Every GP practice in England to conduct sepsis audit by March
All GP surgeries in England will need to carry out an audit of how well they identify and manage sepsis over the next two months, under new Government measures aimed at avoiding thousands of deaths resulting from bloodborne infections each year.
Under the plans, the Department of Health (DH) said all practices will have to carry out the audit of their performance by March.
In addition, GPs are set to get a new tool - which will be available ‘from the autumn’ - to help them diagnose sepsis among children under five.
But the GPC and RCGP have said that the imposition of an audit was ‘unhelpful’ and ‘unrealistic’ and will add to increasing workload pressures.
The DH said it wants tackling sepsis to become as much of a priority for the NHS as approaches to combating MRSA and C.difficile.
Currently sepsis claims around 31,000 lives each year, costing the NHS about £2bn - but the Government estimates 11,000 lives and £160m could be saved each year through better diagnosis and treatment.
The plan is for ‘every GP surgery in England to audit their currrent performance by March 2015, to help improve practice in line with NICE guidelines’ and to introduce ‘a new electronic tool from autumn 2015 to prompt GPs to check for the signs and symptoms of sepsis in line with NICE clinical guidelines’, which will ‘start with children under five years old, and eventually extend to adults’.
The DH said GPs would initially be required to audit their handling of children admitted to hospital with infection according to NICE guidelines on febrile illness in children, but in future will be tasked with running an electronic audit tool similar to the GRASP-AF tool for anticoagulation of patients with atrial fibrillation.
A spokesperson told Pulse: ‘The audit tool being proposed is similar to the “GRASP-AF” tool that is already in use in over 3000 practices… We are developing a similar electronic tool on sepsis to enable practices to measure their performance on the assessment of young children with febrile illness.
‘The electronic audit tool is being developed for roll-out in autumn 2015. In the meantime GPs are encouraged to use the audit provided by NICE to accompany their guideline on febrile illness in children to review the care of ten consecutive children from their practice who have been admitted to hospital with infection, and to determine whether an appropriate assessment for sepsis was made when the child presented in primary care.’
Other measures include new diagnosis and treatment goals for hospitals, a potential public awareness campaign, better training through Health Education England and ‘more open reporting of avoidable harm through the new Duty of Candour’, the DH said, while NICE is introducing new guidelines specifically on sepsis in adults next year.
Health secretary Jeremy Hunt said: ‘I want the NHS to rival the safety record of the airline industry and become the safest healthcare system in the world. There has already been good progress. We have virtually halved C. diff and MRSA infection rates in the last four years, saving money, but more importantly improving patient care.
‘Sepsis is a devastating condition that kills more than 80 people in England every day. It’s time to apply the lessons we’ve already learnt on patient safety and reduce the number of lives that are needlessly lost to this silent killer.’
Dr Richard Vautrey said that despite concerns around the impact of sepsis, the call for practices to carry out the audit over the next two months was ‘unhelpful’ given the current workload pressures practices are under.
Dr Vautrey said: ‘I think we need to see the details – clearly it’s an area of concern in terms of the impact that sepsis has, but equally practices are under huge workload pressure at the moment. This is just yet one more thing on top of everything else that has to be done.
He added: ‘Unfortunately we’re in pre-election mode and everything will have a deadline that ends in March with the election in mind – it’s not helpful to have yet more targets or pieces of work short term like this, when we need a much more consistent and sustained investment, both in practices and the wider NHS so we can deliver better care across the board, not in a piecemeal way through various different initial initiatives.’
The new initiative comes as GPs are also under pressure not to prescribe antibiotics unnecessarily because of fears over the growth in antimicrobial resistance. Public Health England recently announced plans to publish individual antibiotic prescribing rates and is in talks with NHS managers about potentially introducing targets to reduce antibiotic prescribing into the GP contract.
Dr Vautrey said this meant GPs are often ‘walking a tightrope’ when managing infectious disease.
He said: ‘At the moment we’re under huge pressure not to prescribe antibiotics for viral infections, yet at the same time there is huge media and Government focus on diagnosing sepsis, so GPs are constantly walking a tight rope in their response to infections.’
Dr Maureen Baker, chair of the RCGP, said: ‘Sepsis is a dangerous condition that can lead to terrible consequences for patients of all ages, so the more GPs can do to identify it as early as possible, the better.
‘Sepsis is difficult to diagnose in general practice as initial symptoms can be similar to common viral illnesses, such as flu or norovirus, so initiatives that will increase timely diagnosis of sepsis and help GPs to keep our patients safe are important and should be encouraged.
‘However, whilst the introduction of a tool to prompt GPs to consider sepsis in their patients would be beneficial, we are concerned that asking GP surgeries to complete a performance audit by March this year is unrealistic, especially at a time when practices are already struggling to deal with the added workload of winter pressures.’