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Say 'NO!' to inappropriate requests with our template letters

Pulse can help you inform hospitals they should be booking appointments with patients directly

In the GP Forward View, it was stated that the NHS Standard Contract for hospitals has been changed so that hospitals can no longer adopt blanket policies whereby patients who miss appointments are automatically discharged for re-referral. It also emphasised that internal referrals for non-urgent, related conditions can be done within the hospital and there is no need for patients to book an appointment with their GP. 

Pulse has produced template letters for GPs still receiving inappropriate requests so they can inform the hospital that it is their responsibility to book another appointment with the patient. We have also produced letters for patients to explain the situation.

Feel free to download, amend and share these letters as you see fit.

  • Download a letter to the hospital department who asked you to re-refer a patient after a missed appointment
  • Download a letter to a patient asked to book an appointment with you for re-referral after a missed appointment
  • Download a letter to the hospital department who asked you to refer a patient to another hospital department
  • Download a letter to a patient asked to book an appointment with you for a hospital internal referral

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Readers' comments (16)

  • Azeem Majeed

    Thanks. Very useful letters.

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  • Daft GPST question - is this just applicable to NHS England, or to Scotland as well?

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  • These are based on the GP Forward View, so are probably not so applicable outside England. But the BMA have template letters you can use:

  • Thanks.
    V similar to BMA templates, but helpful nontheless.

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  • Onward referrals by hospitals were actually stopped GPs and CCGs. Used to happen as a norm years ago!
    Now reversed as predictably causes unnecessary work.

    So the challenge now is for hospital clinicians and GP colleagues to know what the exceptions are, as indicated in the template. Good luck!

    I guess it will slowly return to what was before the original changes.

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  • I used to work in Primary care and am very surprised it has taken so long for such letters to be produced.

    On reflection, all "traffic" causing extra work and resulting in extra administrative duties ought to be reviewed and actions taken to reduce the primary care work load and more importantly force the other providers to do what they are supposed to do in the first instance.


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  • Very useful letters indeed, we get the above scenarios very frequently from the hospital taking up a lot of GP time and administrative time.

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  • Anonymous | Consultant16 Jun 2016 2:30pm

    I think you'd find it was PCTs and some CCGs. GPs has not asked for this and I'm yet to meet a single GP who wanted onward referral to be stopped (yes, I know CCG is a membership organization o GPs but most decisions are not made by the GPs)

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  • What a fine example of building professional relationships these are.

    It was GPs who stopped the referrals in the first place and GPs who say they want to be the central coordinator of the patients care and help them navigate the system. Now you find it involves actual work on your part, because the patient actually needed the appointment and it wasn't just the hospitals 'gaming the system' as we were accused, you don't want to do it after all.

    it makes me wonder what a GP is actually prepared to do anymore. And while we on the subject, please stop sending me unsigned compliment slips with all the blood tests you can't understand and expect me to sort out for you

    And read the letter we send and amend the prescription or tell us you disagree with our advice, so the patient can improve by the next review.

    And when you're asked to organise investigations for an unrelated condition in primary care actually do it or even tell us you can't be bothered, instead of ignoring the request altogether

    And above all, get our colleagues at the CCG to stop punishing us by fining us for doing all of this on your behalf.

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  • You are right the CCG has become a odd one man organisation
    Some guy takes the lead and gets all these paid retired gps and redundant pct guys
    Everyone gets deals...just look at locality leads getting contracts.
    I know many gps have no say .

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  • 8:17: NHS is corrupt. If you don't make a deal when you are ordered to under threat of being struck off the GMC Register and instead you defy by exposing the deal proposer and maker, you get a letter :
    'On the basis of an internal meeting, we have come to the conclusion that you are an unreliable partner for the PCT and therefore, your contract will be terminated w.e.f on xyz. We will now set a timetable to transfer patients and collect all equipment from the Practice'
    I've been there and survived but things haven't changed.

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