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CAMHS won't see you now

GP abuse by secondary care needs to stop

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I was working in the dark both literally and metaphorically, feeling a familiar mix of empathy, with mounting frustration and anger. This was yet another unacceptable incidence of GP abuse. I sat on the edge of my patient’s bed listening to her account of the conversation with the discharging hospital doctor - an account that I half expected to conclude ‘And they said my GP would bring about world peace’.

This is about safe patient care

‘They told me at the hospital last night to get you to visit me today. I have a headache. They said that they weren’t happy with my head scan and you’ll have to refer me. I don’t know what was wrong but they said that you’ll have the report. They didn’t give me anything to help because the hospital don’t give out medicines overnight. They said you would do that.’

I had been pulled away from my busy practice to carry out tasks that could have been done more effectively and efficiently by my hospital colleagues who, unlike me, had access to key results. In order to manage my patient safely, I was going to have to repeat the assessment that had been carried out by my hospital colleagues a few hours before and then play the ‘urgently obtaining clinical information from a hospital’ game. This game has the dual purpose of checking the phone lines in the hospital through its numerous rounds of being putting on hold and redirected. Sadly, it invariably culminates in my head banging against my desk as a consultant’s secretary’s recorded voice informs me of his/her very limited working hours and invites me to leave a message.

Thankfully, the interface between hospital and secondary care is highlighted in the GP Forward View, and I’m delighted that hospitals are being urged to ’fully implement new requirements in a robust and timely way’. These requirements include sending discharge summaries electronically within 24 hours for A&E attendances, allowing secondary care doctors to refer within the same hospital, supplying patients with medication following discharge, and notifying patients of results of clinical investigations.  

Trusts have been informed that this will save about 13.5 million unnecessary GP appointments a year, thereby alleviating pressure on hospitals. I remain unconvinced that this will be sufficient incentive for debt-ridden hospitals to stop the effortless workload shift and invest in communication with GPs. These national measures must be followed by appropriate standards that are more meaningful than ‘robust and timely’. GPs should report incidences of breach of the requirements and both hospital and commissioners must be held to account for delivering these requirements.

Despite the obsession with A&E waiting times, this is not just about liberating appointments to relieve pressure on hospitals. This is much more far-reaching. This is about safe patient care, understanding the immense pressure in general practice and valuing the role of a GP. GPs are leaving the profession, practices are closing. What more does it take to demonstrate that general practice is at breaking point? GP abuse needs to stop.

Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG

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Readers' comments (15)

  • Tt works both ways, and I think GPs are equally bad offenders.

    Today I received a faxed copy of blood tests taken by the GP last February (that's over six months ago!!!). There was no covering letter, but they had helpfully circled the abnormal ones. Presumably they thought I'd magically sort it out for them.

    Likewise, we find that despite sending timely clinical letters with an important diagnosis or change in medication, they are ignored entirely. Even though they are written in bold at the top of the letter, the patient never gets the right treatment.

    It was you GPs who forced us to stop doing follow-ups to save money, saying you could do the job just as well. As a former CCG chair you must know this. Surely you can't be surprised that it increased your workload, but I think you have to take some responsibility for this.

    We need to agree where the clinical responsibility is, and then resource it properly. Lets accept we're all under pressure, and stop using emotive terms like 'abuse', its so unprofessional.

    Either fund primary care or secondary care to do the job, because neither of us can do it for free.

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  • If there is good relationship between GPs and hospital consultants many of these difficulties could be easily does not help anyone to say things to patients like your Gp should have referred earlier or similar.
    I try to sit in regularly with hospital consultants and see what the view is on the other side of the fence.
    We are all working in the same NHS and if we work together it is in everyone's best interest.

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  • @ 11.34am

    When you send letters with important diagnoses or changes in medication, do you inform the patients, AND inform the GP that you have informed the patients? Or are you expecting the GP to contact the patient to give them the diagnosis?
    Often it isn't clear if the patient knows the diagnosis, or if the patient knows the planned changes in medications. It's fine if the letter has been copied to the patient and the GP has been told the letter has been copied to the patient.
    You would not believe the amount of time wasted by us GPs trying to contact patients by phone to see if they know their diagnosis, if they know that their medication has been changed, if they have a supply of the medication they need, and if they understand the plan and if they would like a copy of the hospital letter.
    I'd say it is half and half whether they already know or not. (except where the hospital letter says they have been told of course)
    It is a lot harder for us to contact the patient to tell them about medication changes than it is for the hospital doctor - who has them sitting in front of them at the time - to tell them.
    Please don't rely on the GP responding to a letter from yourself, to inform patient (who may be out, on holiday, screening phone calls, busy etc) about changes. Please do it yourself and tell the GP that you have done it.

    I couldn't agree more that we all need to work together, but to do so we all need to see things from each others viewpoints too. And for what it's worth, I agree it is outrageous for a gP to just send you out of date blood results with abnormalities circled - unless they had been requested by the hospital - but there should always be a covering letter.

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  • This cannot be resolved by individual GPs and Consultants deciding to "play nice".

    Every time either GP or Consultant needs to step in to plug the gap in service, this needs to be logged, escalated and reviewed at the Trust/CCG level until the rules of engagement are clear.

    This is a Quality issue and really needs to be taken outside of "let's moan about it" framework.

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  • The poor communication between secondary care and patients as well as ,secondary care and GP's are significant barriers to safe and efficient patient care

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  • Russell Thorpe

    Medicine is a team event and like the most successful teams we should all do as much as we can to make the job of the next doctor, whether they be a fellow GP or within secondary care, as easy as possible. Also I find patients and their families are not fully reliable and can say things to generate the response they desire.

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  • they don't care they don't care they don't care

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  • I echo comments from colleagues above. In response to the person moaning 'important diagnosis' are ignored and medication changes not implemented I ask - did you bother to tell the patient? You might not be aware but most patients don't live in their GPs house. Every day I read upwards of 40 letters from hospital specialists, often glibly delegating tasks such as implementing some medication change and/or 'titrate as nesessary' ...without bothering to inform the patient. I guess the assumption is maybe we'll see them on the landing in the morning as we make our way to the bathroom? Why don't you tell the patient to book to see the GP..wouldn't take you half a second to copy your letter to them and aren't you supposed to be doing that anyway these days?? Don't patients carry ANY responsibility for managing their own illnesses, or are you seeking to disempower them entirely?
    As for suggesting the reason hospital Drs don't follow up patients like they did was because GPs 'forced them' what distorted rubbish!. It is to save money pure and simple.
    I disagree the the bulk of your comment entirely .

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  • I'm afraid this primary care-secondary care bitching will achieve nothing. The whole system - on both of sides of the interface - is collapsing. We need a new NHS - fit for purpose for the 21st century - not one designed for post-war Britain

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