ObjectivesTo estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful.DesignPopulation-level survey.SettingGreat Britain.ParticipantsA nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016.Main outcome measuresCounts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public.Results3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have ‘no confidence and trust in primary care’ compared with ‘yes, definitely’ (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful.ConclusionsThis study highlights the importance of actively soliciting patient’s views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to improve confidence and trust in primary care.

ObjectivesTo design and pilot a survey to be used at the population level to estimate the frequency of patient-perceived potentially harmful preventable problems occurring in UK primary care. To explore the nature of the problems, patient-suggested strategies for prevention and opinions of clinicians and the public regarding the potential for harm.DesignA survey was codesigned by three members of the public and one researcher and piloted through public and patient involvement and engagement networks.SettingSelf-selected sample of the UK population.Participants977 members of the public accessed the online survey during October and November 2015.Primary outcome measuresRespondent feedback about the ease of completion of the survey, quality of responses in terms of review by clinicians and members of the public, preliminary estimates of the frequency and nature of patient-perceived potentially harmful problems occurring in the last 12 months.Results638 (65%) members of the public completed the survey and few respondents reported any difficulty in understanding or completing the survey. 132 (21%) respondents reported experiencing a potentially harmful preventable problem during the past 12 months and 108 (82%) of these respondents provided a description that was adequate for at least one clinician to form an opinion about the potentially harmful problem. Respondents were older than the UK generally, more likely to work or volunteer in the healthcare sector and tended to use primary care more frequently but their confidence and trust in their own general practitioner (GP) was similar to that of the UK population as measured by the annual English GP patient survey.ConclusionsThe survey was acceptable to patients and mostly provided data of sufficient quality for review by clinicians and members of the public. It is now ready to use at a population level to estimate the frequency and nature of potentially harmful preventable problems in primary care from a patient’s perspective.

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The historical trends for each category were compared by age group and sex and with the corresponding data from series of mortality statistics'2 whenever these were an acceptable substitute for morbidity. The direction of the trends in the mortality series, tested for statistical significance, was compared with the direction of the curves used to prepare extrapolations. A commentary was written and questions framed about discharge rates and durations of stay in terms which drew attention to compatibility or any clear inconsistency between the discharge rates and mortality data-for example, the projection of historical trends of discharge rates for strokes shows a rise in most age groups contrary to the current falling mortality rates.A similar procedure was followed using statistics from notifications in the case of tuberculosis. When mortality was not an acceptable proxy for morbidity and when it was thought helpful to do so, attention was drawn to the relation between the trend in hospital discharge rates and the relative levels of general practitioners' consultation rates in 1958 and 1970-1, taken from the two national studies of morbidity in general practice.13 14 The projections and questionnaires were sent for comment to selected individual clinicians and national professional organisations whose members had specific interest in the particular disease. The same procedure was followed with epidemiologists, chosen on similar grounds. They could also be expected in making their comments to draw on other available evidence of the incidence of these diseases for which it is not possible validly to compare hospital discharge rates with mortality statistics or general practitioners' consultation rates.In nearly all instances the comments that were received were interpreted in line with the following predetermined ground rules:(1) When those consulted agreed with the projected values, that was accepted as the forecast.(2) Alternative figures supplied were accepted as the forecast if they fell within the 95% confidence limits.(3) When advised that discharge rates would rise higher than projected the upper confidence limit was chosen likewise; the lower