Refreshing Safety Checks After a Major System Upgrade

Executive Overview

Major system upgrades can introduce new risks even when suppliers test extensively. This guide explains how GP practices in England can plan, execute, and follow up safety checks so upgraded systems support clinical workflows from day one.

Prepare Before the Upgrade

Gather information: request release notes, known issues, and testing evidence from the supplier well in advance.
Update documentation: review your DCB0160 safety case, hazard log, and change control plan to reflect the upcoming change.
Define critical workflows: list the journeys most at risk (triage, repeat prescribing, results filing, messaging) and agree test cases.
Schedule resources: allocate time for clinicians, admin staff, and IT support to run checks; confirm fallback plans if issues arise.

Run Pre-Upgrade Verification

Test in a training or sandbox environment if available, using realistic data scenarios.
Validate integrations (for example NHS spine services, pathology links, appointment systems) before the live upgrade.
Check that patient communications and templates still work as expected.
Record findings in the safety file, noting outstanding questions for the supplier.

Coordinate Go-Live Safely

Communicate go-live dates and expected downtime to staff and patients; update website banners, telephone messages, and reception scripts.
Assign a go-live lead to coordinate with the supplier and internal teams.
Keep the safety log open on the day so staff can report issues immediately.
Run a short stand-up during go-live to share observations and decide on immediate mitigations.

Complete Post-Upgrade Checks

Within 24-48 hours of go-live:

Execute agreed test scripts for critical workflows; involve both clinical and admin staff.
Confirm alerts, decision support, and routing rules trigger correctly.
Verify that data feeds and interfaces are functioning (lab results, referrals, summary care records).
Spot-check access rights and smartcard roles to ensure no unintended changes occurred.

Log results, capture screenshots where helpful, and update the hazard log with any new or changed risks.

Monitor and Stabilise

Track incidents, near misses, and performance metrics daily for the first two weeks.
Hold brief daily huddles to review open issues and supplier tickets.
Keep a running list of temporary workarounds and share them with staff until fixes are in place.
Review the safety file weekly and update the Clinical Safety Case once the system stabilises.

Scenario: Kingshill Practice

Kingshill upgraded its EPR and planned a one-hour testing session focused on referrals, medication safety alerts, and task routing. They identified a new default that hid certain alerts from reception staff. Logging it immediately enabled the supplier to issue a fix within 48 hours, preventing patient impact and providing evidence for commissioners.

Pitfalls to Avoid

Skipping preparation: without clear test scripts, critical issues can be missed.
Assuming supplier testing covers your workflows: always validate local processes.
Poor communication: if staff do not know about changes, they will revert to old habits or miss new features.
Failing to log findings: undocumented checks cannot support assurance or future upgrades.

Action Checklist

Collect release information and update the safety file.
Agree critical workflows and prepare test scripts.
Run pre-upgrade tests where possible and log issues for the supplier.
Coordinate go-live communications and on-the-day reporting.
Execute post-upgrade checks, monitor closely, and update clinical safety documentation.

Resources to Bookmark

Key Takeaways

System upgrades are safest when the practice treats them as controlled change events: plan tests, involve the right people, communicate clearly, monitor closely, and refresh clinical safety documentation. This approach keeps upgraded systems aligned with patient and staff needs.