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NHS trusts continue to send discharge summaries to GPs later than required

Exclusive The number of discharge summaries being sent by NHS trusts in England to GPs later than the required 24 hours has risen by 12% in the past three years despite preventative measures being brought in, a Pulse investigation has revealed.

In 2015, around 1.8 million summaries were sent to GPs more than 24 hours after a patient was discharged, compared with just over 2 million in 2018, according to data obtained by Pulse from 51 NHS trusts in England through freedom of information (FOI) requests (see graph, below).

NHS England introduced changes to the contract for NHS trusts in 2016/17 stipulating summaries for inpatient / daycase care and A&E attendance must be sent within 24 hours.

The move was part of efforts to reduce the amount of work being dumped on GPs by secondary care services.

GPs warned the ongoing practice of NHS trusts sending summaries late posed a risk to patient safety and created additional work for general practice.

But NHS trusts with policies in place stating summaries can be sent later than 24 hours said this is due to issues, such as staff availability, which cause delays.

Dr Nicholas Grundy, chair of grassroots campaign group GP Survival, said: ‘Delayed discharges carry risk if actions are on there which don’t get done. The classic is a hospital discharge saying something like “GP please recheck kidney function in 48 hours” – not much use if you get the letter a week later.’ 

Though he added he had ‘some sympathy’ for trusts due to NHS IT being a ‘disorganised mess’.

Another GP, who asked to remain anonymous, said: ‘I had a patient who’d been to hospital coughing up blood. He’d been given tranexamic acid, but he had a rash all over, which looked like a drug reaction.

‘We had no discharge letter. I had no idea what was going on. My receptionist had to spend all afternoon trying to get a discharge letter. It took five days, which was appalling. I needed to know what their diagnosis was.’ 

At Tameside and Glossop Integrated Care NHS Foundation Trust it is local policy to send GP summaries for inpatients and the emergency department within 48 hours, and for outpatients within five days.

A spokesperson for the trust said: ‘The 48-hour target is a local contractual standard agreed with the CCG and GPs. There are valid reasons why some discharge summaries are delivered to GPs outside of the 24-hour window.  For example, needing the input of a clinician who is not available on the day of discharge.’

An NHS England spokesperson said: ‘Good communication and co-operation between primary and secondary care is a vital part of delivering high-quality care.

‘Where there are remaining concerns, local GPs should ensure their CCG – whose governing body they elect – takes appropriate action in line with the national contract.’ 

Pulse’s investigation also revealed NHS trusts are discharging just under half of patients who do not attend their first appointment back to their GP, with some enforcing this approach as a blanket policy – also a breach of the contract.