Greater Manchester Primary Care Patient Safety Translational Research Centre
Annual Report 2013 - 2014
Primary Care is health care provided in the community for people making an initial approach to a medical practitioner or clinic for advice or treatment.
Patient Safety
is the prevention of errors and adverse effects to patients associated with health care.
Contents
Introduction to the NIHR Greater Manchester PSTRC
2
Core Aims
3
Research Themes
4
Medication Safety
5-6
Case study: RCGP eLearning Prescribing Module
7
Multimorbidity
8
General Practice
9
Interface and Informatics
10
Governance
11
Patient and Public Involvement
12
Case study: Formation of the Research User Group
13
Public Engagement
14
Research Capacity Building
15
Industry Links
16-17
18
Links to Other Organisations
Communications
19
Finance and Grant Income
20
Looking to the Future
20
Introduction Welcome to the National Institute for Health Research (NIHR) Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC) annual report for 2013-2014. Greater Manchester PSTRC is funded through the NIHR for five years (£6,291,208 from August 2012). It is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust with an ongoing collaboration with the University of Nottingham on its Medication Safety theme. Eighty five percent of contacts with the NHS take place in general practices, pharmacies or dental practices: there are 340 million general practice appointments a year, over one billion prescription items dispensed each year and 1.6 million people visit a pharmacy daily, of whom 1.2 million for health reasons. Current estimates suggest that nearly two percent of all GP consultations result in a patient safety incident – some of which can cause serious harm to a patient. Despite the scale of the problem, patient safety in primary care is under-researched compared to research in hospital settings. Understanding the issues around patient safety in primary care is still limited and our Centre has been set up to help address that deficit. We have developed four research themes which cover a range of the main priority areas where further research will help improve patient safety in primary care:
Prof Stephen Campbell Principal Investigator
• Medication Safety • Multimorbidity • General Practice • Interface and Informatics Patient and public involvement and engagement is a central part of our work. In this report we have highlighted the range of our activities in this area, illustrating ways in which we have engaged and involved patients, carers and the public as partners. We are also collaborating with the Greater Manchester Clinical Commissioning Groups, Greater Manchester Academic Health Science Network (AHSN), general practices and pharmacies as we seek to improve safety in primary care.
Prof Aneez Esmail Director
2
Core Aims To develop evidence-based approaches to keep patients safe in their interactions with primary care To develop capacity in primary care patient safety research To develop and test educational interventions aimed at both patients and practitioners to improve patient safety
3
3
Research Themes
Primary care has many components; whilst work within the Greater Manchester PSTRC focuses solely on GP surgeries and community pharmacy, we recognise that primary care as a whole encompasses additional aspects of healthcare, such as dental surgeries, optometrists and other non-acute community services.
Medication Safety
Problems with medicines including prescribing, dispensing and taking are the biggest area of concern and potential cause of harm in primary care. Prescribing errors are thought to occur in nearly 1 in 20 prescriptions in primary care. In this theme we are developing ways to reduce these errors by providing better information to patients and healthcare professionals, particularly during the prescribing of medicines.
4
Multimorbidity People now live longer and are more likely to have more than one long term medical condition. This is known as multimorbidity. More medical conditions usually means more drugs, which need to be prescribed and taken appropriately. Because of the complexity of managing the medical conditions of people with multimorbidities, the likelihood of things going wrong is increased. Our research aims to identify how we can help patients reduce the risk of harm in these situations.
General Practice
Problems such as delayed and missed diagnoses can have a significant impact on a patient. Our research aims to increase our understanding, to provide better support to general practitioners (GPs) and patients. This will increase GP and patient awareness of how and why things can go wrong and increased awareness will allow patients to better manage their self-care.
Interface and Informatics
The appropriate use of clinical information held in electronic patient records can improve the care of patients. We are developing a platform which will reference medication prescribing indicators against electronic patient records, to identify patients who may be at risk of a prescribing error.
Medication Safety Much of the work within the theme focuses on how patients, pharmacists and GPs currently interact. This information will be used to identify how to have a positive impact on the medicines use process, and thereby reduce the number of errors.
Theme Lead Prof Darren Ashcroft
Nottingham Lead Prof Tony Avery
Highlights Developing a medication Safety Management System (SMS) including • identifying indicators that highlight prescribing error • developing and piloting methods to extract data from GP computer systems • gaining understanding of potential issues and barriers in the transfer of patients from primary to secondary care.
Developed an e-learning module for RCGP on prescribing in general practice
The Medication Safety theme is based at the Universities of Manchester and Nottingham. The overall aim of this theme is to develop a medication Safety Management System (SMS) covering key stages of the medicines’ use process (including the prescribing, dispensing and taking of medicines).
Previous work resulted in the development of a set of indicators to highlight prescribing errors. These indicators are based on the current health status of the patient and on the medication they have been prescribed. For instance, patients with specific conditions should not be prescribed certain drugs as if they were, this could potentially cause them harm. This study was called Pharmacist-led INformation technology intervention for reducing Clinically important ERrors in medication management (PINCER) and was led by Prof Tony Avery at The University of Nottingham. Work within the medication safety theme has built upon this previous study, increasing the number of indicators into an expanded list called PINCER+. Work is now ongoing to develop and pilot methods for extracting data from general practice computer systems to test how the indicators might be used and integrated in ‘real world’ settings, such as GP practices. Alongside the development of the medication safety indicators for the SMS, the theme has also developed an e-learning module on ‘Prescribing in General Practice’ for the RCGP. This is described more fully in our impact case study. The theme has also been specifically investigating issues around medicines management for patients with acute kidney injury as they transfer from secondary to primary care. Interfaces between different organisations can cause barriers to the timely and accurate flow of information. For patients moving between hospital (secondary care) and back home under the care of their GP (primary care), the flow of accurate information on their health status and medicines as they move through the healthcare system is critical. The theme is interested in understanding potential issues and barriers as a patient is transferred across this organisational interface. In understanding this process better, the aim will then be to develop ways in which these issues might be overcome, thereby keeping patients safe as they move within the healthcare system. Alongside developing interventions that may be used by healthcare professionals, the theme has explored patient experiences of issues with managing medication and their interactions with the primary care system. In seeking patients views the theme aims to identify key areas where potential interventions around medication safety could help keep patients safe. 5
Publications and Presentation
6
Authors
Title
Published in
Phipps DL, Tam WV, Ashcroft DM
Integrating Data From the UK National Reporting and Learning System with Work Domain Analysis to Understand Patient Safety Incidents in Community Pharmacy
J Patient Saf. 2014; Feb 27
Cresswell K, Howe A, Steven A, Smith P, Ashcroft D et al.
Patient Safety in Healthcare Preregistration Educational Curricula
BMJ Qual Saf 2013; 22: 843-854
Keers RN, Williams SD, Cooke J, Ashcroft DM
Causes of Medication Administration Errors in Hospitals
Drug Saf 2013, 36: 10451067
Presenters
Conference
Date
Dr Phipps, Prof Ashcroft, Dr Parker
Resilient Health Care Net Annual Meeting
August 2013
Case study RCGP e-learning module on prescribing A study by the General Medical Council found that prescribing errors in general practices occur in around 1 in 20 prescriptions and that many factors increase the risk of error. One of the recommendations from the report was to produce educational materials to help enhance the knowledge and skills of GPs in relation to safe prescribing. Based on the findings of the study, the Safer Prescribing e-learning course (http://www. rcgp.org.uk/) was developed. The five lessons contained within the course aim to raise awareness of GPs for potential prescribing errors, to equip them with good prescribing habits and to help them lower their personal risk of making prescribing errors. The course is particularly useful for GPs in training and those in the first five years post qualification. The e-learning package was launched nationally on the RCGP e-learning platform in February 2014. Participants have to complete pre- and post- course assessment
questions based on the material covered in the e-learning package. Comparisons are planned between preand post- course assessment scores. Participants are also asked to complete an online evaluation form, and are invited to take part in a telephone interview one to three months following their completion of the online learning course. Preliminary findings for the first six weeks of use were very encouraging. The site was accessed by more than 1200 individual users, and more than 150 users left responses to a detailed feedback questionnaire.
Impact Ninety eight to ninety nine percent of respondents agreed that their knowledge of prescribing was increased, that the e-learning module had a positive impact on their attitude to the importance of developing safer strategies for prescribing and that the exercise had been a useful part of their continuing professional development. Screenshot from the RCGP e-learning module on prescribing
7
Multimorbidity Multimorbidity – having two or more long-term conditions at the same time – is increasingly common and makes up a significant proportion of the healthcare provision in primary care. However, currently much of the service delivery and quality improvement schemes within healthcare are focused around single conditions. Theme Lead Prof Peter Bower Highlights MAXIMUM
• Observing and interviewing patients, GPs and care providers over an 18-24 month study.
Reviews of current literature on multimorbidity
The multimorbidity theme aims to help address this by better understanding the most prevalent safety issues faced by patients with multimorbidities, and to develop interventions which reduce their vulnerability to safety failures. As a platform to identify potential interventions, the theme has started a study observing and interviewing patients with multimorbidities, GPs and other care providers over approximately 18-24 months. This study, MAXimising Involvement in MUltiMorbidity (MAXIMUM), aims to provide insights into the interactions patients have with the primary healthcare system. Alongside the MAXIMUM study, several reviews of previously published research are underway, investigating: • the relationship between safety and multimorbidity in primary care • a meta-synthesis (summary) of qualitative studies of patient safety in primary care • a meta-synthesis of qualitative studies of people’s experiences of multimorbidity.
Presentations
8
Presenters
Presentation title
Presented at
Hays R, DakerWhite G, Bower P
Patient Safety in Primary Care: Exploring Risks and Opportunities for Involvement for Patients with Physical and Mental Health Problems
Primary Care Mental Health Conference 2014
Bower P, Campbell S
NIHR Greater Manchester Primary Care Patient Safety Research Centre
NIHR School for Primary Care Research Showcase, London, 2013
General Practice With the vast majority of NHS contact taking place in general practice surgeries, it is essential to increase the amount of research into patient safety in this area. Within the theme a number of projects are ongoing looking at various aspects of patient safety as patients interact with their GPs.
Theme Lead Prof Stephen Campbell Highlights Isabel
• testing a differential diagnosis tool through a small pilot scheme.
‘Never Events’
• refining a list of ‘Never Events’ for primary care in GP surgeries.
Preventing misdiagnosis is one area that has been researched over a number of years and interventions such as differential diagnosis tools (software that provides potential diagnoses based on patient symptoms) have been generated to help guide doctors. A significant number of studies have already been undertaken that have assessed how these tools can be used and the impact (or not) on the decisions taken by doctors when diagnosing a patient’s condition. The theme is gathering evidence to assess how well such differential diagnosis tools are able to accurately determine the diagnosis for a particular patient. This assessment will link with a small pilot project planned to assess one such differential diagnosis tool known as Isabel. One concept that has been developed within the hospital (secondary care) setting is the idea of a ‘Never Event’. A ‘Never Event’ has been described as “a serious, largely preventable patient safety incident that would not occur if the available preventative measures had been implemented”. Whilst this concept has worked well for hospital treatment, the idea has not yet been adopted within the primary care setting. Initial work undertaken by NHS Education for Scotland developed a preliminary list of potential ‘Never Events’ applicable to primary care. The theme is working with NHS Education for Scotland to help refine the list of ‘Never Events’ and to test the concept of ‘Never Events’ in a primary care setting with GPs..
Presentation & Publication Presenter
Presentation title
Presented at
Prof Stephen Campbell
NIHR Greater Manchester PSTRC: Improving Primary Care Through Research
NHS England Greater Manchester 2nd Primary Care Commissioning Summit, Sept 2013
Authors
Publication title
Published in
Bell B, Spencer R, Avery A, Gookey G, Campbell SM
Identification of an Updated Set of Prescribing Safety Indicators for General Practitioners
British Journal of General Practice, April 2014
9
Interface and Informatics The appropriate use of clinical data which is held in electronic patient records, and also the development of effective and timely ways of sharing data between GPs and hospitals, is essential to reduce the risk of potential harm to patients in the interface between primary and secondary care. Theme Lead Prof Iain Buchan
Highlights Development of an alerting system to reduce patient safety incidents, through:
• validating PINCER+ prescribing indicators • creating software to cross-reference indicators against electronic patient records.
Assessing the development of ‘Never Events’ based tools
The theme is also working closely with the General Practice theme to assess the development of ‘Never Events’ based tools that may also be incorporated into a patient safety alerting system. This will be based on the outcomes of the ‘Never Events’ project (described in General Practice theme). In addition to these activities, to maximise impact, the Interface and Informatics theme is collaborating closely with the Medical Research Council (MRC)-funded Health e-Research Centre (www.herc.ac.uk) and in particular on themes such as Missed Opportunity Detection (MOD), and Co-producing Observations with Patients (CoOp). The theme is also linking into The Farr Institute (www.farrinstitute.org).
Collaborating with other key organisations
Publications
10
The primary aim of the theme is to develop an alerting system that reduces the potential for patient safety incidents. The outputs from a number of projects from themes across the Greater Manchester PSTRC will be used to develop the patient safety alerting system. In conjunction with the Medication Safety theme, Interface and Informatics have provided expertise in validating the prescribing indicators (PINCER+). Following on from this, the theme is creating a piece of software that will crossreference these validated prescribing indicators against electronic patient records, identifying patients who may be at risk of a prescribing error.
Authors
Publication title
Published in
Fraccaro, Ainsworth, Buchan
Adoption of Clinical Decision Support Journal of Medical Internet Research in Multimorbidity: A Systematic Review
Williams R, Prosperi, Buchan, Ainsworth
Using String Metrics to Identify Patient Journeys through Care Pathways
AMIA Conference 2014
Brown, Williams, Ainsworth, Buchan
Missed Opportunities Mapping: Computable Healthcare Quality Improvement
Studies in Health Technology and Informatics, 2013
Governance The Greater Manchester PSTRC Principal Investigator and Director, in conjunction with the Research Theme Leads, Research User Group and the governance boards below, shape the strategy and overall direction of the Centre. Executive Management Board An Executive Management Board was set up to oversee the Greater Manchester PSTRC and to hold the Centre’s leadership to account for its management and performance. The Board met twice during the 2013-14 financial year, with meetings chaired by Dr Mike Burrows and vice-chaired by Sir David Dalton. Dr Mike Burrows Sir David Dalton Dr Ivan Benett Simon Denegri Ailsa Donnelly Ian Moston Dr Hamish Stedman Dr Anne Talbot Prof Paul Townsend
Area Director NHS Commissioning Board– Greater Manchester Chief Executive, Salford Royal NHS Foundation Trust Clinical Director of Central Manchester Shadow Clinical Commissioning Board and GP with specialist interest in Cardiology Chair, INVOLVE; NIHR National Director for Public Participation and Engagement in Research Chair, Research User Group (RUG) Director of Finance, Salford Royal NHS Foundation Trust Chair, Salford Clinical Commissioning Group (CCG) Clinical Director and GP, Bolton Community Practice CIC/Associate Medical Director Service Transformation Greater Manchester Associate Dean for Business Engagement and Professor, University of Manchester
A series of Key Performance Indicators (KPIs) have been established to help the Executive Management Board to monitor the work of the Centre. These include: • KPIs relevant to delivery of the contract as agreed with NIHR, including such areas as governance, finance, Patient and Public Involvement and staffing • KPIs relevant to academic standards, such as published papers, conferences and grants • KPIs relevant to impact, focussing on service delivery, health and patient and/or professional behaviour.
Strategic Advisory Group An international Strategic Advisory Group was established to advise the Greater Manchester PSTRC leadership on the forward direction of the Centre; it meets twice yearly. Prof Bryony Dean Franklin Prof Mike Kelly Dr Itziar Larizgoitia Dr Katherine Murphy Prof Richard Roberts Prof Aziz Sheikh Dr Sarah Yardley Prof Dr Cordula Wagner
NIHR Imperial PSTRC National Institute for Health and Care Excellence (NICE) World Health Organisation (WHO) Chief Executive, The Patients Association Family Physician and Professor, University of Wisconsin Professor of Primary Care Research, Co-Director Centre for Population Health Services, University of Edinburgh NIHR Academic Clinical Lecturer in Medical Education, Keele University and Specialist Registrar in Palliative Medicine, West Midlands Professor of Patient Safety, VU University Medical Center, Programme Manager, Netherlands Institute of Health Services Research (NIVEL), Head of Research Center Safety 4 Patients at NIVEL/VUmc 11
Patient and Public Involvement PPI Lead Prof Stephen Campbell
The Greater Manchester PSTRC works to the INVOLVE definition of patient and public involvement (PPI), which is: “Research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them.” The importance of patient and public involvement has now been fully recognised within healthcare research, with active involvement of patients, carers and members of the public leading to better research and clearer outcomes. The Greater Manchester PSTRC is committed to ensuring that opinions of, and advice from, patients and members of the public are sought, considered and appropriately actioned within the work of the Centre. Key Methods The following key methods are being used to monitor the effectiveness of, and to identify ways to improve, PPI within the Centre: • an evaluation of the collaboration between the PPI group, the Core RUG and PSTRC research staff, is taking place, led by an external PPI researcher. This includes PPI evaluation work within the PSTRC, such as an evaluation of RUG members’ roles and perceptions of impact • a PPI Evaluation Advisory Group (PEAG) was
created, consisting of researchers and RUG members, to advise on the external PPI evaluation • Feedback forms have been created to allow members of the Research User Group and PSTRC researchers to feed back on PPI activity within each of the Centre’s themes. Strategic Links Strategic links have been established with the following organisations and groups, to offer advice, conduct work on the Centre’s behalf and feed in to the PSTRC’s PPI strategy: • the Patients’ Association were commissioned to identify and report on patients’ perceptions and experiences of patient safety in primary care • North West People in Research Forum and Nowgen promote the work of the PSTRC to members of the public, as well as helping to organise public engagement events • the NIHR-funded School for Primary Care Research’s PPI group, Primary Care Research in Manchester Engagement Resource (PRIMER), and the Health e-Research Centre (HeRC) collaborate with the PSTRC’s RUG to ensure best practice. Research User Group involvement Research User Group members have been involved in a number of projects and activities during the second year of the Greater Manchester PSTRC, including: • being co-applicants, commenting on and reducing jargon in ethics applications • being involved in the development and approval of theme level publicity materials • being partners in the Never Events public engagement event in March 2014 • being involved in systematic literature reviews, including a qualitative synthesis on contributory factors to patient safety in primary care • making suggestions for cross-theme research projects. Training for members of the RUG has been provided to enable full involvement in the work of the Centre. Starling et al (Nowgen, Central Manchester NHS Foundation Trust and the Faculty of Medical and Human Sciences at The University of Manchester) produced a diagram (see left), based on a similar model by the Wellcome Trust, showing the spectrum of patient and public involvement and engagement activities. The Greater Manchester PSTRC is beginning to focus on populating each of the six layers of involvement activity.
12
Case study
Formation of the Research User Group In its first year, the Greater Manchester PSTRC created a Core Research User Group (RUG), which consists of 12 members; 10 of whom were recruited from the general public following an open application process, and two who were seconded from pre-existing patient and public involvement (PPI) groups in the North West of England, to enable the exchange of ideas and sharing of good practice. Each member of the Core RUG is affiliated to a research theme and attends regular meetings with staff working within the themes, becoming involved in projects, offering their opinions and advice, and ensuring a patient perspective is considered in the work that takes place. The second year of the Centre focused on strengthening the foundation of the Research User Group, aiming to incorporate PPI in every aspect of the PSTRC’s activity. This has involved regular meetings of the Core RUG, encouraging positive relationships to develop between members, creating communication channels between RUG members and Greater Manchester PSTRC researchers, and presenting a structure which others can emulate.
As well as the Core Research User Group, the Centre’s PPI structure also includes Associate RUG members, who will be involved in work at individual project level within themes. In addition, Friends of the Greater Manchester PSTRC also receive the quarterly newsletter. This broad, deep PPI infrastructure consolidates relationships between the RUG and other PPI organisations, which allows a wide and diverse range of patient perspectives to be heard. Linking in to local networks also enables joint learning and training of researchers and RUG members, encouraging trust and harmonious working. PPI in future years will build on this solid grounding and framework.
Photo courtesy of the NHS
13
Public Engagement Public engagement is increasingly recognised as essential in conducting worthwhile and successful research. The Wellcome Trust published a paper following their International Public Engagement Workshop in 2012, entitled “Engaging with Impact: How do we know if we have made a difference?” In this paper, Clare Matterson, Director of Medical Humanities and Engagement, states: “Many scientists are committed to engaging the public with their work for multiple reasons: to inspire, to educate, to inform, to involve. Whether a funder, researcher or participant in public engagement, we all want to believe that it has had an impact and is worth doing... Engagement…includes diverse activities and interactions between different groups. As researchers, engagement practitioners [and] communicators…engagement is about the exchange of ideas, opinions and practice between research and communities, the public and policy makers.”
Public Engagement events: In March 2014, the Centre’s first public event, arranged in conjunction with Nowgen, took place, with the session focusing on Never Events. A range of people attended, with members of the public and clinical and academic professionals sharing their opinions on patient safety and Never Events. Afterwards, all written input was analysed and considered by researchers within the Centre. Following the success of the first event, the Centre is looking at holding further public engagement sessions, with the second event planned for October 2014 as part of the Manchester Science Festival.
Acknowledging the importance of engaging patients, members of the public, healthcare professionals and wider stakeholders with its work, the Greater Manchester PSTRC utilises a variety of ways to encourage interest, involvement and action. NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre
Public Event: Exploring Patient Safety Thursday 27 March 2014, 4 – 6pm Kanaris Theatre, Manchester Museum, M13 9PL
Have Your Say… What should never happen at your GP surgery? Patient safety is a top priority in the NHS. We want to hear your views about this important topic and explore what can be done to prevent harm in primary care (for example in GP surgeries). This event will explain what the ‘NIHR Greater Manchester Primary Care Patient Safety Centre’ is working on and ask for your input into our research and future plans. Everyone is welcome to our event. No background knowledge or expertise is required. We look forward to hearing your views. Limited places, so booking advised: http://gm-pstrc.eventbrite.co.uk Free event. Refreshments served from 3.30pm. More information: www.gmpstrc.nihr.ac.uk or call 0161 275 7642 The NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre is funded by the National Institute for Health Research (NIHR) and is a partnership between the University of Manchester and Salford Royal NHS Foundation Trust.
Flyer from the Greater Manchester PSTRC’s first public engagement event
14
Using the definition of public engagement as [ways in which] information and knowledge about research is provided and disseminated, other methods of engagement include: • producing information sheets and leaflets written for non-specialists • attendance at local open days e.g. Salford Royal Open Day, which allows direct dialogue between Centre representatives and members of the public • production of a quarterly newsletter, which is sent to around 400 subscribers • jargon-free blog posts written by members of the Core Research User Group, Centre researchers and students • Twitter account used to disseminate information on events and Centre activity • webpage with updates on events and PPI recruitment opportunities • current members of the public who sit on the Research User Group, link with other interested groups within their wider networks.
Research Capacity Building Research capacity building in primary care patient safety is the second core aim of the Greater Manchester PSTRC. This includes training for staff, doctoral training and fees for PhD students, and attendance at conferences for training purposes. In the 2013-14 financial year, 9.3 percent of the total budget was allocated to training, broken down as follows: • Training for staff and PhD 0.9 percent • Conference attendance 1.9 percent • PhD fees and stipend 6.5 percent. There have been a number of internal training opportunities for staff and PhD students during the second year of the Greater Manchester PSTRC. For example, a full-day training session on Patient and Public Involvement (PPI) was arranged by the PSTRC in October 2013 and attended by all staff and students. A session on social media was also arranged and hosted in January 2014. Training sessions on Citizens’ Juries were arranged in conjunction with Salford Royal NHS Foundation Trust’s Engagement in Research team in October and December 2013. Academic and research staff Each member of staff within the Greater Manchester PSTRC has an individual training and conference attendance budget, to encourage career development, and assist with disseminating the work of the Centre. The University of Manchester provides a “New Academic” training programme, which is recruited through open competition: two members of Greater Manchester PSTRC staff, Dr Sally Giles and Dr Denham Phipps, began this training during the Centre’s second year. All PSTRC-funded staff have an annual Performance and Development Review (P&DR) with their line manager. The P&DR includes advice on personal development, academic progression and career planning. PhD students The Greater Manchester PSTRC has five fully-funded PhD students , all of whom are in their first year of study, with a further PhD student due to begin her programme in April 2014. Support for the Centre’s PhD students is extensive; • a PhD group has been established for the five PSTRC students • the PhD students are also members of the Centre for
Primary Care’s PhD group, which consists of more than 25 PhD students • PSTRC PhD students are invited to Institute of Population Heath doctoral training events, which more than a hundred PhD students attend • Greater Manchester PSTRC has created an innovative doctoral training network alongside the University of Manchester’s Business School (Health Foundation- funded) safety improvement PhD students, which meets quarterly to provide collaborative training and support. • all Greater Manchester PSTRC students have access to modules in the University of Manchester Masters in Research (MRes) and the Masters in Public Health (MPH) • two PSTRC PhD students, Paolo Fraccaro and Christian Thomas, attended the NIHR Training Camp in July 2013. The Greater Manchester PSTRC are fully committed to, and actively encourage, the development of staff and students and will continue to do so throughout its duration.
Christian Thomas: based in the Manchester Pharmacy School, Christian’s PhD topic is “Understanding & addressing procedural violations in pharmacy” Paolo Fraccaro: based in the Centre for Health Informatics, Paolo’s PhD is entitled “Developing context awareness for e-Health alerts to improve patient safety” Jonathan Stokes: based in the Centre for Primary Care, Jonathan’s PhD is on “Integrated care, patient safety and CCGs”. Shoba Dawson: based in the Centre for Primary Care, Shoba’s PhD is on “Patient & Public Involvement for BME groups”. Tina Wulff: registered in the Manchester Business School, Tina’s PhD is on “Primary Care Patient Safety Improvement Science”. Hayley Gorton: based in the Manchester Pharmacy School from 1 April 2014, Hayley will be studying “Suicide & self-harm: implications for medication safety in primary care”.
15
Industry Links In the 2013-14 financial year, the Greater Manchester PSTRC linked in with a number of local and national companies and organisations.
PINCER is a pharmacist-led information technology intervention for medication errors that was developed by Prof Tony Avery, University of Nottingham, with collaborators including PRIMIS, a business unit of the University of Nottingham. The intervention helps to identify patients potentially at risk of a prescribing error and organisations such as the Department of Health are interested in rolling this out nationwide. PRIMIS has had a pivotal role in enabling a selection of the computer queries used in the PINCER trial to be made freely available to UK general practices through the PRIMIS Hub and enabling GP practices to view the results of the searches in a user-friendly format to identify patients within their practice who are potentially at risk of prescribing error. To further develop the intervention, the Medication Safety theme (through Prof Darren Ashcroft and Prof Tony Avery) has developed a further 15 prescribing safety indicators (PINCER+) and are currently working closely with PRIMIS to add these to the original PINCER indicators. Since launching the PINCER Query Library in February 2013, 1,271 GP practices across 173 Clinical Commissioning Groups have downloaded the computer queries to identify patients at risk. The tool is available at: http://www.nottingham.ac.uk/primis/index.aspx #PINCER. As a next step, work is currently taking place with the software company, TCR (Nottingham), to develop methods for primary and secondary care data extraction and linkage to investigate hospital admissions associated with serious medication-related adverse events linked to the PINCER and PINCER+ safety indicators.
16
Isabel Healthcare has developed a web-based Diagnostic Checklist System designed to assist clinicians in the diagnostic process. The General Practice Theme set up the Isabel system in one practice in 2013-2014 and will evaluate Isabel in the same practice in 2014-2015.
A local communications consultancy were commissioned to produce a video to represent the Greater Manchester PSTRC, highlighting the people and architecture of Greater Manchester, primary healthcare in the region and to provide an invitation to viewers to become involved in the work of the Centre. The video will be used at conferences and symposia, events and exhibition stands to help engage people with the ongoing work of the Centre.
To support our Public and Patient Involvement, and Public Engagement programme, Inspiration NW has provided advice and support on potential methods of engaging with people around research within the centre.
As part of the evaluation of Patient and Public Involvement in the work of the Greater Manchester PSTRC, external advice has been provided by TwoCan Associates. Safety Culture Associates Ltd (Dianne Parker) For the Medication Safety theme, Safety Culture Associates Ltd has provided external scrutiny over data analysis and conclusions on a number of qualitative studies, which has supported the ongoing work in the development of a medicines Safety Management System.
People’s Voice Media was commissioned to undertake community reporting to obtain one hundred one-minute videos on public perspectives of primary care dentistry, working in conjunction with an NIHR Programme Development Grant. This exploratory methodology and industry link will help to inform future community reporting in Greater Manchester PSTRC..
The Farr Institute, of which HeRC is one of four founders, holds an annual industry forum. At the inaugural forum in December 2013, over one hundred delegates from pharmaceutical, information technology and management consultancy sectors were in attendance. Involvement in the annual industry forum also enabled the I&I theme to access the Manchester Connected Health Ecosystem, which brings together over 50 industry members with NHS, local government and academic partners.
The opportunity to increase industry contact by combining efforts with other established centres has been Interface and Informatics (I&I) theme’s approach to industry links. For example, I&I has combined its activities and strengths with those of the Health eResearch Centre (HeRC). HeRC itself has named industrial partners, including Microsoft, Siemens, AstraZeneca, Cisco, Intel and Janssen Healthcare Innovation.
The Centre for Health Informatics at The University of Manchester, which hosts the Interface and Informatics theme, has a service delivery arm called North West eHealth (NWeH), which was established to commercialise research outputs. In March 2014, NWeH won a £0.5m contract from Farr Institute capital funds to develop and supply Farsite software to several Academic Health Science Networks (AHSN), including the COCPIT software tool, which was designed by Interface and Informatics theme.
Photo courtesy of The University of Manchester
17
Links with other organisations It is particularly beneficial for the Greater Manchester PSTRC to link with other organisations who represent the interests of and/or are conducting work in primary care patient safety. It allows the sharing of ideas, builds upon work already done and results in a strong combined effort to lobby for change.
• the Greater Manchester PSTRC has strong historical and ongoing links with the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester and the NIHR School for Primary Care Research (NIHR SPCR)
• The University of Manchester, Salford Clinical Commissioning Group (CCG) and Salford Royal NHS Foundation Trust are members of the Manchester Academic Health Science Centre (MAHSC) and the NIHR CLAHRC Greater Manchester • to allow sharing of ideas and experiences, as well as highlighting potential for collaboration, Prof Bryony Dean-Franklin (NIHR Imperial PSTRC) and Prof Stephen Campbell (NIHR Greater Manchester PSTRC) are members of each of the two PSTRC’s Strategic Advisory Groups.
NIHR CLAHRC Greater Manchester NIHR School for Primary Care Research Manchester Academic Health Science Centre Salford Clinical Commissioning Group Salford Royal NHS Foundation Trust NIHR Imperial PSTRC
18
Multi-centre grant applications Members of the Greater Manchester PSTRC have coapplied for a number of grants this year, in conjunction with other NIHR-funded centres: • Prof Campbell is a co-applicant on a grant with the NIHR Imperial PSTRC • Prof Esmail is a co-applicant on a grant with the NIHR Imperial PSTRC • Prof Bower is a Principal Investigator and coapplicant respectively on two NIHR grants • Prof Campbell is co-Principal Investigator of an NIHR Programme Development Grant looking at developing a primary dental care quality and safety toolkit. • Prof Ashcroft is a co-investigator with the University of Keele on a Department of Health Policy and Delivery Research Programme looking at self-harm in primary care patients. Ongoing cross-Centre research There are a number of pre-existing projects that members of the Greater Manchester PSTRC are involved in: • staff in the Medication Safety and General Practice themes are working with researchers funded by the NIHR School for Primary Care Research project on “Developing, testing and implementing the NSPCR Patient Safety Toolkit in general practices in England” • there are close links between the Greater Manchester PSTRC Multimorbidity theme and staff and projects on long term conditions and multimorbidity that are funded or co-funded by the NIHR School for Primary Care Research • there are links between the Greater Manchester PSTRC Research User Group (RUG) and PRIMER, which is the University of Manchester Centre for Primary Care Research in Manchester Engagement Resource, which was funded originally by the NIHR School for Primary Care Research.
clahrc-gm.nihr.ac.uk/ www.spcr.nihr.ac.uk/ www.mahsc.ac.uk/ www.salfordccg.nhs.uk/ www.srft.nhs.uk/ www1.imperial.ac.uk/cpssq/pstrc/
Communications The Greater Manchester PSTRC recognises the importance of creating and maintaining communication channels with members of the public, healthcare professionals, stakeholders and internal staff and students, and undertakes this in a variety of ways. Internal communications: • a monthly newsletter is produced for Greater Manchester PSTRC staff and PhD students, updating on news and activities of relevance to an internal audience • regular meetings take place which are attended by Research Fellows, Associates and PhD students, providing an open forum for communicating work around projects, as well as raising issues • monthly meetings take place within each research theme, when project updates and future plans are discussed. External communications: • the Centre has a number of active Twitter accounts, including a general Centre account and two themespecific accounts, one for Multimorbidity and the other for Medication Safety, both of which tweet on issues of particular relevance to their themes • a range of leaflets and information sheets are produced by the Centre, which are available at all Greater Manchester PSTRC events, as well as online
Where to find information on the Greater Manchester PSTRC: Website www.gmpstrc.nihr.ac.uk
• the Greater Manchester PSTRC has a website hosted by the University of Manchester, where a range of information can be found, including research theme pages, job opportunities, information about current and past events as well as details on how to become involved in its work • a quarterly newsletter, providing information on projects, events, opportunities for involvement, is produced and sent to a list of subscribers who have signed up as “Friends” of the Greater Manchester PSTRC • a Greater Manchester PSTRC blog, hosted by Wordpress, is regularly updated with posts on a wide-range of topics, including reviews, information on initiatives and opinion pieces. Blog posts are written by Greater Manchester PSTRC staff and students and members of the Core Research User Group (RUG).
Blog www.gmpstrc.wordpress.com Twitter accounts @gm_pstrc | @meds_safety | @multimorbidity YouTube channel https://www.youtube.com/channel/UC18GlgZdtIjV8kX_OA5GJkg Sign up to the newsletter http://bit.ly/GMPSTRC 19
Finance and grant income As a result of work taking place in the Greater Manchester PSTRC, the following grants have been secured in the Centre’s second year: Research Theme
Funding Body
Grant Title
Core
Health Foundation
Closing the Gap: Evaluation of Safety Surveillance in Hospital Trust Boards and CCG Governing Bodies
Medication Safety
Department of Health Policy and Self-harm in Primary Care Patients: A Nationally Delivery Research Programme Representative Cohort Study Examining Patterns of Attendance, Treatment and Referral, and Risk of Self-harm Repetition, Suicide and Other Causes of Premature Death
Multimorbidity
Health Services and Delivery Research Programme
Improving the Management of Patients with Multimorbidity in General Practice (3D study)
Multimorbidity
Health Services and Delivery Research Programme
Comprehensive Longitudinal Assessment of Salford Integrated Care (CLASSIC)
General Practice
Health Services Delivery and Research Programme
Evaluation of National Surveillance System for Mortality Alerts
Looking to the future Most contacts with the NHS take place in primary care. As highlighted in the introduction, there are 340 million general practice appointments and over one billion prescription items dispensed each year. Many patients have more than one condition (multimorbidity) and interact with multiple health care providers both in primary and secondary care. This generates an ever-increasing amount of electronic data exchange between providers. A focus on general practice, prescribing, multimorbidity and how informatics is used in healthcare is a starting point. These are our priority areas, which we have now established, and will be delivering research findings on, for the remainder of the PSTRC contract. This report has described our progress to date. In parallel with delivering our ongoing research we are beginning to think strategically for future plans and priorities. Greater Manchester PSTRC staff have been successfully awarded grants over the last year and we need to look to extend our focus to beyond 2017, working closely with our RUG members to bring in new income and embedding patient and public involvement and engagement at all stages of the research process. At every step, we are committed to working in close collaboration with patients and the public and healthcare providers in order to meet our aims and help make primary care in Greater Manchester, and elsewhere, safer. Lots done - lots to do.
20
The National Institute for Health Research (NIHR) Greater Manchester Primary Care Patient Safety Translational Research (Greater Manchester PSTRC) is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust. This document summarises independent research funded by the NIHR Greater Manchester PSTRC. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
NIHR Greater Manchester PSTRC Suite 11, Floor 7, Williamson Building Institute of Population Health University of Manchester Oxford Road, Manchester M13 9PL