Conclusions and recommendations
1. PCTs do not routinely include outcome measures
for quality and safety in their commissioning arrangements. In
developing its guidance for PCT commissioning, the Department
should include the need for PCTs to include clear outcome measures
on quality and safety in their contracts so that the performance
of healthcare providers can be monitored and evaluated.
2. One of the areas particularly associated
with improving quality and safety was effective clinical leadership,
yet members of PCTs' Professional and Executive Committees often
lacked effective leadership skills. PCTs
should put training and development programmes in place which
focus on developing leadership skills for those responsible for
managing the commissioning and provision of services. Priorities
should be given to developing skills in:
(i) Management and leadership skills for the
Professional Executive Committee members, so that these Committees
can play a strategic role in embedding quality and safety in the
PCT Board agenda in relation to commissioning and provision of
services;
(ii) Joint working methods, to improve interaction
between health and social care and also with voluntary and other
local agencies,
(iii) Patient and public engagement, which focus
on involving service users more actively in service design and
development across primary care.
3. Not all GPs understand the concept of clinical
governance and how it relates to their day to day work. PCTs
need to use the opportunity presented by the new commissioning
arrangements to communicate more effectively with their independent
contractors on the importance of clinical governance systems and
processes, and how the various components contribute to maintaining
the quality and safety of healthcare provision.
4. Patient and public involvement is less
well developed than other aspects of clinical governance. PCTs
need to have a clear strategy for consulting patients and the
public on service design and delivery. Where PCTs obtain
the views of patients and the public they need to show how they
have acted on these views, including how these views have impacted
on their commissioning decisions.
5. Of the 14 voluntary groups surveyed by
the National Audit Office, all felt that PCTs could engage more
effectively with their client groups.
PCTs should identify where they can achieve efficiency
gains and more consistent support to patients and their carers
from closer joint working with voluntary groups, including joint
provision of information to healthcare providers about support
available to patients. They should routinely consult patient organisations
and carer groups to capture and learn from their experiences and
identify areas for improvement.
6. Patients in primary care are often unclear
about how to complain or how their complaints will be dealt with,
whilst staff are not always informed of the outcome.
PCTs need to work with their Patient Advice and Liaison Service
and other local patient advocacy groups to develop and put in
place an effective complaint handling process. They should communicate
the processes to staff, independent contractors, patients and
carers; including what to expect in terms of timely feedback on
the outcome of complaint handling. PCTs should also implement
strategies for communicating effectively with patients and carer
groups who may be unable to frame their complaint or present it
effectively because of cultural, language or literacy issues.
7. Only 4% of GPs report untoward events and
clinical incidents to the National Patient Safety Agency's National
Reporting and Learning System resulting in limited sharing of
learning either locally or nationally. PCTs
should include in their contracts a requirement that all providers
have an active incident reporting system that links to the national
reporting system. PCTs should undertake regular audits, including
cross referencing to complaints, to ensure that incidents and
untoward events are being captured, and also benchmark performance
to help identify under-reporting, whether by types of staff or
by types of incidents. PCTs should require reports on the root
causes of serious or recurring incidents and draw out themes so
that solutions and risk reduction strategies can be developed.
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