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How GPs can fight back against hospitals dumping admin work on them

Our quick guide

Stack papers - files - work load - online

Stack papers - files - work load - online

What should be happening…

1 DNA patients not sent back to GPs

Hospitals are no longer allowed to adopt ‘blanket policies’ of sending patients back to their GP if they fail to attend a secondary care appointment.

2 Fewer patients bounced back to practices

Consultant-to-consultants referrals for related conditions are expressly permitted to avoid unnecessary referral back to the GP.

3 Adequate medication supplied on discharge

Providers have to supply patients with medication following discharge from inpatient or day-case care.

4 Discharge summaries within 24 hours

Hospitals are required to send discharge summaries electronically for inpatient, day-case or A&E care within 24 hours, and these must be made easier for GPs to interpret.

5 Outpatient information communicated to GPs

Hospitals are to ‘communicate clearly and promptly’ with GPs following outpatient clinic attendance when there is relevant information. 

6 Further changes came into effect on 1 April, requiring hospitals to:

  • Issue fit notes where needed. It will be mandatory for hospitals to write fit notes for patients that were treated by hospital staff.
  • Put in place arrangements for handling GP and patient queries
  • This should be for both patients and GPs.

Source: Letter from NHS England national director of operations and information Matthew Swindalls to CCGs and NHS trusts, dated 28 July 2016


…and what to do if this is not happening

Farah Jameel

Farah Jameel

1 Develop a practice policy on how to push back inappropriate hospital requests that breach the standard contract Perhaps use your next practice meeting to agree this. This could be a ‘Docman’ filing system, which allows you to set ‘return to sender’ as an option, and your admin staff could be trained to use the right template when necessary. Or your admin staff could be trained to use these templates on receipt of any relevant correspondence from secondary care.

2 Ensure all GPs in the practice are made aware of these new standards Use GPC templates1 (or any of your own), on each occasion that a hospital has failed to meet the new standards. Embed the template into your clinical system for automated use (you could ask your CCG IT lead to support implementation).

3 Ensure breaches are notified to the CCG using the GPC ‘CCG template’1 The CCG should act on this and engage in dialogue with the trust, ensuring such contract breaches are not repeated. 

4 Keep a record in the practice of all breaches, and the nature of the breach Feed back this information to your LMC on at least a monthly basis.

5 If your LMC has not contacted trusts and CCGs about this matter, ask them to do so on your behalf There are pre-written template letters for the LMC to use.

Dr Farah Jameel is GPC workload lead and chair of Camden LMC, north London

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Readers' comments (3)

  • Discharge summaries within 24 hours?
    Med3 forms available in hospitals?
    Does any of this apply in Wales at all, or are we going to wait several years for it to be translated into Welsh first?
    and, if so, has anybody told the hospital staff at all?
    Nurses tend to block Med3s, refusing to pass on patient requests to hospital doctors, stating that 'only GPs can issue them' - which is silly if we don;t have the discharge letter, so don't even know what the diagnosis is.
    Would all be welcome improvements though!

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  • If only they could just do it right in the first place. And what do CCGs actually do when hey do breach? Can't be anything that big because otherwise they wouldn't keep doing this nonsense

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  • There is a simple way to make this stick and that is with financial penalties for hospitals, paid to GPs (or whoever does the work)
    It will make sure that GPs follow up breaches.
    And teach trusts to follow the rules in the first place.

    It does not have to be draconian, but instead progressive. For example for the first 3 months just 5 or 10 pounds per breach.
    Then 20 pounds for months 4-6, 30 pounds for the next 3 months and 60 pounds thereafter.

    I guarantee that the problem will be ended within 12months with the above plan. And if not at least GPs will be compensated for the extra work.

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