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BMJ. 2007 October 27; 335(7625): 847.
PMCID: PMC2043437

Safety agency wants to do more to engage clinicians, its head says

Anaesthetists will be the first specialists in England to have their own reporting system for patient safety incidents, the government's safety agency has announced.

The new system, which is due to be piloted next year, will work in tandem with the national reporting and learning system, which the National Patient Safety Agency set up in 2004 to capture mistakes and near misses involving patients in the NHS (BMJ 2004;328:481 doi: 10.1136/bmj.328.7438.481).

But questions have been raised about the usefulness and accuracy of the data captured by the current system and the speed with which the information has been interpreted and fed back to the NHS.

Nurses use the system, which now receives around 50 000 reports a month; but on the whole, doctors do not.

The move signals the agency's intention to work much more closely with clinicians, said its chief executive officer, Martin Fletcher. Mr Fletcher, who was appointed to his post in May this year, was speaking at a conference in London last week on safety in clinical practice, organised by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland.

“The work we're doing with you will be the prototype for work we will do elsewhere,” he told delegates.

If specialist reporting proves successful, similar systems for radiologists, obstetricians and gynaecologists, physicians, and GPs could also get the go ahead.

“There is much greater awareness of patient safety across the NHS, but this has not always been translated into practical action,” Mr Fletcher said. He said that the agency recognised and wanted to address the criticisms levelled at the national system and would involve clinicians far more in analysing the data, so that it was much more useful for specialists and at a local level.

“We haven't inspired people enough. We need to make patient safety the first priority at board and chief executive level,” he said.

Sara Johnson, the agency's lead for safer practice, said that the move towards specialty reporting had been prompted by recommendations in the chief medical officer for England's report in December 2006, Safety First (BMJ 2007;334:12 doi: 10.1136/bmj.39071.679595.DB).

It was part of a “safety package” of measures, worked out with anaesthetists and other perioperative and operating specialist professions, she said. “It's clearly very important that patient safety is owned and led by the professionals carrying out the clinical work.”

Les Gemmell, who chairs the safety committee of the anaesthetists' association, said that the specialty had a long history of prioritising patient safety. “But many of us feel that the [national] reporting system is not sufficient.”

The new system signals a sea change, he said. “The main reason why people don't report is the lack of timely feedback, and they like to report to their own profession rather than a government agency.”


Articles from The BMJ are provided here courtesy of BMJ Group