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Consultant-to-consultant referral to be mandated to avoid GP workload dump

Consultant-to-consultant referral to be mandated to avoid GP workload dump

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

Complete care

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.



Please note, only GPs are permitted to add comments to articles

Nathaniel Dixon 9 May, 2023 5:16 pm

Another old idea being recycled, this should already be being done and wont help much

Turn out The Lights 9 May, 2023 5:36 pm

They dont get it too much damage has been done.They could have a 2004 moment and chuck monay at it but it still wont make any difference.Instead we have this dogs dinner thats doomed to fail,they have lost the room and General Practice.

Peter McEvedy 9 May, 2023 5:56 pm

And how does that work with the internal market – will drain Primary Care unless changes made.

Giles Elrlngton 9 May, 2023 6:11 pm

Oh dear we can go back to patients being passed from SpR to SpR.

Darren Tymens 9 May, 2023 6:42 pm

All of these ‘innovations’ are already in the hospital contract or already extant, they just aren’t ever enforced and they won’t be this time. It’s more meaningless hot air for public and press consumption.

Anonymous 9 May, 2023 6:52 pm

Have a read through their agenda. They are pushing the SAS concept into primary care.
The end is nigh.

Simon Gilbert 9 May, 2023 7:17 pm

May consultant to consultant referrals will be mandated but the consultants’ specialist nurse and the trainee psychiatric practitioner will still send us letter with a long ‘GP to do in time for next consult’ list…

C Ovid 9 May, 2023 7:33 pm

Sort of ok and not ok. Consultants seem to think that someone on the ward with pneumonia might need help with their ongoing psoriasis ( NOT OK to ask a dermatologist straight away) but a breathless patient with abnormal echo shouldn’t be thrown back at the GP for a resp assessment 900 months later. Really? Show some basic sense please..! We all worked together as juniors but only some of us know what GPs can handle because they haven’t any experience of primary care. Why does this have to be? Please talk.

Matthew Shaw 9 May, 2023 7:52 pm

Its an important if small step that this has been recognised.
However, at least two other areas of work dump/ transfer remain
1] doing their pre-referral screening + data collection + clerking for free [the unilateral imposition of referral pathways restrictions and pro-formers – CAMHs forms etc]
2] doing their secondary care blood tests and follow up work after referrals.
Until we see an end to all unfunded work transfer backed up with LMC terms, + attaching a mechanism for billing secondary care + a profession prepared to inconvenience patients by politely declining any unfunded work I think wont be holding my breath.

Bonglim Bong 9 May, 2023 10:42 pm

Matthew Shaw has it correct. It is time to understand that GPs are a scarce limited resource and filling their time with work that can be done by someone else is totally unacceptable.

– So when a referral is needed, it can be triggered by the GP, and if the patient needs an x-ray blood test or other intervention before being seen by the consultant that can be organised by a secondary care doctor, nurse, other health care professional or administrator.
– And when a patient has been discharged and there are a list of tasks, there should be no expectation that the GP gets involved at all.
– And finally when someone needs to follow up after their hospital intervention, they have a way to contact that team directly – even if they have been provisionally discharged from their service. ‘Discharged’ is not some mythical one way vote that cannot be reversed.

Perhaps listen to GPs when coming up with a rescue plan.

Not on your Nelly 10 May, 2023 9:40 am

Just one thing…no letter or discharge summary should have any sentence that states “GP to…”
That will sort it.

Rogue 1 10 May, 2023 10:25 am

Just had a letter returned, saying patient will not be seen and has been discharged
Can we do a trial of treatment, then order a scan (no time interval indicated)
If patient is no better then refer back
Think this is wholly inadequate….

Keith Greenish 10 May, 2023 11:10 am

Definition of oxymoron – Government promise.

Dylan Summers 10 May, 2023 2:08 pm


Pre-referral workups are a real problem. Our local fertility clinic demands:

– FSH, LH, progesterone +- prolactin, TSH, testosterone, SHBG, rubella
– Ultrasound including antral follicle count
– Vaginal triple swabs
– Check smear up to date
– Semen analysis (repeat if abnormal)

When you have GP locums involved it often grinds to a halt with random selections of the tests ordered… it can take months to get it all in order. How I would love this to be taken out of GP hands.

Dharam Dickinson 13 May, 2023 11:40 am

Not being aware of local protocols is a real issue for all not just locums. I think the systems let us down in this regard. Where am I expected to find the details of all the local pathways and pre-requisites for referral as a new gp or a locum? Doesnt help that the services constantly change. The amount of time wasted due to lack of overview is huge. Even something as simple as yearly monitoring for LTC I have not seen one good example of this working. There simply doesn’t seem to be the time to actually sort out our processes. Or you have to have a huge admin team that need a lot of training but they are hard to keep hold of as there is just not enough money in the system to pay them well enough. Having a good line of defence with automatic bounce back of workload dumps, trained receptionists so we don’t get requests to be signed back on to work! Or other such nonsense. I think 70% of my time is actually wasted on things I did not need to be involved with. Then again many GPs seem to like being the goto option and pride themselves on their holistic care. We’ve made a rod for our own backs.

Jamal Hussain 13 May, 2023 11:44 am

Primary care needs to be funded on a fee for service format.
Nothing will improve until then.

Dr No 14 May, 2023 1:20 pm

All of these problems are symptoms of an overloaded service both primary are secondary care. The proposed policies address the symptoms not the illness.