The Patient Safety Incident Response Framework

Definition

The Patient Safety Incident Response Framework (PSIRF) is NHS England's framework for how organisations providing NHS care respond to patient safety incidents. Published on 16 August 2022, it replaced the Serious Incident Framework (2015), with providers completing the transition by autumn 2023. Its stated purpose is learning and improving patient safety rather than apportioning blame.

Source: NHS England, August 2022 · Last reviewed 6 July 2026

What PSIRF is

NHS England describes PSIRF as setting out "the NHS's approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety". The framework's own guidance is blunt about the scale of the change: "The PSIRF is not a different way of describing what came before. It fundamentally shifts how the NHS responds to patient safety incidents for learning and improving."

The shift has two parts. First, incident response moves from fixed thresholds (an incident is either "serious" and investigated, or it is not) to a planned, proportionate approach where each organisation decides in advance how it will respond to the incident types it actually sees. Second, the method changes: the root cause analysis report that dominated the old framework gives way to a range of learning responses, from a same-day team huddle to a full patient safety incident investigation.

Who PSIRF applies to

PSIRF is a requirement of the NHS Standard Contract, so it applies to providers of NHS-funded secondary care: acute, ambulance, mental health, community healthcare, maternity and specialised services. That includes independent providers where they deliver care under the contract. Adoption in primary care is optional at this stage, though NHS England has signalled interest in extending it.

Fully private activity sits outside the framework. Many independent providers apply it across the board anyway, since running two incident systems side by side creates exactly the inconsistency the framework was designed to remove.

The four aims

Everything in the framework hangs off four aims: compassionate engagement and involvement of those affected, application of system-based approaches to learning, considered and proportionate responses, and supportive oversight focused on strengthening how the response system works. Each aim carries its own NHS England guidance document, and each is examined in detail on the principles page.

How incident response changes in practice

Under the old framework, an incident crossing the "serious" threshold triggered a root cause analysis with a 60 working day deadline, whatever the incident and whatever the organisation already knew about it. Under PSIRF, each provider writes a patient safety incident response plan based on its own incident profile, agrees it with its integrated care board, and publishes it. The plan states which incident types get which response.

Where risks are already understood and improvement work is under way, the guidance is explicit that it is acceptable not to open an individual response at all. Resources go where learning is available, which is the framework's central bet: fewer, better responses over many procedural ones. A small set of incidents keep a nationally mandated response, including deaths thought more likely than not due to problems in care, which always require a PSII.

The full comparison with the old framework, including what happened to root cause analysis and the 60 day deadline, is on the PSIRF vs Serious Incident Framework page.