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About the LINNEAUS Euro-PC Project

Why the focus on primary care?

In many countries in Europe, access to specialist care occurs through the medium of primary or generalist care. In the UK for example nearly 750,000 patients consult their GP each day. In Germany there are nearly 1.5 million visits per day to primary care and in the Netherlands every citizen has nearly 3 consultations with their GP each year. Primary care is therefore a vast organised sector for health care with millions of interaction occurring every day throughout the European Union. Primary care accounts for nearly 80% of the health concerns reported to a physician compared to 5% for hospital care.

Evidence suggests that there are between 5-80 safety incidents per 100,000 consultations which in the UK would translate to between 37-600 incidents per day. The vast majority of incidents can be categorised into 4 main areas covering diagnosis, prescribing, communication between health care providers and patients, and organisational. Although the potential for error is great, research also suggests that 50% are of no consequence, 20% result in non-clinically relevant delays in diagnosis, 10% result in upset patients but more significantly 20% of errors could have serious consequences. Therefore , even if the overall risk is lower, the potential for harm is significant.

Why we need to study patient safety in primary care?

The vast majority of research on patient safety has up to now, focused almost exclusively on hospital/specialist care. There is perception of primary care as a low technology environment where safety is not a problem. Primary care is also a much more heterogeneous in its organisational arrangements and in virtually all European countries the organisational arrangements between primary and secondary care are different and complex. There is a multiplicity of sites where primary care is carried out (the clinician’s office, the telephone and the patients’ home). The interfaces between primary and specialist care are hugely important and vary widely between European countries, making the study of patient safety at the interface problematic. Consultation and interpersonal skills are critical to the delivery of primary care and exploring issues related to patient safety in this area raises specific challenges. All these factors make the study of patient safety in primary care difficult.

The LINNEAUS collaboration

The LINNEAUS collaboration includes partners from England, Denmark, Netherlands, Germany, Spain, Greece, Austria, Poland and Scotland. Each group within the collaboration leads a work package responsible for researching, networking and developing tools which can be used across Europe for improving patient safety in primary care.

Key areas of work include:

  • Developing a taxonomy which can be used in primary care (Germany, WP2).
  • Developing instruments to assess safety culture and leadership in primary care (UK, WP5).
  • Identifying how decision making can improve clinical practice and reduce error (UK, WP4).
  • Reducing medication errors (Austria, WP3).
  • Using quality improvement techniques to enhance patient safety (Netherlands, WP6).
  • Piloting the use of accreditation in quality and safety (Greece).
  • Investigating barriers to safety improvement in countries where safety is not considered an important public health issue (Poland, WP7).
  • Involving patients (Denmark, WP8).
  • Communication related threats to patient safety at the primary-secondary care interface (Scotland).
  • Developing indicators for patient safety (Spain).