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Abstract

Over the past twenty years, health care has adapted to the ?quality revolution? by moving away from direct provision and hierarchical control mechanisms. In their place, new structures based on contractual relationships are being developed coupled with attempts to create an organisational culture that shares learning and that scrutinizes existing practice so it can be improved. The issue here is that contractual arrangements require surveillance, monitoring, regulation and governance systems that can be perceived as antipathetic to the examination of practice and subsequent learning. Since the NHS was founded in the UK, general practitioners (GPs) have largely been independent of the NHS. Their contracts have been amended since 2004, with the introduction of the Quality and Outcomes Framework (QoF), a system of performance management and payments. Participation is voluntary and GPs still earn fees per patient, but the QoF can enhance income significantly. Historically, reporting levels from general practice have remained low; little information is shared and consequently lessons are not shared across the general practice community.Given large-scale under-engagement of GPs in incident reporting systems,significant event analysis is advocated to encourage sharing incidents to inform the patient safety agenda at a local and national level. Previous research has concentrated onthe secondary care environmentand little is known about the situation in primary care, where the majority of patient contacts with healthcare occur.To explore attitudes to incident reporting, the study adopted a qualitative approach to GPs working in a mixture of urban and rural practices reporting to a Welsh Local Health Board (LHB). Sampling for this qualitative study was purposivein order to gain a range of views, rather than use a representative sample, and sought to achieve variation in practice location and size. Semi-structured interviews were audio-recorded, transcribed verbatim and themes described. The study found that GPs used significant event analysis methodology to report incidents within their practice, but acknowledged under-reporting. They were less enthusiastic about reporting externally.A number of barriers exist to reporting, including insufficient time to report, lack of feedback, fear of blame, and damage to reputations and patient confidence in a competitive environment.If incident-reporting processes are perceived as supportive and formative, and where protected time is allocated to discuss incidents, then GPs are willing to participate. They also need to know how the information is used, and whether lessons are being learned from errors.

Biography