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Out and about

MPS recently undertook its 1,000th Clinical Risk Self Assessment at Dr Fletcher and Partners in Ripon. Anne Price, MPS clinical risk assessment facilitator, reports from inside a CRSA

So what is a risk assessment?

Patient safety is paramount. CRSAs aim to prevent avoidable harm to patients. A CRSA is a systematic approach to identifying risks and developing practical solutions to ensure quality of practice, and preventing harm to patients by making the systems in your practice safer.

A CRSA involves a full-day visit to a practice by a risk assessor, who then writes a report detailing all the findings of the day – that is used as a tool to improve your practice. A CRSA is not an inspection but a supportive and confidential visit designed to help practices reflect on the systems and processes they employ and consider if things could or should be done differently.

Risk Assessment-1

The beginnings

Risk Assessment-2

Before embarking on the CRSA Dr Fletcher and Partners were asked to complete a pre-visit questionnaire providing basic information about staffing, practice activities and any specific challenges that are faced. Staff were asked to anonymously complete a Patient Safety Survey.

It is increasingly recognised that safety within a healthcare organisation is dependent upon its ‘safety culture’ so the results of this survey can be a powerful tool when used together with a risk assessment. Before arriving I familiarised myself with Dr Fletcher’s practice using the information provided by the practice. As I walked through the door on the day of the visit I was aware that, in common with patients, a warm welcome at the reception desk conveys a genuine desire from staff to offer a good service and helps to put everyone at ease.

Interviews with staff

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The usual plan for a typical CRSA is to undertake interviews with key members of staff during the morning – this would normally include the practice manager, a practice nurse, a GP and a member of the reception or administrative team. The interviews are a crucial part of the CRSA.

The systems by which the core work of general practice is completed varies hugely from practice to practice so the interviews help me to understand how responsibilities are fulfilled within the practice. How do patients access services for example? How does the team communicate amongst themselves and with their patients? How is correspondence managed for test results, repeat prescribing and so on? How are staff prepared for their responsibilities and supported in their roles and, importantly, how does the practice respond when things go wrong?

It’s a busy day at Dr Fletcher’s for all concerned and always helped by the provision of regular cups of coffee.

Box 1: What is a CRSA?

  • Not an inspection… supportive
  • A one-day practice visit
  • Involves whole team
  • Staff interviews
  • Workshop
  • Feedback from Staff Survey of Patient Safety Culture


Risk Assessment-4Once the interviews are completed, the next part of the day involves a workshop for all staff. Clinical risk management involves everyone from cleaners, maintenance and administrative staff to management, doctors and nurses, so the more staff who participate in the workshop the better the outcome.

Dr Fletcher’s workshop begins with a presentation to guide the team through an understanding of risk management using examples from everyday life. Once staff realise how they already manage risk in their personal and family lives they begin to acknowledge and engage with their role in risk management at work. We look at what happens when risk management goes wrong and consider how gaps in management, training and resources contribute to the lack of a safety culture within any organisation.

Risk Assessment-5

Why do human beings make mistakes and how can robust systems help to reduce the risk of avoidable errors? Staff are given an opportunity to identify potential risks within the practice and discuss them in multidisciplinary groups. My reward is hearing participants share concerns and discuss possible solutions with a collective passion for offering a safe service to patients.

Each group then feeds back to the whole team in a plenary session when the facilitator’s experience from other practices can sometimes help a team to resolve a problem.


Next comes the report, which will include a list of actions prioritised in the light of MPS experience of medicolegal risks along with information and resources to help the practice take things forward.

Dr Fletcher and Partners

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I was warmly received by Dr Fletcher and his staff who participated enthusiastically in the day.

As usual the busy day concluded with a final conversation with the practice manager, supplemented on this occasion by delicious cake made by one of the practice team so many thanks to the practice for their hospitality and participation on this special day.

More events...

MPS Practice Management Seminars

  • Designed to guide you through the minefield of patient safety and complaints, these are practical and interactive
  • When: Throughout the year
  • Where: Across the UK
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MPS GP Conference

  • MPS’s 2013 Annual General Practice Conference – Keeping Safe, Back to Basics
  • When: 26 June
  • Where: Radisson Blu Hotel, Manchester Airport
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National First5® Conference

RCGP Annual Conference

  • The ‘must attend’ event of the year for GPs and practice team colleagues
  • When: 3-5 October
  • Where: Harrogate International Centre, Harrogate
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Management in Practice

  • This free event for practice managers, GPs and commissioners shares tips on healthcare management
  • When: 17 October
  • Where: Business Design Centre, London
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Communication skills workshops

  • The Mastering series of workshops aim to minimise risk. All our facilitators are GPs, consultants or clinicians. Where possible and applicable, our workshops qualify for CPD accreditation
  • When: Throughout the year
  • Where: Across the UK
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1 comment
  • By SANJAY AHLAWAT on 27 April 2015 05:50 I liked reading the above article. I am looking at it as I will be filling in a crsa registration details online form/ questionnaire. Our surgery needs as much help as it can get. I will be using above hints at trying to list as many hazards as possible. 
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