Healthcare professor from Manchester based patient safety research centre recognised in New Year Honours

Professor Tony Avery

A trailblazing professor who is one of the Research Leads at the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) has received an OBE in the Queen’s New Year Honours.

Tony Avery, GP and Professor of Primary Healthcare at The University of Nottingham, and a Senior Investigator for the NIHR, received the award for his ‘Services to General Practice’.

At the GM PSTRC he’s a lead for the Medication Safety research theme. He has led groundbreaking studies to identify the frequency, nature and cause of prescribing errors and avoidable harm in primary care.

Professor Avery has also developed and evaluated a range of interventions that have led to improvements in patient safety. One example being PINCER, a pharmacist-led information-technology-based intervention. It effectively reduces prescribing errors in general practice while saving money.

It has been rolled out to 350 general practices in the East Midlands. The approach was also recommended for national adoption by the National Institute for Health and Care Excellence (NICE) in 2015. PINCER is now being used at more than 2,500 general practices across England and as a result, over 20,000 patients have benefitted from safer prescriptions.

Professor Avery said: “I’m absolutely delighted to receive this honour, and I would like to thank all my colleagues for the contribution they have made to my career. I would particularly like to thank my wife, Chris, and my family and friends for their love and support.”

Professor Avery has worked in the medical field for over thirty-five years. After completing his undergraduate medical degree at the University of Sheffield in 1986, he then went on to complete his GP training in Nottingham, and has been a clinical academic at the University of Nottingham since 1992. He has been part of the GM PSTRC since 2017.

Professor Darren Ashcroft, Director of the GM PSTRC, said: “We’d like to congratulate Tony on being awarded an OBE. His contribution to patient safety in general practice is quite incredible and we feel fortunate to have been able to work alongside him.”

Professor Avery has received several prestigious awards throughout his career. At Sheffield University he was awarded the Francis Davis Cup for the ‘most outstanding pre-clinical student’. In 2008 he was awarded the John Fry silver medal by the Royal College of General Practitioners for his research, and in 2016 he received the silver medal for delivering the James MacKenzie annual lecture.

Between 1998 and 2012, he led a major expansion of the Division of Primary Care, securing membership of the NIHR School for Primary Care Research in 2009. He was appointed as the Director of Research for the School of Medicine at Nottingham in 2013 and was Dean and Head of Nottingham School of Medicine from 2015-2019.

Professor Avery also works as a GP at the Valley Surgery, Chilwell, Nottingham, and he has introduced many innovations since joining in 1992. He leads on patient safety for the practice, and had an important role in the practice achieving an ‘Outstanding’ rating from the Care Quality Commission in 2015.

Professor John Atherton, Pro-Vice-Chancellor for the Faculty of Medicine and Health Sciences at the University of Nottingham, said: “I am absolutely delighted that Tony has been awarded this OBE; it is so well deserved. Tony has given his life to medicine and served patients and the medical community in many ways – through patient service, research and education. His research on safe prescribing in particular has made a real difference to a huge number of patients in the UK and worldwide. We in the University of Nottingham are incredibly proud of everything he has achieved.”

NIHR Greater Manchester PSTRC Meet the Team – Jane Sarginson

The third in our NIHR Greater Manchester PSTRC ‘Meet the Team’ series introduces Jane Sarginson, Daphne Jackson Fellow in Medication Safety theme.

Jane Sarginson_Meet the Team

NIHR Greater Manchester PSTRC Meet the Team – Philip Hammond

The second in our NIHR Greater Manchester PSTRC ‘Meet the Team’ series introduces Philip Hammond, the centre’s Patient and Public Involvement (PPI) Coordinator.

Philip Hammond_Meet the Team

Greater Manchester PSTRC Meet the Team – Jill Stocks

The first in our Greater Manchester PSTRC ‘Meet the Team’ series introduces Jill Stocks, Research Fellow in our Core research theme.

Jill Stocks_Meet the Team

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What are the important issues in patient safety?

by Professor Bryony Dean Franklin, Professor of Medication Safety, UCL School of Pharmacy and member of the NIHR Greater Manchester PSTRC Strategic Advisory Group

What are the important issues in patient safety? I was wondering where to start: the important problems? the important solutions? the important research questions? These are all rather big questions, and somewhat inter-related, so I thought I’d go with two general reflections.

First of all, I am increasingly struck by the enormous challenge of seeing the whole system – just like the tale of the blind men and the elephant.  We (researchers, clinical staff and managers alike) all tend to focus on individual parts of the bigger system – the medication bit, the surgical bit, the hospital bit, the GP bit – whatever our focus may be.  This is often driven by necessity – we need to break things down into manageable chunks to create achievable objectives and to focus our expertise appropriately.  However there are two key problems with this approach. First, we risk shifting problems from one area to another.  An example might be the mid 2000s’ introduction of bedside lockers to store inpatients’ medication in hospitals, with the aim of supporting medication reconciliation on admission and speeding discharge. However this has created new problems for nurses who often have to work out which of the overflowing pile of medication boxes should be given to the patient at discharge.  We hear of patients given supplies of ward stock medication, discontinued medication, or even medication belonging to the patient who occupied the bed before them.  Second, there is the very real possibility that we make one very small part of the system work well, while the stages before and after it still function badly. Given that most processes are only as good as the weakest link, this is potentially wasted effort. Going back to the story of the blind men and the elephant, the Wikipedia entry for this explains how it is based on a group of blind men, each of whom feels a different part of the elephant. They then compare notes and learn that they are in complete disagreement. Various versions of the story then differ in how violent the conflict between the men becomes, and if and how the conflict among their perspectives is resolved.  And so too within patient safety, the challenge for us is how we resolve this in order to understand the entire ‘elephant’ and improve patient safety across the whole system. Since we are each only likely to be experts on one small part, this is likely to need collaboration and creation of a shared understanding with a wide range of relevant stakeholders – including patients and carers.

Second, we need to consider patients’ experiences of care as well as other measures of patient safety. The subjective sense of patients and carers have other the extent to which they ‘feel safe’ with their healthcare, and the possibly more objective ‘freedom from harm’ that healthcare professionals may focus on, are different. Both are important, but viewed as two circles within a Venn Diagram, I suspect there may be little overlap. Even if someone’s care is ‘safe’ from a medical perspective, if they feel unsafe, perhaps due to receiving conflicting information of poor communication, then the system is not safe from their perspective.

Two important issues in patient safety are therefore the challenge of seeing the whole system, and including the perspectives of patients and carers. As patients are often the only people who experience the whole healthcare system, focusing on their experiences and perspectives may be the key to addressing both challenges.

Should the public have access to written patient complaints and is it time to re-badge “patient complaints”?

by Rahul Alam, Research Associate in General Practice theme

Affording patients the opportunity to “complain” regarding the care they receive is now seen and recognised as an essential part of improving patient safety. The Francis report described the short comings in patient safety when patient complaints are not heeded [1]. “Provide every patient with a pen and paper by their bedside to provide comments and concerns” was one recommendation for improving patient safety in another recent government review [2].

Recognising these concerns, the NHS has embraced and pro-actively encouraged the collection of complaints, which have soared from 148,200 written complaints in 2010-2011 to 174,872 in 2013-2014. Over 60,500 were reported from primary care and they contribute to a staggering 3,300 written complaints a week within the NHS in England and Wales alone! [3]

Given the wide-ranging healthcare services that are available and the varying levels of patient interactions, it is likely that complaints vary in their properties and dimensions. Currently, patient complaints are not easily accessible to the public, so there is no easy mechanism for identifying and acting on complaints raised by patients. Concerns have been raised around patient consent and confidentiality which means that only some senior NHS staff can access and act on these complaints. However, should anonymised patient complaint data be made available to the public? Benefits could be considerable. For example, second-hand experiences could empower patients to act, if and when they experience similar events themselves. Healthcare organisations can learn from each other, foresee potential problems from previous complaints and adopt examples of good practice. And finally, the research community, with input from patients and the public can explore salient issues in an attempt to improve patient safety and minimise harm.

Issues around confidentiality and consent could be mitigated if “complaints” are used as an opportunity to tap in to patient’s feelings, experiences and knowledge and used to drive patient-driven improvements. The complaint could be seen as an opportunity not only to say “what went wrong” but also to emphasize and ask “what can be done” to prevent future episodes of failure.

When health, well-being and patient safety is at stake, the patient complaints can be used to make improvements from the perspective of the patient. Complaints from patients and their families can often be emotionally charged but at the same time, patients and their families are probably best positioned to answer these key questions around improvement. Asking patients for a “suggestion for improvement” is likely to funnel patient emotions and discontent. This may lead to patients producing material that can be useful to improve care and patient safety at the same time as addressing their concerns and reassuring patients that preventative efforts are being made. We need to think of mechanisms of how we can harness these views for improvement.

Given the increasing numbers of patient complaints, it seems prudent to capture as many patient suggestions as possible. I would argue that a complaint coupled with a “suggestion to improve” is better than a complaint alone. There may be occasions when a “suggestion to improve” is not possible or some may argue that they do not wish to provide a “suggestion to improve”. My counter argument would simply be that we all have a shared responsibility to contribute to the system’s well -being, just as the system has a responsibility for our own well-being.

1. Francis, R., The Mid Staffordshire NHS Foundation Trust. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. ID 2535334 01/13, ISBN: 9780102981476. London: The Stationery Office, Crown copyright. 2013.
2. Clwyd, A. and T. Hart, A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture. Final Report. Crown copyright 2901299. 2013.
3. HSCIC, Workforce and Facilities Team, Health and Social Care Information Centre. Data on Written Complaints in the NHS 2013-14. 2014.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

GM PSTRC Newsletter – second edition now live

by Philip Hammond, GM PSTRC PPI Coordinator

The latest edition of our newsletter is now available online.

With some key updates from the work of our research themes as well as other articles of interest including:

• Learning materials for safer prescribing valued highly by GPs
• MAXIMUM moves ahead, piloted by involvement
• Healthcare hashtag project [#]
• Closing the Gap
• early details of our forthcoming Research Symposium
• opportunities for people to get involved.

Make sure you don’t miss out on our free quarterly newsletter by signing up to become a Friend of the Centre at http://bit.ly/GMPSTRC

 

‘The earlier the better’ – why visiting your local pharmacy sooner rather than later could make all the difference

by Christian Thomas, 1st year PhD student in Medication Safety theme The beginning of 2014 sees the introduction of the new NHS campaign “The earlier, the better”. Designed to reduce the increased pressure experienced by our A&E departments and GP surgeries during the winter months, this campaign sets out to change public behaviour on a large scale.  Mainly aimed at elderly and frail individuals who are often admitted to hospital with respiratory conditions which may have been brought on by immobility, cold environments and viral illnesses – the aim is to begin treating these conditions before a visit to the GP or a stay in hospital is required, through a visit to the local pharmacy. Professor Keith Willett, NHS England’s Director for Acute Care said many of the patients seen in hospital are those who have not had or sought help early enough. Commenting, “We have to do better at helping people stay well, not just picking up the pieces when they fall seriously ill. Too many people make the mistake of soldiering on, losing the opportunity to nip things in the bud.” How then, can the general public become more aware of the services provided in their local pharmacies? The NHS are proposing a national PR campaign, where the public will see adverts in the national newspapers and on websites, hear adverts on local and national radio stations and see posters in their local pharmacy. It is believed however, that word of mouth will be a vital means in which to encourage people that may be our family, our friends, our neighbours or even ourselves to visit the local pharmacy. Speaking up about suffering from a bad cough, cold or sore throat could be crucial in preventing a minor illness developing into something more serious. It can be easy to underestimate the local pharmacy, with many unaware of the range of services that numerous pharmacies provide. Clare Howard, Deputy Chief Pharmaceutical Officer at NHS England explains, “Pharmacists and their teams are well trained and well placed to be able to offer advice to people seeking help. They can provide medicines’ advice and support for minor ailments, advise you about how to manage a long term condition and tell you if something needs more urgent medical attention from your GP, or even your local hospital.” As somebody who works as a dispenser in a community pharmacy, I am fully supportive of this campaign, having witnessed countless instances of customers coming into the pharmacy for what is sometimes, lifesaving advice. At times the most important advice can be in ensuring an individual does visit their GP or the local hospital for something that they were sure ‘is probably nothing’. There is great satisfaction in knowing that had it not been for their visit to the pharmacy their condition may have been left either unnoticed or worse still, untreated. Therefore, perhaps the most important aspect of this campaign could be in raising the public’s awareness that the pharmacy is another option for those who may put off going to visit the doctor for “just a cold”. It is always better to check your symptoms, at most it could save your life and at the very least, you are sure to feel better in the long run. For more information, please visit http://www.nhs.uk/asap.

Welcome to the NIHR Greater Manchester PSTRC blog!

The NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre is funded by the National Institute for Health Research and is a partnership between the University of Mancheter and Salford Royal NHS Foundation Trust.

We will be keeping you up to date on the exciting work taking place within the centre, including updates on current projects by our friendly research staff, plus patient and public perspectives from our Research User Group (RUG) members.

Come back often to view our most recent posts!