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Managing deterioration – working with primary care

Spotting and acting on the signs of deterioration in a patient or care home resident is vital to ensuring patient safety. The objective of the national Managing Deterioration Safety Improvement Programme (ManDetSIP) is to create and embed the conditions for staff across the healthcare system to improve the safety and outcomes of patients by managing deterioration, and provide a high quality healthcare experience across England. We’re working across primary, community and acute care to help early identification of acutely unwell people. Read more about the ManDetSIP here. 

The ManDetSIP forms part of the National Patient Safety Improvement Programme (NatPatSIP) which is led by NHS England and Improvement. The NatPatSIP is locally delivered by 15 regionally-based Patient Safety Collaboratives (PSCs), including here in the West of England. Read more about the NatPatSIP here. 

Care provider training on use of RESTORE2

Recognising when a person’s health is deteriorating is important, particularly at this critical time. We are working, as part of the NHS response, to enhance the confidence of care staff working in the community in detecting and responding to deterioration (through use of RESTORE2) and communicating concerns to healthcare professionals. We have worked closely with primary care and care providers to ensure our free online training enables care staff to feel confident in seeking the right support at the right time from primary care. Read more about our virtual training available to care homes. 


ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT form creates a personalised recommendation for someone’s clinical care in emergency situations where they are not able to make decisions or express their wishes.

The process is that trained staff, often in primary care, guide selected patients through an extended conversation. The process results in a completed ReSPECT form that details the person’s wishes for their care, along with appropriate clinical recommendations. Professionals including paramedics, out-of-hours doctors, care home staff and hospital staff will be better able to make immediate decisions about a person’s emergency care and treatment if they have quick access to agreed clinical recommendations on a ReSPECT form. Read more about ReSPECT here. 


National Early Warning Score2 (known as NEWS2) is the latest version of the National Early Warning Score, developed by The Royal College of Physicians (RCP). The use of early warning scores is being recommended in primary and community care settings. Currently, all acute trusts, out-of-hours GP services, mental health trusts, community service providers and clinical commissioning groups (CCGs) in our region have signed up to support the adoption and spread of NEWS2, and communicating this score at the interfaces of care across the system. You can watch our video to show NEWS2 in action within primary care. Read more about NEWS2 here. 

COVID Oximetry @home and COVID virtual wards

We are supporting the continued set-up of ‘COVID Oximetry @home’ and virtual ward services in our region. Our local support offer makes use of our existing expertise, infrastructure and resources. We are working closely with NHS partners and leaders in primary care to produce a series of webinars, briefing papers and a phased implementation support pack. Read more about COVID Oximetry @home here. 

By mid-February 2021 over 1600 people with COVID have been enrolled in COVID Oximetry @home and COVID virtual ward services across the West of England. Read more about how we worked rapidly and collaboratively to roll out these services across our region, alongside reviewing a case study exploring the patient’s journey. 

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Improving patient safety

Our award-winning support for improving patient safety is central to our work in transforming health services and systems.

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Managing Deterioration Safety Improvement Programme

Spotting and acting on the signs of deterioration in a patient or care home resident is vital to ensuring patient safety. Our Managing Deterioration Safety Improvement Programme helps health and social care staff spot the signs of, and manage, deterioration.

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Keeping people safe during and after COVID-19

Take a look at our training events and resources for care home and NHS colleagues during the COVID-19 pandemic and beyond.

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ambulance paramedics

Safer care through NEWS

Delivered by the West of England AHSN, this Patient Safety Collaborative programme encourages the use of a single early warning score – the National Early Warning Score (NEWS) across the region.

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