The Primary Care Patient Safety Toolkit (#1951)

Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
There is a growing understanding of the importance of patient safety in primary care. In response a Patient Safety Toolkit has been developed that consists of a total of eight tools that address patient safety across a number of domains.
Overview of Innovation:
The Patient Safety  Toolkit was a multi-site multi-phase venture funded by the NIHR National School of Primary Care Research. Tools were piloted across some 50 practices across England and were intended to meet the challenge of dealing with patient safety incidents across a number  of domains. The toolkit included an aid to rapid retrospective note review to detect patient safety incidents; an on-line survey to assess the safety climate amongst staff; a questionnaire to gauge patients’ experiences of safety in primary care; a software based intervention to prevent medication related injury; a tool to assess medicine reconciliation for recently discharged patients and a concise safe systems checklist .

The toolkit was the National School for Primary Care Research has said that the Toolkit project was one of the ten most valuable they have been involved in over the last decade. Each of the individual elements of the toolkit are available to download free of charge from the RCGP website ( (
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content2
Innovation 'Elevator Pitch':
The PCAF service is a nationally recognised, peer reviewed, multi-award winning service that is provided within GP practices to support the identification, diagnosis and treatment for patients with AF with the aim of preventing AF-related strokes.  
Overview of Innovation:
The PCAF service is an innovative consultant-led service that provides dedicated expert resource to GP practices to: 
  • Identify additional 'unknown' AF patients within the clinical system; 
  • Qualify the accuracy of the AF register(s), referring patients for diagnostics to secure a diagnosis where required;
  • Assess the risk of stroke within the AF population by using a robust risk assessment tool (i.e. CHA2DS2- VASc);
  • Undertake comprehensive case note reviews of all patients who have been assessed as being at high risk of stroke with the aim of identifying those who would benefit from receiving an expert review;
  • Provide ‘in-house’ consultant-led AF clinics, ensuring that all patients at high risk of stroke receive access to an expert review and patient education;
  • Optimise the treatment and management of patients with AF, supporting quality outcomes and an increase in health related quality of life;
  • Provide one-to-one and group clinical education, thus ensuring a ‘legacy’ is left amongst clinical teams within primary care;
  • Enable access to an AF Stroke Prevention RCGP and CPD accredited eLearning package, enabling clinicians to increase their knowledge and skills on the current evidence base;
Primarily, the service will optimise the treatment and management for patients with AF (whilst being fully compliant with NICE Guidelines, local guidelines/pathways and the local medicines management formularies), ensuring a reduction of AF related stroke incidence within GP practices.

The service comprises of the following four phases, all of which are provided by Inspira Health:
  • Phase 1 - PRIMIS audits are run on the practice clinical system (including GRASP-AF).
  • Phase 2 - 5 clinical audits are completed and involve comprehensive patient case note reviews.  Each audit will identify patients at high risk of stroke who would benefit from an expert review;
  • Phase 3 - Patients are systematically invited to an expert review and are provided with education;
  • Phase 4 - Patients are reviewed by an independent local specialist (e.g. Consultant Cardiologist) within their GP practice and their management is optimised.
All clinicians within the practice are provided with an opportunity for one-to-one education during Phases 2 and 4.  In addition, all clinical staff are offered the opportunity to undertake an RCGP and CPD approved AF Stroke Prevention on-line eLearning package which consists of 5 modules and a competency assessment through patient case scenarios. 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Education, training and future workforce / Innovation and adoption / Patient and medicines safety / Person centred care
Benefit to NHS:
The following are benefits to a GP Practice:

The PCAF servicve will ...
  • Identify 'new' AF patients through a case finding exercise on the clinical system;
  • Significantly improve the quality of the AF disease register;
  • Achieve maximum indicators and performance thresholds in 2016-17 QOF (as a minimum standard);
  • Increase capacity within the clinical team through increasing knowledge, awareness and confidence in relation to evidence-based treatment strategies for AF.  This is achieved through one-to-one education, group education and/or eLearning;
  • Increase anticoagulation therapy in patients with AF at high risk of AF-related stroke;
  • Reduce the incidence of AF-related stroke within the practice population;
  • Ensure compliance with CQC standards in relation to patient safety and clinical effectivness;
  • Independently review the practices current poathways, processes and governance in relation to warfarin patient safety;
  • Provide a unique opportunity for personal development (PDP) and to gain CPD points for appraisal and/or revalidation.
Implementing the PCAF service would mean allignment with a number of key themes and strategic objectives as per the commissioning plans across the West Midlands.  The service woiuld contribute towards the following:
  • Improved health and healthcare through the introduction of a high quality, outcome driven, innovative service;
  • Increased life expectancy and the quality of life in the local population through optimising evidence-based treatment strategies, therefore reducing AF-related stroke incidence;
  • Increased medium-long term efficiency and productivity through the introduction of a sustainable service and a more educated, confident primary care workforce;
  • Improved and accurate AF disease registers;
  • A reduction in CVD related mortality;
  • A reduction in unplanned hospital admissions;
  • Improved patient experience;
  • Value for money;
  • The introduction of evidence-based practice across the West Midlands footprint.
Initial Review Rating
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Benefit to WM population:
The following are benefits to AF patients within the West Midlands

The PCAF servicve will ...
  • Increased a patients knowledge and awareness about their AF condition and their current and future risk of stroke through one-to-one education;
  • Provide an opportunity for patients to discuss their AF condition with a local expert within their GP practice;
  • Provide an opportunity for patients to learn more about their treatment options in relation to their overall AF management, quality of life and reducing their AF-related stroke risk. 
Current and planned activity: 
The PCAF service has been delivered in a vast number of GP practices and CCG's throughout the UK and has been recognised as a method of best practice nationally.

Inspira Health have engaged with the following key stakeholders;

GP Practices
GP Federations
Public Health England
Public Health Departments
Strategic Clinical Networks
Pharmacutical Industry
Charity Sector (eg British Heart Foundation, Arrhythmia Alliance, Stroke Association)
Commercial Partners (eg, INR Star, Blue Stream Acadamy)
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Commercial information:

The PCAF service is in full development and has been implemented in practices throughout the UK.

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Overview summary:
ESCAPE-pain is an evidence-based, NICE-recommended group rehabilitation programme appropriate for people with osteoarthritis, commonly called chronic joint pain, in their knee and/or hip.
Challenge identified and actions taken :
The probability of having hip replacement is 2.87 times higher in people receiving usual care (for e.g. GP care) compared to those who have participated in individually tailored exercise programmes such as ESCAPE-pain.

What is ESCAPE-pain?

ESCAPE-pain is a group rehabilitation programme for people with chronic joint pain in their knee and/or hip. Participants attend facilitated sessions twice a week for 6 weeks. Each session involves education and exercise components which are individualised for each patient. The Programme is both clinically and cost effective, producing measurable improvements in physical and mental health. It delivers the core NICE recommendations for the management of osteoarthritis in adults.

Research papers show it has wide health benefits and reduces healthcare utilisation. It is cited as a case study in the NHS /Rightcare QIPPseries. 

Delivering ESCAPE-pain typically involves implementing changes to current service provision coupled with a commitment from the CCG and Provider organisation to ‘invest to save,’ using the ‘evidence-base’ of ESCAPE-pain to ensure that a minimum of 10 (and ideally 12 sessions) are offered to participants, for longer-term benefit.
Impacts / outcomes: 
  • Clinical outcome measures - KOOS (Knee osteoarthritis outcome score), HOOS (Hip osteoarthritis outcome score) and HADS (Hospital anxiety and depression scale) assess pain, function, activities of daily living and quality of life.
  • Data from live sites demonstrates improvements in pain, function, and the ability to carry out activities of daily living; as well as improvements in mental health for participants completing the programme.
  • Staff and participant satisfaction: scores in both domains are consistently very positive.
  • Capacity benefits: grouping participants into cohorts for ESCAPE-pain reduces wait time for 1:1 physio.
  • Savings: research evidence showing a reduction in overall healthcare utilisation following the programme can be easily extrapolated to the local MSK prevalence using the MSK calculator (Arthritis Research UK).
  • From a baseline of 2 sites (2014), ESCAPE-pain is now delivered at >80 sites in England/Wales, including leisure centres as well as clinical departments - over 7000 participants to date.
  • Physiotherapy savings: extrapolation of research findings suggests physiotherapy savings of £82 per person, i.e. £574,000 total national savings to date. In practice this will have meant capacity release, as disinvestment in physiotherapy services is unlikely to have occurred.
  • Overall health and social care utilisation per patient: extrapolation of research findings suggests reductions achievement of overall health and social care utilisation of £1,511 per person per programme i.e. £10.6 million total national savings to date
Awards and endorsements
Which local or national clinical or policy priorities does this innovation address:
Health and Wellbeing
Supporting quote for the innovation from key stakeholders:
The ESCAPE-pain website is a project supported by the Health Innovation Network. Founded by NHS England, the Health Innovation Network is the Academic Health Science Network (AHSN) for South London. Their objective is to deliver service improvement and sustainable change, through collaborating with partners from the NHS, universities, local government, industry, the third sector, and prioritising involvement from service users and the public, to drive innovation and best practice across South London.
Plans for the future:
  • Approximately 1 in 5 of the adult population over the age of 50 have osteoarthritis. Access to ESCAPE-pain need not be limited to clinical environments. ESCAPE-pain is currently being offered in hospitals, physiotherapy departments, gyms, local leisure centres, and community halls etc. One of the aims is to grow the number of leisure sector providers offering the programme and also providers based out in the community.
  • The programme has been selected by the AHSN Network for national adoption and spread during 2018-2020.
  • The free ESCAPE-pain app is available on both iOS and Android devices. It contains 16 high-quality exercise videos and engaging animations and videos to help people learn how to manage their condition better and feel more in control of their pain.
  • An additional digital tool has been launched to further support the ESCAPE-pain programme. ESCAPE-pain Online is a web-based version of the app which replicates the same education and exercise videos. It allows people who don’t have smart phones to continue exercising safely in their own homes. ESCAPE-pain Online has been designed to be accessed from a computer.
Tips for adoption:
  • Facilitators must attend a one-day training course to become an ESCAPE-pain facilitator covering key areas such as the content of all 12 sessions, the evidence-base, Motivational Interviewing, the importance of collecting the clinical outcomes etc.
  • Initial support and mentoring to ESCAPE-pain facilitators (typically physiotherapists and fitness instructors) to set up the Programme.
  • Describing aligned incentives – delivering ESCAPE-pain in groups releases capacity in physiotherapy services, and is cheaper for CCGs, as well as delivering participant benefits.
  • Influencing commissioners through existing fora/more detailed discussions where CCGs are re-procuring MSK services.
  • For National Programme spread monthly webinars are scheduled to bring together ESCAPE-pain project/programme managers with those who have experience in delivering the programme. Each webinar covers key topics and provides an opportunity for sharing best practice and discussing challenges. Face-to-face events are planned as well.
  • Ongoing use and promotion of the ESCAPE-pain website to demonstrate digitally and succinctly how to deliver the Programme; the website also provides research evidence/financial data for commissioners.
  • Ongoing use and promotion of the free ESCAPE-pain app which is available on iOS and Android devices, and ESCAPE-pain Online.
  • Distributed leadership: clinical champions and champion sites regularly showcase the Programme.
  • Annual event to bring together sites delivering the Programme to learn from each other. gives all the materials required to commission the Programme and provides information on how to access the training.
Contact for further information:
Andrea Carter
E: website for healthcare professionals and commissioners, showing videos of the Programme, full evidence-base, educational information for patients etc. Register for free to access the education and exercise videos.
Metrics: outcome data can be provided
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