Cheshire and Merseyside ICS has produced a consensus document to tackle inappropriate transfer of work between hospitals and GPs.
The set of principles includes that hospital clinicians should avoid asking the GP to organise specialist or blood tests, that whoever orders a test is responsible for its result, fit notes should be provided for the full time needed and onward referrals between specialists should be arranged directly.
For the part of GPs, referrals to secondary care should be clear in their ‘ask’ and appropriate assessments and investigations already done as well as long-term conditions well managed for those waiting for an operation, the document states.
The goal of the consensus document is to improve relationships between colleagues, remove unnecessary administrative burdens and create a more efficient system, the ICS said.
With significant excess demand across the NHS as a result of the pandemic, ‘it is imperative we work together to tackle increasing presentations and lengthening waiting lists’, the document noted.
The principles are supported by leaders in primary and secondary care but there will be exceptions and clinicians ‘are trusted to make appropriate decisions based on individual circumstances’ it added.
Work should also be done to better communicate with patients on waiting lists to ensure they know their referral has been received, how long the wait may be and what to do if their condition deteriorates.
The clinician prescribing a medication is responsible for communicating the need for the treatment, including risks and benefits, and arranging any follow-up needed. And any immediate prescribing needed from outpatients should be done there and then, the consensus document said.
Dr Jonathan Griffiths, a GP in Cheshire who has been working in an advisory role to the ICS, said the consensus came from a task and finish group that had been set up to look at system pressures across the region.
‘We wrote to all healthcare professionals in primary and secondary care and said what would make your lives easier, what would help with the demand and quite a lot of the answers that came back are met by this consensus document.’
He said PCNs, trust medical directors and LMCs were all involved in developing the final version.
‘It’s about trying to help system pressures and it is not about finger pointing but trying to build consensus, trying to build relationships.’
Some of the issues are about clinicians being unaware of what they should be doing as historically they may have been told they could not refer to another consultant, for example, or they have no idea how the current fit note system works, he explained.
The next step will be to get the document in front of everyone who needs to see it, he added.
‘It’s trying to encourage people to do the right thing, rather than beating them with a stick. The difficult bit is the implementation,’ he said.
Cheshire LMC said the principles set out in the document had been well received and work was now being done to put the document into practice and engage with clinical colleagues in other sectors.
As part of last year’s winter support package to general practice, NHS England had told hospitals ‘eliminate unnecessary’ workload transfers.