This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Sarah and Jaydee are working on an innovative project at NHS Dorset Integrated Care Board (ICB) to ensure general practice is a central part of improving patient safety across services. They talk about the value and challenges of collaborative working, how they are tailoring their offer to fit the needs of local GP practices, and making patient safety a core part of training for all healthcare professionals.
About the Author
Sarah Kay is a portfolio General Practitioner based in West Dorset with her family. She has experience in leadership and management, quality improvement and assurance, and GP education. Her clinical work is as a locum GP and she holds a variety of other roles.
As a Registered Nurse for more than 30 years, Jaydee Swarbrick has been involved in service and quality improvement projects throughout her career with the aim to enhance patient experience and outcomes. Since appointment to the Patient Safety role in March 2017, Jaydee has worked with local system partners to take a collaborative approach to Patient Safety in Dorset embedding partnership working in the Integrated Care System.
Questions & Answers
Hello Jaydee and Sarah. Please can you tell us who you are and what you do?
Jaydee: I’m Jaydee Swarbrick, a nurse by background and currently the Patient Safety Specialist at NHS Dorset Integrated Care Board (ICB). When I took on this role in patient safety, I quickly realised I needed to work closely with primary care, and was supported by NHS Dorset to recruit a GP Lead for patient safety - and we appointed Sarah!
Sarah: I’m Sarah Kay and I’ve worked in Dorset as a portfolio GP for a number of years. During the Covid pandemic, I got involved in clinical governance for the Covid Clinical Assessment Service which was taking calls for NHS 111. I became interested in patient safety in terms of understanding why some patient journeys go well, and others need to have some learning from them. Just over a year ago I saw the role with Jaydee’s team advertised and it felt like it had my name written all over it!
How did you first become interested in patient safety?
Jaydee: When I was a sister and then a matron, I had oversight for patient safety in medicine and cardiology. I realised that patient safety is fundamental to making sure people get the best experience of care, and that focusing on patient safety means we are supporting staff and valuing their contribution. I began to take on project lead roles for safety improvement and then realised at a certain point that patient safety was what I wanted to do, which is when I got a full time patient safety role.
I also have a personal interest in patient safety. I moved to Leeds after my training and worked in a pioneering cardiac centre. My grandmother had bad heart disease from 1976 and I could see that she was not receiving the same level of care. The postcode discrepancies were striking and patients had very different experiences, outcomes and safety depending on where they lived. As a nurse, it always drove me to seek improvements in the practice areas where I was working.
Sarah: My interest in patient safety came from attending some excellent quality improvement courses. I learned about concepts which just made such a lot of sense, like functional workplaces and civility. I could see that these practices contribute to patient safety, but realised the contribution they make wasn’t widely understood. When I learned about the Swiss Cheese Model, things really clicked into place for me—it’s not usually a single point of failure, but multiple points that line up to result in an outcome of harm. In patient safety science, it’s very hard to achieve ‘zero events’ but if you really look into the incidents that exist, learn from them and put things in place to prevent them, it can make a huge difference.
Tell us a bit about how the team operates and how you work together.
Sarah: I work one day a week and Jaydee is full time, so it’s really important for us to find a good length of time together each week to focus on priorities. I try to keep on top of my emails so I have all the things Jaydee might be talking to me about on my radar, and then we discuss what I should be spending my time on. There is so much to do that this role could be full time and I still wouldn’t get to everything! My experience working locally in primary care means I can most usefully contribute to the team by focusing on clinical issues. For example, if the primary care team is asking what a GP might reasonably do, I’m the go-to contact, or if the medication management team wants some clinical input, they would come to me.
Jaydee: The biggest thing we have been working on together is the Patient Safety in Primary Care project, which is a collection of workstreams to improve patient safety in general practice. NHS England’s National Patient Safety Strategy (NPSS) doesn’t really focus on primary care, but in Dorset we think that primary care, and particularly general practice, is a fundamental element of our health service. We don’t want to start a transformation project without primary care being involved. It’s a wide ranging project that covers the strands from the NPSS around reporting incidents, improving the quality of investigations and making sure learning is shared. We also link with our primary care commissioning team to ensure everyone is aligned on the project aims.
How is the project making a tangible difference to general practice in Dorset?
Jaydee: The Care Quality Commission (CQC) have started their inspection rounds again following the pandemic. Obviously, over the past two years there have been significant changes in practice and new operational pressures for GPs. In some cases, we’re seeing that primary care has lost focus on the processes that support good governance, so our team is reaching out and offering support to practices who have been downgraded for safety by the CQC. We can see that if practices had access to some simple governance processes, it could help them better apply patient safety practices and evidence them to the CQC.
Sarah: We are trying to get a better understanding of the patient safety issues that affect primary care and where we would like to see change. It’s going to take a little while, but we want patient safety to be just one of those core things that you do in primary care. We would love it to be given the same focus as something like safeguarding; everyone working in general practice has mandatory safeguarding training, a local safeguarding link and talks about safeguarding in their appraisal, and we would like to see this happen for patient safety. I’d love to see a patient safety lead in every Primary Care Network (PCN), but we need to work out how to resource that.
We are very focused on sharing learning and Jaydee and I recently recorded a podcast for Wessex LMCs looking at a specific patient safety incident. We need to make sure that we bring patient safety to life for staff in general practice by using case discussions, rather than just talking about theory.
Which part of your role do you find the most fulfilling?
Jaydee: Working together on this project is really exciting! It’s always fulfilling to try something new and bring people on a journey. I really enjoy reaching out, raising awareness and bringing staff on board.
Sarah: I really enjoy working with Jaydee—she’s the gin and I’m the tonic! We’re a good team as she’s got that acute head on her and I’ve got the community head on me. It’s also really great to share learning with colleagues and network across different regions. When you look at the national picture, different places are working at different speeds and the idea that everyone has to go through the same painful process is awful! If one area experiences the challenges and then shares that learning with those who want to pick it up, it liberates time for other areas to pursue different projects and priorities. We want our knowledge to make others’ journeys smoother.
Jaydee and I have done quite a lot of work on sharing the rollout of the Medical Examiner programme into the community, as it has gone quite well in Dorset. There have been people from other areas who are a bit further behind in the process who have asked for help, and it’s been lovely to be able to share our journey and signpost them to the key people who can support them.
Jaydee: That push outwards is one of the things Sarah has really brought to the team, helping us recognise what we’re doing well and sharing it more widely. We all need a challenge and a push to get things moving, so it’s great to work together on this.
What patient safety challenges does the health system face at the moment?
Jaydee: A major challenge for general practice is workforce pressures. At the moment there isn’t much capacity to support the work we are doing as staff don’t necessarily have time to think about something new, or even consider what they are already doing for patient safety.
Sarah: General practice is working incredibly hard, with a huge increase in demand compared to before the pandemic. I think backlogs in secondary care are impacting on the number of people trying to access their GPs at the moment. Asking staff to do anything additional is a very big ask, and we’ve accepted that we need to work at the pace of those around us in general practice.
One of the approaches we’ve taken is trying to address issues that are already on practices’ to-do lists, rather than adding new things. For example, we did a two topic webinar with one of our local cancer alliance colleagues on safety netting in Covid and cancer. As well as being an important patient safety issue, safety netting is a valid clinical CPD topic. Also, if safety netting is effective it can help reduce complaints and help practices respond to them. Lots of practices are concerned about an increase in complaints at the moment because patient journeys aren’t always going smoothly. So we’re trying to offer support that’s good for patient safety, but also addresses clinicians' other concerns.
What do you think the next few years hold for patient safety?
Jaydee: We’re on a big transformation journey with the NPSS and the national team at NHS England are aware that primary care and GP has been missed in that initial launch. There have been some national working groups to try and ensure the strategy and its requirements can be applied within primary care. We’re working with the national team as an early implementer to test new processes, give feedback and see how things are going in other areas of the country.
Sarah: The team’s current priorities are pressing forward with the different workstreams, recruiting a patient safety fellow—either a GP or practice nurse and when the time is right, getting people to engage with the national patient safety e-learning. I think we’re going to be pretty busy over the next few years!
We are also trying to connect more with other areas. There is now a patient safety primary care forum on the NHS collaboration platform that means people who are interested in the primary care side of patient safety can find each other. In the South West, we are due to be starting a new Primary Care and General Practice Safety Network, and we’d like other areas to do the same so that people can build connections locally and strengthen the focus on primary care patient safety in their area.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
Jaydee: The one thing that I would change is making patient safety a more fundamental part of training for students and trainees. I want healthcare workers to see patient safety as a clear priority right at the start of their career, as I don’t think I had that when I trained as a nurse.
Sarah: For me, I would like us to get to the stage where people can own things that don’t go well and share them without shame. We’re quite a long way from a no-blame culture at the moment and people still feel worried about saying when things have gone wrong. It’s a very complex system we work in, with complex patients who might be seeing GP teams, community teams, hospital teams and other healthcare professionals. Things are never going to go right 100% of the time, but when things don’t go well, let’s share it and learn from it. What’s more tragic than something going wrong once, is the same thing going wrong again when the second incident could have been prevented.
Jaydee: We both feel that being open and having a just culture are really important, and we’d like that to be central to training, right from the very beginning.
Are there things that you do outside of your role which have made you think differently about patient safety?
Jaydee: I’m a Royal College of Nursing (RCN) representative and that’s made me realise the significance of workforce issues to patient safety, such as retention and the staff supply line. I see how the staff shortage primary care faces at the moment is inseparable from patient safety.
Sarah: It’s quite new to me, but I’ve started to become interested in the health inequalities side of climate change and can see the effect it has on patient safety. I did a population health management fellowship a few years ago and the variation between outcomes in different populations and postcode areas is stark. Climate change affects some people more than others, and that needs to be addressed. For example, the pandemic lockdowns were more challenging health-wise for people living in high-rise flats with no outside space, than for people with gardens. During the heatwaves this summer we’ve seen an increase in demand for GP, ambulance and A&E services as a result of climate change. We need a more joined-up approach to forge forward with the climate change agenda, because that is what will help reduce health inequalities. Unfortunately, I think the health impacts of climate change are going to make Covid look like a picnic.
Tell us one thing about yourself that might surprise us!
Sarah: A couple of years ago I helped set up a parkrun in my hometown, so that's what I do most Saturday mornings. It's such a wonderful and inclusive way for people to get out and about and meet people in their local community. I would encourage anyone who’s never tried it to look up your local parkrun and go along!
Jaydee: On the theme of exercise, I’ve surprised myself recently by cycling to work every day, something I thought I wouldn’t be able to do!