Nottinghamshire LMC was not aware of a serious incident in 2017 whereby the hospital trust failed to send over 400,000 letters and documents intended for GPs, Pulse has been told.
The CQC has also confirmed it was not aware of this incident at NUH and ‘had no record of being informed about the issue’. The regulator will now follow up with the trust directly to ‘establish the circumstances’.
BBC News revealed today that Nottingham University Hospitals Trust’s (NUH) own investigation into the incident found that 411,000 letters and medical documents had been sat unauthorised on Medical Office, a paperless system for typing letters.
Nottinghamshire LMC chair Dr Carter Singh told Pulse he had no knowledge of the incident until reports today, despite being involved in the LMC for nearly 10 years.
However, NUH said in a statement that ‘GPs were informed’ and the trust ‘worked alongside representatives from primary care to agree which correspondence should be resent, which was completed’.
NUH chief executive Anthony May confirmed that a serious incident was declared at the trust in 2017, and that a ‘clinically-led’ assessment identified just under 23,000 GP correspondence documents, out of the total 411,000, that needed action.
The incident came to light when a GP contacted the trust after having received six letters about their patients which dated from four years previous, according to the BBC.
The issue with unauthorised letters started from 2000 onwards, but the majority of unsent letters accrued between 2008 and 2014.
A similar incident involving 24,000 GP letters was revealed in Newcastle earlier this week, and in March, Pulse exclusively reported that a hospital trust in Essex had failed to send more than 53,000 letters due to an IT fault.
Dr Singh said : ‘We are dependent in general practice on an efficient two-way stream of information and really there is no excuse in today’s modern world of IT infrastructure why there should be any delay in sending letters, and also on the accuracy of the information contained.
‘If there is a delay or if the letters aren’t received that can lead to, obviously, delays in diagnoses, incorrect treatment given to patients, and these kinds of errors should not be happening based on problems with IT or communication infrastructure.’
GPC representative for Nottinghamshire and Derbyshire Dr Peter Holden told Pulse that the ‘business of hospital letters going astray has been a longstanding issue’, but that the number of letters involved specifically at NUH is ‘enormous’.
He said: ‘As a GP we don’t know what we don’t know – if we don’t know that there’s a letter missing, we’re not going to know unless or until a patient comes.
‘But it has all the danger signs in there, in that medication could’ve been changed and needed monitoring, or medication could’ve been changed and we then saw the patient, and we prescribe something else that interacts.’
Dr Holden highlighted that this incident in Nottingham is indicative of wider issues with the ‘administrative infrastructure underpinning the hospital-general practice interface’.
NUH has said that although ‘no significant patient harm’ was identified, it will undertake a review of the original investigation in 2017 to address patients’ concerns about whether it was sufficiently ‘thorough and robust’.
Chief executive Anthony May said: ‘An issue was identified in 2017 related to the authorisation and issuing of documents from our Medical Office system, which included letters to GPs amongst other documents.
‘As a result, a serious incident was declared and a full investigation was undertaken to establish actions in line with the Trust’s governance processes at the time.
‘Following a clinically-led process, 22,963 documents related to GP correspondence were identified.
‘GPs were informed, and we worked alongside representatives from primary care to agree which correspondence should be resent, which was completed. The Serious Incident Review concluded that no significant patient harm has been identified following the incident.
‘The Trust took positive steps to prevent a similar incident happening again, including improved communication and training with staff covering administrative processes and their use of the system, we also introduced prompts and safeguards into the system to prevent further occurrences.’
“NUH has said that although ‘no significant patient harm’ was identified,”
Nottingham University Hospital appear to have discounted the possibly unmeasurable but neverhteless significant harm that arose through wasted appointment and admin time in primary care: through GPs and their staff having to chase results, follow up without adequate information, call to ask about medication changes etc etc etc… All of this was time that could have been spent providing appointments to patients in a more timely fashion. Time spent = wasted resource = resource not available to do good = harm.
Or are we saying that the lack of letters for so many years truly caused no harm? In which case, perhaps hospital trusts should just stop sending them?
Even I was not made aware…. but I knew- they fail every day all over the country.
Cavalier approach and very poor clinical governance
Who is accountable?
Why would anyone think to inform an LMC? What are LMCs even for nowadays?