Hospital trusts must instate ‘designated lead’ to improve interface with GPs

ICBs must ensure that each hospital trust has a ‘designated lead’ for improving the interface between secondary care and GPs, NHS England has said.

Planning guidance for 2024/25, which has been delayed since December due to funding discussions, said ‘streamlining the patient pathway’ by improving the interface is an ‘important part’ of NHS recovery.

The guidance, which sets priorities for the coming year, also asked ICBs to focus on developing ‘integrated neighbourhood teams’, increasing the use of advice and guidance, and setting up ‘care coordination’ services for GPs to better escalate urgent care.

Last year, the recovery plan pledged to cut bureaucracy for GPs by reducing workload dump from hospitals, and ICBs were required to report on progress on interface issues.

But many ICBs reported issues with progressing this work, with some saying secondary care has not prioritised improving the interface with GPs.

‘Every trust should have a designated lead for the primary-secondary care interface and we ask ICB boards to regularly review progress,’ the new guidance said.

Integrated neighbourhood teams were a central feature of the landmark Fuller stocktake, which recommended the formation of multidisciplinary teams across health, social care and the voluntary sector to work around the needs of the local population.

To build these teams, NHSE told systems to ‘improve the alignment’ of community services to the PCN ‘footprint’.

‘The initial focus should be on delivering proactive care to the most complex and vulnerable patients with the aim of reducing avoidable exacerbations of ill-health and improving the quality of care for older people,’ the planning guidance said.

ICBs have been asked to set up integrated care co-ordination (ICC) services to help GPs escalate urgent cases and avoid hospital admissions. 

Pulse reported in November that no national funding would be directed towards acute respiratory hubs (ARIs) this winter, despite GPs around the country saying they have significantly helped to reduce pressures.

To improve elective care in hospitals, NHS England has directed local commissioners to focus on expanding advice and guidance (A&G), which Pulse showed has already increased by around 60% over the past two years.

Yesterday’s guidance said: ‘Ensure every ICB has an established approach to ensure referrals to secondary care are appropriate, including through increased use of advice and guidance (A&G) to avoid unnecessary referrals and allow patients to receive the appropriate advice or intervention more quickly.’

The national commissioner confirmed last year that, despite reports, there will be no national mandate for GPs to use A&G in a set number of cases. 

But many GPs have voiced concerns with the increased use of ‘specialist advice’, since it can often lead to increased workload and rejected referrals. 

ICBs have also been asked to expand GP direct access to diagnostics by drawing on new capacity such as community diagnostic centres. 

The directive said: ‘Utilise this new capacity to commission a significant expansion in GP direct access, ensuring GPs do not need to refer patients into secondary care because they cannot access core diagnostics directly. 

‘This includes direct access to diagnostics for patients with symptoms that may suggest cancer but who do not meet the threshold for an urgent suspected cancer referral, in line with our guidance, and patients requiring spirometry, fractional exhaled nitric oxide, and the N-terminal pro B-type natriuretic peptide test.’

In September last year, NHSE stipulated that direct access diagnostic tests requested by GPs – such as ultrasounds, X-ray, CT and MRIs – must be completed in under four weeks.

Specifically on GP recovery priorities, systems must focus on ‘building capacity’ by ‘establishing a full understanding of demand and capacity in primary care’.

It is not clear what this demand and capacity modelling might look like, but NHS England said the recently announced contract changes for 2024/25 will ‘support delivery’.

One of these contract changes was a new obligation for practices to provide digital telephony data through a national data extraction, for use by NHSE, ICBs and PCNs. 

But the national director for primary care claimed that this data will not be used to track GP performance.

Other priorities for ICBs in 2024/25:

• provide sufficient clinical placements and apprenticeship pathways to meet the requirements of the NHS long-term workforce plan;
• for elective care recovery: continue the significant expansion of patient choice at the point of referral, with patients offered a choice of 5 providers where appropriate, actively encouraging access to non-local NHS providers or the independent sector where this can shorten wait times for patients (measured by patient survey);
  • this will be supported by the introduction of capacity alerts in the NHS e-Referral Service (eRS) to facilitate informed choice for patient (patient choice was mentioned last year but not in this detail);
• increase vaccination uptake for children and young people year on year towards WHO recommended levels;
  • implement local MMR vaccination improvement plans to increase uptake in unvaccinated cohorts through national call/recall and expansion of alternative operational delivery models that increase access to vaccination.