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Red alert


23 April 2015

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The need to flag up concerns about patients is essential. The Red Button system allows GPs to log any quality issues or concerns they may have, while also including important feedback from patients

The formation of NHS Greater Huddersfield Clinical Commissioning Group (CCG), and the subsequent forging of closer links between primary care and commissioning, has resulted in a more intelligent and insight-led approach to quality and service improvement.

The need to flag up concerns about patients is essential. The Red Button system allows GPs to log any quality issues or concerns they may have, while also including important feedback from patients

The formation of NHS Greater Huddersfield Clinical Commissioning Group (CCG), and the subsequent forging of closer links between primary care and commissioning, has resulted in a more intelligent and insight-led approach to quality and service improvement.


In Greater Huddersfield, the number and nature of quality issues is not dissimilar to those experienced by other, comparable CCG areas and comprehensive incident reporting systems are in place to identify and manage incidents.


The CCG has gone one step further, taking a preventative strategy by identifying emerging issues and triggering resolutions prior to issues escalating into a potential incident.  


By employing a range of techniques that analyse and theme anecdotal feedback and soft intelligence, the CCG can divide information across a number of sources including complaints, patient advice liaison services (PALS) contacts, online feedback, national surveys, and local feedback questionnaires to highlight emerging trends or areas of potential future concern.


The development of the award-winning Red Button was developed because of local GP practice feedback and in line with the recommendations of the Mid Staffordshire NHS Foundation Trust Public Inquiry, which highlighted the need to accumulate patient experience insights and act on any potential quality issues. The Red Button is an ‘early warning’ reporting system that allows GPs to log issues or concerns, while also including important feedback from patients.
Its strength is that, by collecting data on any complaints, concerns or examples of poor experiences, it can prompt action before most people even realise that there is an issue to be addressed.  


Defining a user-friendly system
The system itself is simple; GP practices are able to share feedback on hospital, community or mental health services with other practices and staff in the CCG via a dedicated section on the CCG’s intranet site. This is a secure platform that acts as a repository for archived information as well as up-to-date reports themed into one of five categories:

  • Administrative.
  • Communication.
  • General care.
  • Treatment.
  • Accident and emergency.  
  • Contracting.
     

The themes were derived from direct feedback from practices on the issues that cause concern.


Practice managers were involved in the development of the quality issues reporting form, which has ensured that comprehensive, consistent and insightful issues reports are provided by all participants in the scheme.


Created within existing CCG resources, the only additional focus given to the development of the system was co-production with GP practices so that it would be functional, user-friendly and easy to embed into everyday practice. The CCG firmly believes that this co-production approach has been fundamental to the successful implementation of the Red Button and to the ongoing improvements in the quality and quantity of reporting.


The system’s maintenance and administration and the formation of quality reports is delivered through the CCG’s quality team with a view to automating parts of the reporting process in the future to improve system efficiency even further.

Patient experience
The Red Button is a clearly defined tool; it does not replace local arrangements for reporting incidents but provides commissioners, and GPs with additional thematic information that can be used in contract and quality assurance meetings, and to make direct service improvements.


Themed reports are generated monthly and fed into the CCG governance process through its quality and safety committee, and reported to the governing body to ensure that quality remains a key focus.


Face-to-face meetings are held quarterly with member GP practices to share themes, emerging trends and feedback on interventions that have been made as a result of reports back to the system. More pressing updates are provided via the CCG’s well-established electronic communication mechanisms on a fortnightly basis.

Evaluating and refining the systems
As a new approach to identifying potential quality issues, the metrics developed for the Red Button scheme in its first year have been challenging to quantify. The CCG agreed that the minimum number of practices that should be regularly using the system is 80% and the CCG is on track to achieve this with 30 of 39 practices already engaged in using the tool.   


The first year of the Red Button has identified a broad baseline of conversion activity, in other words, the number of actions taken or service changes made as a direct result of the insight gathered through the scheme.


In 2015, the team will work with GPs to identify future metrics that will support the further evaluation of the Red Button and its contribution to improving quality and patient experience.

Using outcomes to generate change
The Red Button scheme has supported the CCG in delivering priorities in two of NHS England’s national domains: ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm.


The Red Button scheme was rolled out in 2014 and in that year 262 reports were made through the system; an average of 21.8 submissions per month. By January of this year, 77% of member GP practices had reported at least one quality issue using the Red Button system and the number of issues reported monthly had increased from five in its first month of operation to 46 in the last reporting month.


Issues reported through the system have been wide ranging but have identified that communication with patients and administration systems are the root cause of significantly more issues than clinical activity. However, GP practices also continue to report patient safety and clinical issues directly to provider organisations to ensure prompt action is taken through existing mechanisms.


Particular areas highlighted include:

  • Communicating the results of diagnostic tests.
  • Booking and effective administration of appointments.
  • Communication with health professionals in relation to general patient care.
     

Where specific issues have been identified, the focus has been on identifying root causes and implementing prompt action to resolve these problems before they are able to develop into more serious areas for concern. Although hard to quantify at this stage, the CCG believes that in the long-term this approach will prevent incidents from occurring and support people to access more proactive, high-quality, joined-up healthcare.


Some examples of action undertaken in 2014 include:

  • Introducing best practice in certifying deaths out of working hours and introducing multi-organisation training to enable community nurses to certify deaths.
  • Working with provider organisations to improve the quality of discharge letters, including prescribing information and clarifying prescribing responsibilities between primary and secondary care.
     

Future application of the Red Button
The Red Button scheme has significant potential to further enhance and improve patient safety, quality and experience. In February 2015, Greater Huddersfield CCG was successful in winning a Health Innovation Award for the scheme and plans to use the prize fund to further improve the functionality of the system, as well as scoping the roll out of the system to other health and social care professionals.
Further development work is being undertaken with practices to ensure that the system is as convenient and as easy to use as possible and feedback from the last 12 months of operation is informing the development of a more sophisticated IT platform.
The system has been well received by GPs and practice staff across the Greater Huddersfield area and interest has been shown in implementing the Red Button in other CCG areas.

Penny Woodhead is the head of quality and safety for NHS Greater Huddersfield CCG.
Emma Bownas is the CCG’s quality manager.

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