Research, action, and leadership are required

Medicine has always put patients at risk. Modern medicine raises the stakes as its power to do good is accompanied by increasing potential for harm. Only now is the medical world waking up to the importance of ensuring patient safety. 1 2 The shift in the debate from individual mistakes to understanding the systemic factors that predispose to harm is welcome and offers the prospect for making important and sustained improvements in patient safety. 3 4 However, there is a dearth of understanding of patient safety in primary care—where the vast majority of patient-clinician encounters take place—posing a particular challenge to the nascent National Patient Safety Agency.5

Patient care in the community is becoming increasingly complex. Early discharge from hospital, the prescribing and monitoring of potentially dangerous drugs such as methotrexate for rheumatoid arthritis, the pressure of short consultations, and the increasingly fragmented nature of primary care services all increase the risk of unintentional patient harm.

There are, however, two advantages enjoyed by primary care. Firstly, practices are small organisations with fewer layers of bureaucracy than most hospitals. Implementing systemic changes is …