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New guidance on the primary-secondary care interface

Read the new guidance put out by NHS England on managing the interface between primary and secondary care.

NHS England has released guidance for NHS managers and clinicians on how to handle the transfer of work between primary and secondary care.

The guidance has been in development since the GP Forward View was launched just over a year ago, through which NHS England set out a series of contractual measures to stop hospitals passing extra work on to GPs unnecessarily.  In particular the GPFV pledged to clamp down on:

  • Patients being bounced back to GPs after they failed to attend a secondary care appointment;
  • Consultants sending patients back to the GP instead of referring on to another consultant for conditions related to the original referral;
  • Trusts failing to provide patients with proper information or adequate medication.

The move was meant to demonstrate NHS England's commitment to relieving pressure on overburdened GP practices, but Pulse revealed earlier this year that one year on, the directive had made little impact - our investigation revealed that nationally some 3,600 complaints had been made by GPs against Trusts for failing to adhere to the new contractual requirements. Out of almost 100 CCGs, not one had issued a single sanction against a Trust for these contractual failures.

The document describes the key national requirements that clinicians and managers need to be aware of, as set out in the new NHS Standard Contract for 2017-19, under which CCGs commission health services. This includes outlines of:

  • Managing DNAs and re-referrals - stressing that providers must not automatically discharge DNAs;
  • Managing onward referrals - explaining there is no need to refer back to the GP if the onward referral is directly related to the condition for which the original referral was made, or if the patient needs an urgent investigation, eg, for suspected cancer;
  • Managing patient care and investigations - pointing out that secondary care providers must arrange and carry out all necessary steps in a patient's care and treatment and not request GPs carry out tests within the practice;
  • Communicating with patients - stressing that it is unacceptable for providers to refer questions about a patient's secondary care to the GP;
  • Discharge summaries and clinic letters - detailing how providers must now send a discharge summary to the GP within 24 hours of every discharge from inpatient, day care or A&E care, and must provide clinic letters where required within 10 days (reducing to seven days from April 2018);
  • Medication and shared care protocols - obliging hospitals to provide sufficient medication on discharge, and to only initiate care under a shared protocol if the individual GP has agreed;
  • Fit notes - requiring secondary care clinicians to issue fit notes if needed, covering the full period until the patient is expected to be fit for work or until a further clinical review is needed.

Read the full guidance: The interface between primary and secondary care  - Key messages for NHS clinicians and managers.

Readers' comments (11)

  • hats off to CQC finally grasped the fact that if you push different buttons at same time as Mr Hunt more likely to crash the system!

    I'm guessing a functioning contact/service AT ANY LEVEL compared with no contract/service won't count as "improvement"

    4 years looking more like 4 months, just need to dig out the pencils and underpants WIBBLE WIBBLE

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  • CQC is behaving like a cast in search of a play. They obviously don't have enough proper work to keep them occupied.

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  • Hahaha ! It was as if CQC was waiting with the lube ready as the election results were coming out. Couldn't wait any longer to get their hands messy again!

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  • This is a concerted effort to get rid of the partnership model. We should refuse to do this en masse, We need to flex our collective muscles on this one because they cannot close us all down.

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  • Scary down there, sounds like fiddling whilst Rome burns

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  • Partners will have to decide. Give up and go locum/salaried or say no. I think I know which is more likely to happen!

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  • I suspect even if there was a Zombie Apocalypse, and I was operating out of a corner of an abandoned prison, whilst my fellow survivors poked the Zombies through their eyes to stop us being overrun, a CQC inspector would still turn up with a clipboard requesting an audit to demonstrate how I have improved quality in the preceding year.

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  • National Hopeless Service

    We have improved patient care this year by; Soft toilet paper in the bogs, we now only employee beautiful people and provide a free bucket and sponge (bring their own water) to wash their car after the consultation.

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  • Paraphrased as 'evil hospitals must not dump any work at all on snowflake GPs (unless it involves spending money in which case they must ask for permission), and must keep the GP informed of everything immediately on no resources.

    Conversely, GPs have no responsibilities to inform hospitals of anything at all, and can pick and choose what they feel like doing. Hospitals must second guess what that will be each week

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  • Cobblers

    1:06pm. Contract. CCG. Hospital. Stick to it.

    And the second para is utter uninformed crap.

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