Prevention of Future Deaths reports · 2015

David Baddeley

Regulation 28 report to prevent future deaths, reference 2015-0451, written 21 Oct 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Oct 2015
Reference2015-0451
DeceasedDavid Baddeley
CoronerJoanne Kearsley
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

REGULATION 28 REPORT TO PREVENT FI UTURE DEATHS

THIS REPORT IS BEING SENT TO:

Medical Director of the Greater Manchester NHS Area Team

CORONER

Tam Joanne Kearsley Area Coroner for Manchester South

2 | CORONER’S LEGAL POWERS
I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act
2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations
2013

I.

3 | INVESTIGATION and INQUEST
On the 6” October 2015 I concluded the Inquest into the death of David
Baddeley date of birth 29.04.1972 who died on the 23.06.2015 at his home
address 54 Chester Avenue, Dukinfield, Tameside,
The cause of death was 1a) Hanging 2) Schizophrenia
I recorded that the deceased had a history of Schizophrenia. At the time of his
death he was not being prescribed his anti-psychotic medication, He died as a
result of tying a ligature around his neck, at his home address. It is probably he
was suffering from a deterioration in his mental health at the time he died. [
reached an Open Conclusion as there was no evidence the deceased had intended
to end his own life.

Kt
4 | CIRCUMSTANCES OF THE DEATH

As indicated Mr Baddeley, an extremely intelligent gentleman, had a very long
standing diagnosis of Schizophrenia which was controlled With anti-psychotic
medication. He had had a number of hospital admissions throughout his life. For
the majority of his life Mr Baddeley had lived in the Tameside area.
Approximately 4 years ago he moved to the Stockport area. He had a GP in
Cheadle. Whilst in Stockport he had a number of admissions to Stepping Hill
Hospital. His last admission being in 2013. In around September 2014 the Court
heard evidence that the deceased moved back to the Tameside Area. He
registered with the Ann Street Medical Practice in Denton and first attended the
surgery in September 2014 for an unrelated condition. At this stage his manual
records were not with the practice as these did not arrive until at least a month

after he had registered.

Due to the volume of patients and medical records the Court heard that it was not
until the 9" March 2015 that a summary of his medical records was completed.

Even then it was not clear that this was a patient with an underlying mental
health condition.

On the 30 March 2015 Mr Baddeley made an appointment with the practice and
requested a repeat of his Amisulpride medication which he advised he was taking
twice a day, although he did indicate he had reduced his dose due to side effects.

At this stage his GP advised he would contact his Previous Psychiatrist for
further information as it was not possible from the information available to
determine when he had last been seen. He also prescribed his Amisulpride

medication for a period of 4 weeks.

The Court heard that the information from the psychiatric services was not
received until the 6"" May 2015.

However on the 1° May Mr Baddeley had attended the practice and advised the
practice nurse that he had moved and would be registering with a new practice

closer to where he now lived.

On the 12" May he registered with the Davaar Medical Centre in Dukinfield and
his records from Ann Street had been forwarded electronically,

The Court heard that whilst the medical records are sent electronically GPs are
not aware of which practice they are sent to. The Court heard that if the GP had
known the details of the practice Mr Baddeley had registered with he would have
spoken to them about his mental health issues and the fact that he appeared no
longer to be under psychiatric services and was not receiving his anti-psychotic
medication (save for the one prescription issued on the 30" March).

The Court also then heard from a GP from the Davaar Medical Practice. He
advised the Court that due to the fact that medical practices are on different
computer systems, when Mr Baddelys’ electronic records were received the fact
that he was diagnosed with Schizophrenia was not obvious in the format they

were received.

On the 18" May Mr Baddeley attended for a new patient check and was seen by
a Healthcare assistant, but this was limited and the Court heard that the
Healthcare Assistant would not have been expected to have read all the electronic
records which had been received.

The Davaar Medical practice did not receive Mr Baddeleys written records until
the 28" May 2015, these were not reviewed until the 15" June. When they were

reviewed they were detailed as not requiring any action.

CORONER’S CONCERNS

The concerns noted by the Court during the course of the Inquest are as follows:

1) That the transfer of a patients electronic records between medical

practices can mean that key information is not highlighted due to the
incompatability of the systems.

2) The practice which a patient is leaving is not notified of the new
practice taking over the patients care so that doctors can speak and
discuss any pertinent medical issues.

3) The length of time it takes for a medical practice to receive the full
paper medical records.

4) Due to the volume of work the fact that it takes 8 weeks for a patients
paper medical records to be reviewed and summarised.

5) The fact that the initial new patients health Screenings did not note
that Mr Baddeley had a serious psychiatric illness, which could have
made him a risk to himself or indeed others as he was not taking his

antipsychotic medication.

6) That when his paper records were reviewed on the 15" June nothing
pertinent was thought required and again his mental health diagnosis
and lack of medication not picked up.

6 | ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I believe you
have the power to take such action. It should be noted that both of the medical
practices involved in this particular case had themselves noted flaws in the
systems and taken steps to address some of the issues themselves, however the
findings of the Court highlight an issue which may impact on medical practices

across Manchester.

| YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 16th December 2015 I, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken,
setting out the timetable for action. Otherwise you must explain why no action is

proposed.

8 |

COPIES and PUBLICATION

Ihave sent a copy of my report to the Chief Coroner and to the following
Interested Persons namely, the family of Mr Baddeley.

I am also under a duty to send the Chief Coroner a copy of your response.
The Chief Coroner may publish either or both ina complete or redacted or

summary form. He may send a copy of this report to any person who he believes
may find it useful or of interest. You may make representations to me, the

coroner, at the time of your response, about the release or the publication of your
response by the Chief Coroner. -

21.10.2015

Joanne Kearsley Area Coroner

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Respondent Not Named (PDF)
Miss J Kearsley

Area Coroner
Coroner's Court

1 Mount Tabor Street
Stockport

Se > 201S

OFFICIAL-SENSITIVE: PERSONAL NHS
England

GB

Medical Directorate

NHS England - North

Lancashire & Greater Manchester
4" Floor

3 Piccadilly Place

SK1 3AG ! Manchester

M1 3BN

0113 825 5149
patel@nhs.net

03 December 2015

Dear Miss Kearsley

Regulation 28 Report — Mr David Anthony Baddeley

Thank you for your Regulation 28 Report regarding the death of Mr David Anthony
Baddeley and the concerns with regard to avoidable harms.

1;

NHS England, GPs and Clinical Commissioning Groups have also identified the
risks to patients where records do not make obvious the key diagnoses, blood
tests, allergies or other significant clinical matters.

Since the advent of the new GMS contract, circa 2004, Primary Care practices
have been incentivised and contracted to apply accurate electronic READ
coded items (READ codes are fixed and specific codes used to record patient
diagnoses, blood test results, allergies and so on within the Clinical system).
GP contract terms require IT systems to be approved and demonstrate
compliance to these IT standards.

Where records are transferred electronically, the READ codes are to be used
by the recipient practice to establish for themselves, in conjunction with any
medical records summary, the clinical needs and concerns relating to that
patient. The sending practice has a data governance obligation in ensuring

accuracy.

Today, the electronic transfer of patient records within England takes place
using GP2GP. This is the consistent single tool for practices to transfer all
READ coded items automatically to the receiving clinical system. All narrative
data is also transferred. This occurs regardless of the computer system used,
providing that both of the practices are GP2GP enabled (currently 98% of GP
practices in England have GP2GP capability). | can confirm that the two
practices involved are GP2GP enabled.

High quality care for all, now and for future generations

OFFICIAL-SENSITIVE: PERSONAL

14. NHS England has recently procured Capita to manage it’s Primary Care
Support Services. One of the work streams is the management of medical
records. From June 2016 it is planned that practices will be able to track
records and see expected delivery dates. In the meantime, practices can, when

necessary, request paper records urgently.

15. Electronic records can be summarised in the usual way at the receiving GP
practice. If there is a concern about a patient, the practice may prioritise the
summarising of a particular set of notes, usually at the request of the clinician
who may be looking after them at new practice, especially if it is felt that the
patient may have a complex medical history.

16. Note summarising was included as part of the national GP contract as part of
the Quality and Outcome Framework. This ceased at the end of 2012/13 when
it was retired on the grounds that it was standard good practice and would be
maintained. This standard for this indicator was that 80% of newly registered
patients had their notes summarised within 8 weeks of receipt by the practice.

17. Practices will be reminded to ensure that when patients are seen at new patient

health checks that they are screened for serious psychiatric illness.

18. Practices will be reminded to ensure that when a patient deregisters and
transfers to another practice, that the patient record, both electronic and paper,
should be checked to ensure that significant diagnoses are recorded,
highlighted and correctly coded.

My apologies for the small delay in sending this response. This response is on
behalf of NHS England Lancashire and Greater Manchester. | have shared this
letter with the North of England Medical Director to learn if this response can be on
behalf of NHS England more widely. | am awaiting a response.

Yours sincerely

Dr Raj Patel
Medical Director, Lancashire & Greater Manchester

Director of Commissioning, Lancashire

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