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Hospitals banned from requesting re-referrals from GPs

Hospitals will be prevented from automatically discharging patients who do not attend an outpatient clinic appointment into the care of GPs as a blanket policy, in a bid to reduce the workload dump on GPs, NHS England has said.

It has also told hospitals they would be allowed ‘onward referrals’ of patients to other parts of the hospital, meaning GPs will not be required to refer the patients themselves.

It is part of NHS England’s attempts to reduce GP workload through its General Practice Forward View.

NHS England said it was changing the NHS Standard contract to ’relieve some of the administrative burden on practices’.

It said the changes mean ’hospitals will not be able to adopt blanket policies under which patients who do not attend an outpatient clinic appointment are automatically discharged back to their GP for re-referral’.

Under the contractual changes, ’unless a CCG requests otherwise, for a non-urgent condition related to the original referral, onward referral to another professional within the same hospital is permitted, and there is no requirement to refer back to the GP. Re-referral for GP approval is only required for onward referral of non-urgent, unrelated conditions’.

NHS England is also looking to cut workload burdens caused by commissioners requiring mandatory training from GPs, saying it will review and reduce requirements for training in areas such as fridge procedures, fire safety and complaints handling to ensure ‘a far more proportionate approach is taken.’

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It added that it would also review the impact of appraisal and revalidation requirements.

The package involves a string of other new policies to stop secondary care dumping work on general practice.

NHS England said the plan would contractually require hospitals to:

  • Publish evidence of having taken account of GP feedback when considering service development and redesign;
  • Send discharge summaries by direct electronic or email transmission for inpatient, day case or A&E care within 24 hours, with local standards being set for discharge summaries from other settings;
  • Provide summaries in the standardised format agreed by the Academy of Medical Royal Colleges, so GPs can find key information in the summary more easily;
  • Communicate clearly and promptly with GPs following outpatient clinic attendance, where there is information that the GP needs quickly in order to manage a patient’s care (no later than 14 days after the appointment). For 2017/18, to strengthen this by requiring electronic transmission of clinic letters within 24 hours;
  • Organise the different steps in a care pathway promptly and to communicate clearly with patients and GPs;
  • Notify patients of the results of clinical investigations and treatments in an appropriate and cost-effective manner, for example, telephoning the patient;
  • Supply patients with medication following discharge from inpatient or day case care and for the period established in local practice or protocols, but must be for a minimum of seven days (unless a shorter period is clinically necessary).

NHS England added that GPs should notify their CCG in the event that the contract is not being followed.

The plan also proposes to relieve GP workload with a £30 million national programme called ‘Releasing Time for Patients’.

Run over three years, NHS England said the programme would introduce new ways of delivering care, such as telephone consultations or different use of other professionals in the general practice workforce. The programme, which was piloted in 2014/15, will launch in 2016/17 and run for three years.

The programme will:

  • Gather and disseminate successful examples and measure impact. This will include support on implementation of the Ten High Impact Actions, and a specific focus on addressing inequalities in the experience of accessing services, where there are national trends.
  • Host local learning programmes with expert input, supporting practices and federations to implement high impact innovations which release capacity and improve patient care.
  • Build change leadership capabilities in practices and federations, enabling providers to improve quality, introduce care innovations and establish new arrangements for the future.

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