Patients' reports and evaluations of patient safety in English general practices: a cross-sectional study

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The problem

One of the most remarkable features of patient safety research in primary care is the sparse attention paid to the patients' themselves. The aim of this study was to examine patients´ perceptions and experiences of patient safety in general practices in England.

The approach

A cross-sectional study was conducted as part of the development and piloting of the NIHR Patient Safety Toolkit. The Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to 6,675 adult patients from 45 practices distributed across five regions in England (Manchester, Nottingham, Keele, Southampton and Birmingham). Practices were selected through purposeful sampling in order to ensure variation in terms of list size and levels of deprivation. Questionnaires were sent by practices with a covering letter and a pre-paid reply envelope to a computer generated random sample of 150 patients. Main outcome measures included: patients' perceptions of the safety of the healthcare received in their general practices, experiences of safety problems, and experiences of harm. We conducted descriptive analyses at the patient level, and estimated intra-cluster correlation coefficients to examine potential differences across practices' mean scale scores.


Completed questionnaires were returned by 1,244 patients (18.6%). Respondents were more likely to be female, elderly and of ‘‘white'' ethnicity. We observed relatively high mean (sd) scores for safe environment 83.7 (18.5), perception of patient safety 86.0 (16.8), and trustworthiness 87.4 (16.1), (all scales ranging 0-100). However, 478 patients (40.4%) reported having experienced at least one safety problem in the previous 12 months, most frequently related to appointments (351 patients), diagnosis (105), coordination between healthcare professionals (97), and patient-provider communication (96). Almost all of these patients (93.6%) thought that the problems could have been prevented. More than three quarters of the patients (78.6%) reported that the practice had at least some responsibility, whereas 18.7% reported that they themselves had some responsibility. A minority of patients (n=221, 19.4%) reported having been harmed as a result of the healthcare provided in their general practice in the previous 12 months, and the harm was rated as low (mean harm score = 35.3/100 (SD=26.4)). Most frequent types of harm reported were anxiety/stress (155 patients) and pain (105). Intra-cluster correlation coefficients were statistically significant for the vast majority of the scales and ranged from 0.02 to 0.20, indicating small to moderate differences in patient responses across practices.


This is the first study evaluating the safety of general practices in England as experienced by patients themselves. Despite its limitations concerning response rate obtained and limited evidence of PREOS-PC's psychometric properties, this study allowed us to identify potential areas for improving patient safety in general practices in England in relation to appointments, diagnosis, communication and co-ordination.


  • Ignacio Ricci-Cabello, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
  • Kate Marsden, Institute for Science and Technology in Medicine. University of Keele, Keele, UK
  • Anthony Avery, Institute for Science and Technology in Medicine. University of Keele, Keele, UK
  • Umesh Kadam, Institute for Population Health. University of Manchester, Manchester, UK
  • David Reeves, School of Medicine, Pharmacy and Health, Durham, UK
  • Brian Bell, Institute for Science and Technology in Medicine. University of Keele, Keele, UK
  • Stephen Campbell, School of Medicine, Pharmacy and Health, Durham, UK
  • Sarah P Slight, Academic Unit of Primary Care and Population Sciences. University of Southampton, Southampton, UK
  • Katherine Perryman, School of Medicine, Pharmacy and Health, Durham, UK
  • Jane Barnett, Institute of Occupational and Environmental Medicine. University of Birmingham, Birmingham, UK
  • Ian Litchfield, NIHR Clinical Research Network, West Midlands, UK
  • Sally Thomas, Institute for Health Research. University of Exeter Collaboration for Academic Primary Care
  • Jose María Valderas