Oxfordshire Primary Care Trust (OPCT), the predecessor organisation to OCCG, first deployed Datix in 2008 to support the management of incidents, PALS enquiries, complaints and risks.
In 2012, OPCT decided to expand the Datix implementation programme to meet the needs of a rapidly changing NHS landscape and clinical commissioning in particular. Pivotal to the success of OCCG is a cohesive feedback and patient safety infrastructure for which Datix is the software of choice.
Helen Gandy, Quality Improvement Manager of Oxfordshire CCG takes up the story, “As the organisation grew in size and complexity, having clear sight of care issues and deficits between primary and secondary providers became more difficult. Information was patchy, often anecdotal. With over 600 GPs serving a diverse population the time had come to capture GP feedback across the 78 GP practices accurately, to enable us to analyse and drill down to the root cause of commonly occurring incidents and identify trends. We could then work with providers to prevent future recurrence. The information gathered enables us to identify problems early, which the providers were often unaware of. Early identification enables early resolution meaning improved care for patients. Using Datix to achieve this, we are confident we can help our providers ensure they are providing the best care for patients. We now receive in the region of 50-60 pieces of feedback every week”.
Helen was part of the team that helped design and develop the new GP Feedback Programme using Datix patient safety software. It included a short, easy-to-understand and simple-to-use one-page Datix report form to encourage users to report incidents more readily. Before the system went live in June 2012, Helen and her team spent three months preparing for the launch, personally visiting the six localities of OCCG, explaining the benefits and addressing concerns of GPs and planning the roll-out. GPs are encouraged to use the Datix system themselves and records prove that all 78 GP practices are making excellent use of it to record incidents and provide feedback on services.
Helen Gandy continued, “To kick-start the new GP Feedback Programme, it was important to get the basics right, combining Datix technology with the right people and processes. We put together a truly multi-disciplinary team of clinicians, quality experts and management from OCCG as well as GPs who engage with many people at different levels. Everyone had to take ownership for the programme to make it successful and this all-encompassing approach guaranteed we can elicit and capture feedback in a highly cohesive and meaningful way. Having GPs championing the programme has been pivotal to our success.”
Every week, the team meets to assess the latest feedback from GP practices and then shares it with the relevant healthcare providers, a process that encourages maximum teamwork across the entire health economy. These weekly meetings also provide the ideal opportunity to assess patient safety areas that require prompt attention and to review input from the providers themselves.
Oxford University Hospitals NHS Foundation Trust (OUH), the main provider in the county, is a perfect example of the programme in action. Departments are given direct access to the OCCG Datix system so that they can enter their responses to GP feedback directly, run their own analytical reports and see for themselves the exact data which OCCG is using. According to Helen Gandy, “This exceptional level of transparency and openness is a critical success factor and has a very positive impact on turnaround times for response rates.” Based on the positive OUH experience, all other providers will soon also have access to the OCCG Datix system.
When it comes to closing the loop on GP feedback, Dr Richard Green – OCCG Clinical Director of Quality, a GP himself and clinical lead of the GP Feedback Programme, believes transparency is key and that “openness is the secret to keeping people on board.” Richard writes a simple quarterly report summing up exactly what has been reported, what has been done about it and highlighting any major or recurring themes that are then published widely at locality meetings and distributed to individual GP practices and other important stakeholders including the hospitals about which the CCG has received feedback.
One of the major benefits of using Datix is its ability to share information and learning, essential in a multi-faceted healthcare organisation like OUH where different directorates might face a common challenge but do not know it because they work independently.
Helen Gandy explained, “Information we store in the Datix system is also shared with the provider Risk Management teams and Head of Clinical Governance to provide them with complete visibility of the feedback received from primary care about their services. Previously, responses from specialties were fed manually into spreadsheets, often seen as a barrier to openness and shared learning. Datix has the ability to link information, and responses, inextricably to internal governance processes to minimise risk to patient safety and promote standardised, organisation-wide good practice.”
The majority of providers respond positively to the feedback they receive from OCCG. They appreciate the value that Datix brings as an additional indicator of how they are delivering care to patients.
Relying on accurate data held in the Datix system, the GP Feedback team can match recurring incidents with specific providers and monitor their service provision against contractual obligations over a certain period of time. This can be used to inform OCCG’s decision-making in terms of commissioning.
Helen Gandy said, “Datix is having a tangible impact on our commissioning processes. With the help of the Datix feedback programme, we are able to work with providers rather than against them using the evidence provided by the system to identify and resolve problems early. We’ve also noticed that our own commissioning managers are requesting and utilising feedback from Datix when looking to re-design essential services, for example district nursing and musculoskeletal services. For these programmes of service redesign, GP feedback obtained through Datix has been vital in shaping the way forward”
The OCCG primary care Datix feedback programme has facilitated a more joined up approach to patient safety in the county.
In addition, OCCG has realised a series of tangible benefits such as improved communication between secondary and primary care and the management of test results.
Good clinical communication between primary and secondary care is essential and information should be received in a timely way. Using the Datix feedback programme a significant trend was spotted in identifying delays in primary care receiving information. This meant it was difficult for GPs to continue the good work initiated in secondary care. As a result, providers have improved their systems and processes and most clinical communication is now electronically sent within the contractually agreed timescales resulting in improved continuity of care for patients.
Feedback also identified problems with the management of clinical test results undertaken in secondary care. A number of examples were found where GPs were expected to inappropriately follow up on these tests. The CCG has undertaken work with the provider to ensure all clinicians are clear on their clinical responsibilities relating to the management of test results thus reducing the clinical risk to patients.
By setting a contract indicator for responding to feedback within 14 days which most providers are able to meet, it means that issues can be identified and resolved much faster minimising impact on patient care. Datix also enables the CCG to monitor this and again both parties are using the same data.
Helen Gandy continued, “I don’t think we could run the GP Feedback Programme without Datix. Thanks to the automation provided by the system and the ability to customise the software to meet our needs, we can code and analyse information quickly and intelligently. We can even share it directly with providers allowing them to respond to individual feedback separately and systematically. The transparency afforded by Datix is crucial. Both OCCG and our providers are able to run analytical reports directly from the system without the need for third party technology. This is a major benefit that goes a long way towards encouraging providers to engage closely with our GP Feedback Programme and ultimately enhances the overall patient experience.”
So successful is the Datix implementation that it has become a popular reference site for other Clinical Commissioning Groups also looking for systems to capture this type of feedback. In addition, a number of Oxfordshire GP practices are considering using Datix to manage their own incidents using more traditional processes, again taking advantage of its versatile capabilities.
Next on the horizon is working with NHS England and the National Reporting and Learning System (NRLS) to upload data from the OCCG Datix solution to the NRLS database, a move that will help overcome the deficit of primary care information that currently exists. By closing this critical information gap, OCCG anticipates it can contribute strategically to improvements in patient safety in Oxfordshire and beyond.
The Oxfordshire Clinical Commissioning Group (OCCG) was established in April 2013 following a Government White Paper which set out its long-term vision for the NHS, bringing decision-making as close as possible to the patient. The group buys health services on behalf of everyone living in Oxfordshire and serves a population of 710,000.
To do this successfully, OCCG works closely with local people, over 600 GPs at 78 GP practices, hospital clinicians and other healthcare partners from both the government and voluntary sector.
For more information, please visit: www.oxfordshireccg.nhs.uk