1 National Patient Safety Data Context

2 Data quality information

3 Overview of recording behaviour

Submission of safety incidents to LFPSE began in July 2021, as early adopters of LFPSE and organisations using e-Forms in NRLS began using the new system. Nonetheless, NRLS held the majority of all incidents submitted to NHS England until September 2023, ranging from 81.9% to 100% of all incidents recorded. Thereafter we observed a consistent increase in LFPSE records and a subsequent decline in NRLS submissions, as organisations transitioned to LFPSE. Incidents recorded to LFPSE overtook those reported to NRLS by December 2023, and transition of all NHS trusts to LFPSE was completed in July 2024.

Figure 2: Total patient safety incidents recorded per month in NRLS and LFPSE

This plot illustrates the transition of patient safety incident recording from NRLS to LFPSE. Based on incidents occurring in England and recorded between January 2021 to December 2024.

Table 1: Total patient safety incidents recorded per month in NRLS and LFPSE

This table presents the number of patient safety incidents recorded to NRLS and LFPSE per month. Based on incidents occurring in England and recorded between January 2021 to December 2024.

Preliminary analysis suggests that most organisations transitioning to LFPSE continued to submit to NRLS after their transition date. Further analysis will be needed to examine the extent to which this was dual reporting of the same incidents, versus overlapping reporting of different incidents. Note that the datasets are primarily textual, and there is no direct linkage between the two.

4 Recording lag

Recording lag for patient safety incidents is measured as the difference in the number of days between the date the incident occurred and the date that it was recorded to the national system. The median lag is then taken to minimise the effect of any outliers (such as events which only become apparent many years after occurring).

From January 2021 to April 2024, the national median lag for recording into NRLS ranged between 18 to 32 days. From May 2024, median lag increased noticeably, as the NRLS share of all incidents recorded dropped from 25.4% to 0. Inversely, the national median lag in LFPSE ranged between 1 to 14 days until October 2022, when LFPSE share of all incidents recorded ranged between 0.4% to 3.5%. From November 2022, the national recording lag in LFPSE consistently remained at 0 days. This reduction is due to the live nature of LFPSE, replacing the requirement for providers to manually extract and upload data as was the case for NRLS.

Between January 2021 to December 2024, there were 114 NRLS incidents without an occurring date and for which median lag could not be calculated. The equivalent figure for LFPSE was 29,862 incidents, of which 28,803 had an estimated occurring date. There is currently low confidence in the data quality of estimated occurring dates, and as such, they were not used in median lag calculations.

Figure 3: Monthly median recording lag, in days, for incidents submitted to NRLS and LFPSE

Based on patient safety incidents occurring in England and recorded between January 2021 to December 2024.

The aggregate data displayed below can be downloaded from this file:

• Monthly median lag in incidents recorded to NRLS and LFPSE (CSV, 3KB)

5 Recording patterns of physical harm

LFPSE has a new variable for grading of the psychological harm associated with patient safety incidents. This is an experimental field which seeks to explore if responses to safety incidents need to be different if psychological harm is considered separately from physical harm, rather than rolling them together into one measure, as was done in NRLS. Currently, there is low confidence in the grading of psychological harm, as users familiarise themselves with its use, and as such, it is excluded from this report.

Grading the degree of physical harm to a patient resulting from a patient safety incident can be a challenge for recorders, but by grading patient safety incidents, healthcare providers can ensure consistency and comparability of data. This field is also used in the triage of records for national clinical review, ensuring the most severe harms are prioritised.

Sometimes a problem in care can affect more than one patient, or none at all. To capture this, as a new feature of LFPSE, recorders can submit information for multiple patients per incident, meaning there can be multiple degrees of harm per incident. We have aggregated LFPSE figures based on the highest physical harm level recorded per incident.

As expected with the overall increase in incident recording observed during the operational life of NRLS, we observed increased recording of incidents, for all degrees of physical harm, following transition to LFPSE. NRLS held most incidents submitted to NHS England from January 2021 until September 2023 (table 1). The monthly average of incidents recorded spanning that period of NRLS data is presented in table 2. The LFPSE figures shown for comparison are based on data from July 2024 until December 2024 (i.e., after withdrawal of NRLS and transition of all NHS trusts to LFPSE). Data recorded between October 2023 to June 2024 was not included in table 2 because incident recording was effectively split between systems, as submitters were transitioning from NRLS to LFPSE (figure 2).

Table 2: Monthly average number of incidents recorded to NRLS and LFPSE, by degree of harm, during periods of recording system dominance

Based on patient safety incidents occurring in England and recorded between January 2021 to September 2023 (for NRLS) and between July 2024 to December 2024 (for LFPSE).

The increase in incident recording was not seen proportionally across all physical harm levels. The most noticeable increases in monthly incident recording, following full transition to LFPSE, were observed in moderate harm, severe harm, and fatal incidents (table 2). Given the fact that the data is mostly voluntary, and degree of harm can be subjective, it is unlikely that this represents a real increase in harm occurring during patient safety incidents. There are many possible alternative explanations for this, including but not limited to:

• NRLS was subject to harm corroboration prior to data being available due to its manual upload procedure, as opposed to the current LFPSE live system (although submitters can still revise their records).
• Generally less accurate coding of patient safety incidents in LFPSE compared to NRLS, which may be due to users being unfamiliar with the new system, or staff who are new to using LFPSE.
• De-prioritisation of recording no and low harm incidents in LFPSE compared to NRLS, which may or may not be impacted by the Patient Safety Incident Response Framework (PSIRF).
• Change in the makeup of organisation types submitting to LFPSE compared to NRLS, and the experience of the staff using LFPSE.

Despite the observed increases, the majority of incidents submitted to NHS England continued to record minor physical harm. Between January 2021 to December 2024, most incidents submitted to NRLS and LFPSE recorded low or no physical harm to patients (96.5% in NRLS vs. 93.7 % in LFPSE). We excluded 13 NRLS incidents and 241,162 LFPSE incidents from these calculations as there was no degree of harm recorded against the incident. In the excluded LFPSE group, we identified 241,061 incidents where the number of patients affected was unknown. Preliminary analysis suggests that these records likely represent incidents with no patients involved. We will continue further data quality checks to validate these figures.

Figure 4: Patient safety incidents by degree of physical harm across NRLS and LFPSE

Based on patient safety incidents occurring in England and recorded between January 2021 to December 2024.

The aggregate data displayed below can be downloaded from this file:

• Monthly counts of incidents by degree of harm recorded to NRLS and LFPSE (CSV, 15KB)

6 Primary care recording

As a proportion of all recording into both NRLS and LFPSE, incidents from primary care represented a small volume of all incidents recorded between January 2021 to December 2024. In LFPSE, there were 22,153 primary care incidents, which accounted for 0.7% of all LFPSE incident recording. The equivalent for NRLS was 93,936 primary care incidents, which represented 1.2% of all NRLS incident recording.

Most primary care incidents submitted to either system were recorded by pharmacies. There were 92,865 pharmacy incidents recorded in NRLS, which comprised most NRLS primary care recording (98.9%). Albeit smaller, the recording of incidents by primary care organisations in LFPSE showed a greater variety of submitters. Incidents recorded by pharmacies (i.e., 15,739) accounted for 71.0% of all LFPSE primary care recording, which was followed by incidents recorded by general practitioner (GP) practices (22.6%), primary care networks (PCNs, 5.3%), and other primary care providers (1.1%).

Table 3: Primary care recording in NRLS and LFPSE by organisation type

Based on patient safety incidents recorded between January 2021 to December 2024 and recorded by English healthcare organisations.

Note: ‘Other primary care’ is a category assigned to an organisation by LFPSE and its broad nature requires further validation. We will likely break this category down in the future, after checking organisation codes in this group using NHS England’s Organisation Data Service (ODS), as we have done for pharmacies, GP practices, and PCNs.

Connection to LFPSE is a contractual obligation for both pharmacies and GP practices. However, recording is not mandatory except for severe harm and fatal incidents. Out of the 10,434 open pharmacies in England, 3,930 had an account in LFPSE as of December 2024, and we received at least one incident from 64.5% of them (i.e., 2,535 registered pharmacies). Out of the 6,267 GP practices in the country, there were 2,192 registered in LFPSE and we received incidents from 44.8% of registered practices (i.e., 982). Lastly, from the 1,299 PCNs in England, 584 had registered with LFPSE by December 2024 and we received incidents from 44.2% of them (i.e., 258 registered PCNs). We are currently working on releasing the detailed list of primary care organisations registered in LFPSE as part of our quarterly patient safety event reports.

The introduction of LFPSE has brought patient safety incident recording from new organisation types which did not record, or recorded low volumes, to NRLS. However, we have also observed a decrease in volumes of records received from pharmacies. Although the LFPSE online form was available to pharmacies from July 2021, the majority of pharmacies were using Local Risk Management Systems (LRMS) and therefore transitioned to LFPSE much later, when NRLS was decommissioned in mid-2024. GP practice recording remains broadly comparable to NRLS levels, with further scope for improving future recording rates.

Figure 5: Patient safety incidents recorded by primary care organisations to NRLS and LFPSE

Based on patient safety incidents recorded between January 2021 to December 2024 and recorded by English healthcare organisations.

The aggregate data displayed below can be downloaded from this file:

• Monthly counts of incidents from primary care recorded to NRLS and LFPSE (CSV, 8KB)

7 Feedback

This report is intended as a stand-alone document to provide answers to commonly asked questions, and we are open to revising it should demand arise. We also intend to incorporate some of these measures into our regular LFPSE patient safety events data publications. Your feedback is welcome on the format and utility of this document, so that we can provide reports that are of most benefit. Please contact patientsafety.analysis@nhs.net with any suggestions.

The analysts with overall responsibility for this report are:

Joshua Mutio
Lead Analyst
Patient Safety, Medical Directorate Programmes
Data & Analytics
NHS England

Juan Sebastian Gonzalez-Martinez
Analyst
Patient Safety, Medical Directorate Programmes
Data & Analytics
NHS England

Matthew Webb
Analytical Officer
Patient Safety, Medical Directorate Programmes
Data & Analytics
NHS England