Berkshire East Clinical CCG’s Clinical Concern Report
1st July – 31st August 2013
Overview – BE CCG’s
This paper contains an analysis of the clinical concerns reported by GP practices within the three Berkshire East CCGs
(Bracknell & Ascot CCG, WAM CCG, and Slough
CCG) during the period 1st July – 31st August
Berkshire East CCG's Clinical Concerns Raised
2013.
1 July- 31 Aug 2013
71
number
80
60
During this period there were 113 clinical
concerns reported (42 in July and 71 in August).
This represents a 44% increase in the number of
clinical concerns being reported by GP’s as a
result of the service being more widely utilised.
39
40
20
3
0
Series1
Bracknell &
Ascot CCG
Slough CCG
WAM CCG
71
3
39
The majority of concerns are raised by Bracknell and Ascot CCG (71), WAM CCG (39). Slough CCG has continued to
report low numbers of clinical concerns via the inbox, with an increase of only x1 since the last report in August.
The table below presents the clinical concerns reported for each CCG by the theme of the concern. Referral and
appointment issues continue to attract the highest number of concerns, as previously reported.
Table 1 : Clinical Concerns by Theme across BE CCG’s : 1 July to 31 Aug 2013
Theme
Clinical Concern
Communication Error
Lack of Forward Planning of Appointment
System
Referral Issue / Appointments
Disputing Appointment Charge
DNA Issue
Poor Processes in Place
Service Issue
Inappropriate Response to NHS 111
Waiting Times for NHS 111
Incorrect Demographics NHS 111
Ambulance Waiting Times
Inappropriate Discharge
Incomplete Discharge Paperwork
Incomplete Paperwork
Other
Total
WAM
Bracknell
9
2
8
5
Slough
2
2
25
7
2
1
2
1
1
5
3
1
12
1
3
1
1
6
8
4
1
39
71
3
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Bracknell and Ascot CCG
In July and August, Bracknell & Ascot CCG reported 71 clinical concerns. Of these 25 related to referral and
appointment issues.
Clinical Concerns Raised by Bracknell & Ascot CCG by Theme
July and August 2013
No of Clinical Concerns
30
25
25
20
15
10
5
9
7
2
2
6
2
1
2
1
1
8
4
1
Bracknell
0
Of these 25 concerns, 10 of these concerns related to HWPFT. (Increase of 3 reported since last report)
3 related to RBFT (1 practice reported all 3 concerns, no increase in August).
Of the remaining 7 concerns related to FPFT, where 4 concerns were regarding wrong referrals (inappropriately
redirected to MSK) thus wasting patient’s time. Also Upton children’s services reported 2 concerns regarding
children’s audiology referrals. All of these concerns have been communicated to these providers.
Table 2: Breakdown of Themes relating to Referral and Appointment Issues in Bracknell and Ascot CCG
Referral / Appointment Issue
C&B No Appointments
Follow Up Appointment not made
Audiology Referral process
Cancelled Appointment
GP Unable to make Urgent Appointment
Wrong Referral - wasting time
Request for pre -assessment by GP
Provider Refusing Appointment
Appointment date arrived late
HWPFT
5
3
FPFT
RBFT
BHFT
1
2
1
1
2
4
1
1
1
The 8 concerns regarding incomplete paperwork related to the NHS111 service. This has not an increased since last
report. These have been forwarded to the provider for action.
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Slough CCG
Clinical Concerns Raised by Slough CCG
by Theme July and August 2013
Slough CCG reported 3 clinical
concerns during the period of
the 1st July – 31st August
2013, an increase of x1 since
the last report.
2 of the 3 concerns were
reported by the same practice
and all 3 concerns related to
HWPFT. These concerns have
been reported to the provider.
2.5
No of Clinical Concerns
2
2
1.5
1
1
0.5
0
Slough
Clinical Concern
2
Referral Issue /
Appointments
1
WAM CCG
WAM CCG reported 39 clinical concerns during the review period. (an increase of 15 since the last report). The
theme attracting the highest number of concerns in July was Referral Issues with 5 reports. Three of these concerns
related to HWPFT, and were reported by 3 practices. 1 related to Choose & Book and 1 BHT. All of these concerns
have been reported either directly to the provider of via the contracting team.
No of Clinical Concerns
Clinical Concerns Raised by WAM CCG by Theme
July and August 2013
14
12
10
8
6
4
2
0
12
8
5
5
3
3
1
1
1
However during August there has been an increase in the number of concerns raised in WAM regarding
inappropriate response by NHS 111. All concerns raised by Dr A Hayter, Runnymede Practice.
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Such concerns are summarised in the table below :
Table 3 : Summary of Concerns raised regarding NHS111 Inappropriate Response in WAM
Summary of Concern Reported regarding NHS 111 Response in WAM
NHS111 called to child with a rash - inappropriate response waste of NHS
resources.
NHS111 passing calls on to OOH.
Child was not in a life threatening situation. Inappropriate response by NHS
111
In appropriate Call out by NHS 111
NHS11 Response to child with rash. Inappropriate response.
Pathway directing inappropriate response. Patient appears to have viral
labrinthithis and GP visit already organised.
19:00hrs Walk in Centre - Patient advised to call NHS 111 was then triaged
to OOH.
WIC - suggest contract should be opened to 20:00
Inappropriate response to NHS111.
Inappropriate response to NHS111.
Inappropriate response to NHS111.
Inappropriate response to NHS111. Toothache this should have been sent
to OOH
Inappropriate response to NHS111. Patient triaged by OOH as a 1 hr
response. There should have been paramedic response as there was
possible heart rhythm disturbance causing dizziness.
5 communication errors were reported, (an increase of x1 since the last report) all of which relate to the NHS111
services and were reported by 1 practice. These concerns have been communicated to the service.
There were also 9 general clinical concerns raised by the CCG (an increase of x1 since the last report) the themes of
these concerns included; Issue with availability of recommended sharps; Post Op suture - no information on how to
deal with these; Patient discharged from clinic without results; Patient needed blood thinning injection at hospital
and needed transportation - SCAS could not help as it was seen as non –urgent; no letter given to patient on
discharge – patient had high blood sugars and renal failure. The providers involved were TVPCA; HWPFT; SCAS, FPH
the fourth provider was not given.
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Overview – Provider Issues Reported as Clinical Concerns for all BE CCG’s
NHS111
From an analysis of the 113 clinical concerns reported by Berkshire East CCG practices during the period of 1st July to
31st August 2013, 34 related to the NHS111 service. These concerns are illustrate below and have been reported to
the service and communicated to Kath Havisham, CSU Provider Performance Lead and Contract Specialist.
Berkshire East CCGs Clinical Concerns
reported about NHS111 (1 Jul 13 - 31 Aug 13)
14
12
Number
10
8
6
4
2
0
NHS111
Clinical
Concern
Communicari
on Error
3
5
Inappropriate Incomplete /
Response
Inappropriate
NHS111
Paperwork
13
9
Poor
Processes in
place
Service Issue
Waiting Times
NHS111
2
1
1
HWPFT
There were also 26 clinical concerns reported which relate to HWPFT (an increase of x10 since the last report). The
largest number related to referrals issues (13). The increase in referral issues has almost doubled since last month’s
reports. The other areas of concerns are presented in the chart below.
Number
Berkshire East CCGs Clinical Concerns
reported about HWPFT (1 Jul 13 - 31 Aug 13)
14
12
10
8
6
4
2
0
HWPFT
Clinical Concern
Disputing
Appointment
Charge
Inappropriate
Discharge
5
3
2
Lack of forward
planning of
Poor Processes
appoint ment
in place
system
1
2
Referral Issue
13
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The x13 referral and appointment issues raised against HWPFT are summarised below :
Table 4: Summary of Referral and Appointment Concerns Raised against HWPFT for all BE CCG’s
Referral / Appointment Issue
C&B No Appointments
Follow Up Appointment not made
Audiology Referral process
Request for pre -assessment to be completed by GP
Appointment date arrived late
Patient offered appointment at one location when requested another
HWPFT
6
3
1
1
1
1
FPFT
X16 clinical concerns have been reported regarding FPH since 1st July 2013. Of these x7 were regarding referral and
appointment issues.
Berkshire East CCGs Clinical Concerns
reported about FPFT (1 Jul 13 - 31 Aug 13)
8
7
Number
6
5
4
3
2
1
0
FPFT
Clinical
Concern
Disputing
Appointment
Charge
DNA
Incomplete
Discharge
Paperwork
4
2
1
1
Innappropria
Referral Issue
te paparwork
1
7
Table 5: Summary of Referral and Appointment Concerns Raised against FPFT for all BE CCG’s
Referral / Appointment Issue
Cancelled Appointment
Follow Up Appointment not made
Wrong Referral – Misdirected to MSK - wasting time
Provider refused Appointment
FPFT
1
1
4
1
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Appendix
The following pages contain a copy of all of the clinical concerns reported by Berkshire East CCG during the period
8th August to 31st August 2013. (Previous concerns reported in last monthly report for period 1 July to 7th August
2013 )
Practice
Reporting
Runnymede
Medical
Practice
Provider
Involved
SCAS
Bracknell
Magnolia Hse
Bracknell
CCG
WAM
Date
Theme
03/08/2013 Clinical
Concern
Primary Concern
Patient needed blood
thinning injection at
hospital and needed
transportation. SCAS could
not help as it was seen as
non -urgent.
HWPFT
08/08/2013 Referral Issue
Patient with groin pain
referred late 2012, not
forwarded follow-up
appointment after 3
months. Following
admittance to HWP.
Patient felt diagnosis for
bilat lymph node changes
in groin not investigated.
Some 4 weeks later after
discharge in March, no
appointment received.
Magnolia Hse
FPH
07/08/2013 Incomplete
Paperwork
Patient discharged with
inappropriate and
incomplete paperwork.
Bracknell
Ringmead
Medical
Practice
BHT
08/08/2013 Referral Issue
Bracknell
Sandhurst
Surgery
IFR
12/08/13
(MAY 13)
Other
Patient reviewed by
Audiology team and
advised she needs another
referral.
Surgery requesting
information regarding
weight reduction surgery
Bracknell
Sandhurst
Surgery
FPH
13/08/13
(June 13)
Referral Issue
Orthopaedic Hand Clinic Patient carpal tunnel
release was redirected to
MSK CATS who referred
him to plastics wasting
time.
Bracknell
Sandhurst
Surgery
FPH
13/08/13
(June 13)
Referral Issue
Bracknell
Ringmead
Medical
Practice
HWPFT
08/18/13
Referral Issue
Patient referred to
Orthopaedic Spinal
Surgeons - then redirected
to MSK CATS .
Letter from GP required for
a pre-assessment.
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Bracknell
Great
Hollands
Health Centre
Langley
Health Centre
RBH
13/08/2013 Clinical
Concern
Dr concerned that hospital
did not request 24hr ECG.
HWPFT
14/08/2013 Clinical
Concern
Patient waited 5hrs only to
be told they would have to
wait another 5 hrs. Patient
deteriorated.
Bracknell
Great
Hollands
Health Centre
FPH
15/08/2013 Referral Issue
Referral made in error and
was cancelled. GP surgery
will have to refer again.
Long delay in this patient
being seen.
Bracknell
Great
Hollands
Health Centre
FPH
15/08/2013 Referral Issue
Appointment system at
FPH - patients are being
refused appointments.
WAM
Runnymede
Medical
Practice
Runnymede
Medical
Practice
Runnymede
Medical
Practice
NHS111
10/08/2013 Inappropriate
Response
NHS111
10/08/2013 Poor Processes
in place
Child was not in a life
threatening situation.
NHS111
10/08/2013 Inappropriate
Response
NHS111
In appropriate Call out
Bracknell
Not Known
Health
Visitors
15/08/2013 Service Issue
BE Wide
Not Known
Health
Visitors
15/08/2013 Service Issue
Anxious mother received
advice to have baby
checked by both GP and
HV. Increased Mother's
anxiety and was considered
unnecessary.
A&E contacts. Patient (baby),
Mum noticed a swelling on
the babies scalp and saw GP,
who reassured her that no
action was
needed. Subsequently saw a
health visitor who advised her
to go to A&E that day. She
attended there on two
separate occasions following
this advice, on both
occasions no treatment was
needed. We received no
letter from the health visitor
advising us of her contact
with this patient and the
advice given. It would have
been more appropriate to
refer back to the GP (with a
letter or call advising us)
Slough
CCG
WAM
WAM
NHS111
Foreign visitors to access
GP services privately.
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Bracknell
Ringmead
Medical
Practice
TBA
13/08/2013 Other
Requesting cc contact
details.
WAM
Runnymede
Medical
Practice
NHS111
13/08/2013 Communication Patient triaged by NHS 111
Error
notes say diarrhoea
vomiting and jaundice.
Father says he made no
mention of jaundice.
Bracknell
Sandhurst
Surgery
FPH
15/08/2013 Referral Issue
Patient referred to
Orthopaedic foot clinic
May 2013. Redirected to
MSK . Saw podiatrist in July
who has now referred him
to foot clinic again. Now
awaiting routine
appointment in 3mths time
after initial referral.
Bracknell
Great
Hollands
Health Centre
HWPFT
16/08/2013
Dr received paperwork for
attendance to A&E no
date, wrong GP and
patient advised that he
has not attended A&E?
Bracknell
Binfield
Surgery
FPH
Incomplete
Discharge
Paperwork
14/08/2013 Referral Issue
Bracknell
Forest End
Medical
Centre
Not known
19/08/2013 Referral Issue
Dr has been asked to
make separate referral for
patient for a colonoscopy
from gastro team. Why
were they unable to
arrange this themselves ?
Bracknell
Ringmead
Medical
Practice
NHS111
14/08/2013 Inappropriate
Response
NHS111
Dr felt this was
inappropriate for a sore
throat
Bracknell
Ringmead
Medical
Practice
RBH
19/08/2013 Lack of Forward
Planning in
Appointment
System
RBH has referred patient to
ECCE without further OPD
despite surgery being
cancelled x2
Bracknell
Ringmead
Medical
Practice
NHS111
19/08/2013 Clinical
Concern
Bracknell
Ringmead
Medical
Practice
NHS111
12/08/2013 Other
23/08/13 Report does not
go into enough detail
needs to be clarified on
report.
23/08/13 Clarification
required on the issue.
C&B referral cancelled as
there were no
appointments. Now
patient has a wait of 2
mths for an appt.
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Bracknell
Magnolia Hse
FPH
20/08/2013
Incomplete
Discharge
Paperwork
18/08/2013 Paperwork
Inappropriate
Patient has been flagged
as having an A&E
attendance. Surgery has
no summary of this.
WAM
Runnymede
Medical
Practice
SCAS
Patient identified as
unregistered however, is
registered at a practice in
Marlow.
Bracknell
Magnolia Hse
20/08/2013 Communication No details
Error
Bracknell
Binfield
Surgery
Ashford &
St Peters
Hospital
Trust
RBH
21/08/2013 Clinical
Concern
Palliative care calling
NHS111 have a 3hr wait.
Not acceptable causes
distress to patients
Bracknell
Ringmead
Medical
Practice
NHS111
26/08/2013 Referral Issue
Concerns regarding
referral process through Dr
Booths secretary.
WAM
Runnymede
Medical
Practice
NHS111
10/08/2013 Incorrect
Demographics
NHS111
Incorrect demographics.
Previous consultation had
taken place.
WAM
Runnymede
Medical
Practice
NHS111
10/08/2013 Inappropriate
Response
NHS111
Pathway directing
inappropriate patient
appears to have viral
labrinthithis and GP visit
already organised.
WAM
Runnymede
Medical
Practice
NHS111
16/08/2013 Inappropriate
Response
NHS111
19:00hrs Walk in Centre patient advised to call NHS
111 was then triaged to
OOH. WIC Contract they
should be opened to 20:00
WAM
Ringmead
Medical
Practice
FPH
20/08/2013 Clinical
Concern
No letter provided for
patient on release from
hospital. Patients life put at
risk as patient has sugars of
22 and renal failure.
Bracknell
Magnolia Hse
FPH
20/08/2013 Disputing
Appointment
Charge
A/E attendance Magnolia
House have been charged
for which isn't their patient
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Bracknell
Binfield
Surgery
RBH
21/08/2013 Communication Patient registered at
Error
Binfield Surgery in April
2013. Her GP details have
not been amended at the
Royal Berkshire Hospital
and therefore all her
clinical letters and
discharge summaries have
been sent to Waterfield
Practice, her previous
surgery
Bracknell
Binfield
Surgery
HWPFT
21/08/2013 Incomplete
Discharge
Paperwork
Practice received
Discharge summary but
did not receive a clinical
letter regarding this Knee
replacement procedure or
follow up appts.
Bracknell
Gainsborough
Practice
TBA
15/08/2013 Referral Issue
Referral process via C+B
regarding this patient
Bracknell
Magnolia Hse
Ashford &
St Peters
Hospital
Trust
23/08/2013 Disputing
Appointment
Charge
Patient has been charged
to Magnolia House for an
A&E attendance but has
never been registered here
WAM
Runnymede
Medical
Practice
NHS111
10/08/2013 Inappropriate
Response
NHS111
Inappropriate response to
NHS111.
WAM
Runnymede
Medical
Practice
NHS111
10/08/2013 Inappropriate
Response
NHS111
Inappropriate response to
NHS111.
WAM
Runnymede
Medical
Practice
NHS111
10/08/2013 Inappropriate
Response
NHS111
Inappropriate response to
NHS111.
WAM
Runnymede
Medical
Practice
NHS111
10/08/2013 Incorrect
Demographics
NHS111
Incorrect demographics.
Bracknell
Ringmead
Medical
Practice
Parapet
22/08/2013 Clinical
Concern
Bracknell
Ringmead
Medical
Practice
FPH
18/08/2013 Clinical
Concern
Patient required a high risk
injection and was advised
to see her GP to obtain
this.
Patient with recurrent
urinary tract infection. He is
unable to eat as he is still
unwell. Transferred back
and forth between FPH
and Royal Surrey.
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Bracknell
Ringmead
Medical
Practice
HWPFT
19/08/2013 Referral Issue
Dr referred patient to be
under Dr Sarsam
Bracknell
Great
Hollands
Health Centre
HWPFT
22/08/2013 Clinical
Concern
WAM
Runnymede
Medical
Practice
NHS111
17/08/2013 Inappropriate
Response
NHS111
Acute advised the GP
should have carried out
tests. The GP did not
receive the discharge
letter.
Toothache this should have
been sent to OOH
WAM
Runnymede
Medical
Practice
NHS111
17/08/2013 Inappropriate
Response
NHS111
Patient triaged by OOH as
a 1 hr response. There
should have been
paramedic response as
there was possible heart
rhythm disturbance
causing dizziness.
Bracknell
Binfield
Surgery
BMI
21/08/2013 Incomplete
Discharge
Paperwork
No Clinical letter regarding
procedure received.
Bracknell
Magnolia Hse
Patient left surgery in 2004
?
Bracknell
Balfron &
Forest End
Royal
23/08/2013 Disputing
Surrey
Appointment
County
Charge
Hospital
NHS
Foundation
Trust
FPH
30/08/2013 DNA Issue
Bracknell
Balfron &
Forest End
FPH
Surgery worried this
concern will go through as
a new referral and it should
be a follow up.
30/08/2013 Referral Issue
Patient attended
appointment with parents
only to be advised no
appointment in Clinic then
received a DNA letter
Author:
Chris Sneller
Quality Improvement Lead
CSCSU
September 2013
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