Optimising patient risk management in urgent primary care services (PRIMA)

AIM

This study will investigate the everyday work of managing risk being done by urgent primary care services, their staff, and by patients and their companions using these services in order to optimise patient safety.

WHY IS THIS IMPORTANT?

Urgent primary care services are provided by a variety of organisations and play a vital role in assessing patients and managing clinical risk in the community when GP surgeries are closed.

The management of patient risk outside of hospital remains poorly understood and under-researched. Without greater understanding, we cannot provide evidence-based guidance to clinicians about mitigating patient risks or know what information to share with patients and their companions, or how best to advise them about how to keep themselves or others safe during an episode of urgent care.

WHAT WE ARE DOING 

We are currently conducting interviews with clinical leads of urgent primary care services including NHS 111, GP out-of-hours and urgent treatment centres.

We have NHS Research Ethics approval in place for the next stage of our study which will involve recruiting organisations providing urgent primary care services as case studies. Our researchers will spend time in each site, making observations, interviewing staff, collecting or making recordings of patient contacts, and reviewing record entries. In particular, we wish to recruit patients who may be more at risk of poor health outcomes including:

• Children
• People experiencing mental health problems
• Older people with multiple long-term conditions
• People at the end of life

Following urgent primary care contacts, we will provide a questionnaire, asking patients and their companions (where appropriate) whether they recalled and understood any risk management advice given, and what happened next. We will then conduct interviews with a sample of these service users to understand more about their experiences and what information is most important and useful to them in order to help them stay safe during an episode of urgent care.

How were patients and the public involved

We have involved 22 patient and caregiver representatives in our study to date, all with lived experience of seeking urgent primary care either for themselves or a partner/relative/child. Our plan now is to recruit two/three representatives from each group to form an advisory panel going forward.

On 8^th July 2024 National Voices held a workshop for its members to explore people’s experiences of seeking urgent care when their GP surgery is closed from services including NHS 111, out-of-hours GPs, Urgent Treatment Centres, Minor Injuries Units, Pharmacies etc.

To inform the study, National Voices brought together representatives of member and non-member organisations including:

• Age UK
• Behind the Smile
• British Geriatrics Society
• Caribbean and African Health Network
• Compassion in Dying
• Derbyshire Mind
• Hertfordshire Mind
• Marie Curie
• Mind
• National Association of Deafened People
• Thomas Pocklington Trust

During a two-hour workshop the group shared their evidence and insight around people’s experiences of these services and the extent to which these services were effective in keeping people safe.