general practice that need to be covered by the Patient Safety Toolkit;

f) Developing new methods for extracting data from GP computer systems for prescribing safety indicators;

g) Developing Patient Reported Outcome Measures to assess patient safety in general practices;

h) Selecting a set of tools for testing in a sample of general practices.

Stage 2 (Testing the elements of the Toolkit):

A combination of qualitative and quantitative techniques will be used (in a sample of 30 general practices) to test the particular attributes (acceptability, technical feasibility, reliability, and validity) of the different elements of the Patient Safety Toolkit. The final set of tools will be selected based on their performance and coverage of key safety issues.

Stage 3 (Implementing the complete Patient Safety Toolkit):

This Stage will involve a combination of qualitative and quantitative techniques (in a sample of 60 general practices, including the 30 from Stage 2) to:

a) Obtain feedback from practices on implementation issues;

b) Describe variations in patient safety between general practices;

c) Identify and (where possible) estimate the potential costs and benefits of implementing the Patient Safety Toolkit;

d) Identify potential predictors of patient safety;

e) Obtain data for future sample size calculations.

We shall then consider the best approach to making an application for a NIHR Programme Grant to develop and test an intervention aimed at improving patient safety based on the use of the Patient Safety Toolkit.