The Government has promised to stop patients being sent back to GPs where they need an onward referral from one consultant to another.
In its recovery plan for general practice, published today, the Government said that where a patient has been referred into secondary care and they need another referral ‘for an immediate or a related need’, the secondary care provider should make this referral, rather than sending them back to general practice.
It said that this was the ‘most common request’ from GPs about bureaucracy and would improve patient care and save time.
This is a step further than in 2016, when the GP Forward View said that onward referral within secondary care for a non-urgent condition relating to the original referral was ‘permitted’.
The pledge was one of several measures aimed at reducing the time practice teams spend on ‘lower-value’ administrative work and work generated by issues at the primary-secondary care interface, which ‘practices estimate they spend 10% to 20%’ of their time on, the plan said.
The other measures include:
- Fit notes should be issued by secondary care
- NHS trusts must establish their own call and recall systems for patient follow-up
- ICBs should ensure providers establish single routes for GPs and consultant-led teams to communicate rapidly
The recovery plan was published alongside a report from the Academy of Medical Royal Colleges (AoMRC) on general practice and secondary care working together.
The AoMRC report included a series of case examples of improvements that have already been made across the country and made a series of ‘quick-win’ suggestions.
This included areas establishing regular ‘interface groups’, which it said should bring together local GPs and secondary care consultants to discuss interface issues.
The Government’s plan said NHS England is asking ICB chief medical officers to ‘establish the local mechanism’, which will allow both general practice and consultant-led teams to raise local issues, jointly prioritise working with LMCs, and tackle the high-priority issues including those in the AoMRC report.
In addition to this, ICBs must address onward referral, and three other key areas: complete care (fit notes and discharge letters), call and recall, and clear points of contact.
Improving the primary-secondary care interface
Under the plan, trusts will be expected to ensure that on discharge or after an outpatient appointment, patients get everything they need rather than being left to return to their GP.
This includes fit notes being issued where needed and discharge letters clearly highlighting the actions for general practice.
By 30 November 2023, all secondary providers should have implemented the capability to issue a fit note electronically, the plan added.
Call and recall
Meanwhile, trusts will also have to establish their own call and recall systems for patients for follow-up tests or appointments.
‘This means that patients will have a clear route to contact secondary care and will no longer have to ask their practice to follow up on their behalf, which can often be frustrating when practices also do not know how to get the information,’ the plan said.
Clear points of contact
ICBs will also have to ensure that providers establish ‘single routes’ for general practice and secondary care teams to communicate quickly. The plan gave the examples of a single outpatient department email for GP practices or ‘primary care liaison officers’ in secondary care.
NHS England said it will expect ICBs to provide a progress update on the four areas to their public board in October or November 2023.
The latest recovery plan follows previous plans for general practice that also promised to address the workload dump from secondary care.
In 2016, one of the main pledge’s in the Forward View was to stop secondary care dumping the responsibility for onward referrals on GPs.
And in 2021, former health secretary Sajid Javid’s plan for improving GP access said secondary care providers should be ‘held to account’ to eliminate unnecessary workload dumping on practices such as blood tests and prescribing.