At least 15 million GP appointments are wasted each year due to issues arising from the poor interface between GPs and hospitals, a report has warned.
The Policy Exchange report, published today, made 20 recommendations to reform the primary and secondary care interface, including a proposal to introduce ‘interface specialist’ doctors who can work across organisations within the next two years.
The authors argued that ‘inadequate resource for research in primary care’ and an ‘educational culture’ that ‘creates a negative view of work in primary care settings’ have both exacerbated a breakdown in the interface.
The report, titled ‘Medical Evolution’, also called for a ‘merger of the medical register’ to enable GPs to be recognised as ‘specialists in their own right’, as well as a focus on interface working in the Government’s long-awaited workforce plan.
Issues between primary and secondary care have become ‘increasingly pronounced in recent years’, with the interface ‘too often functioning poorly’ which compromises clinical care while also causing patient frustration, according to the report.
Authors Dr David Landau and Dr Sean Phillips wrote: ‘We estimate that at least 15 million GP appointments per year are dedicated exclusively to managing issues with the breakdown of this interface.
‘Too many patients feel shunted from pillar to post, unclear as to who is responsible for their care. As well as poorer outcomes for the patient, inter-professional relationships and morale are also negatively impacted.’
They also estimated that around 150,000 patients could be stuck on a ‘hidden’ waiting list, where they have not yet reached secondary care and their conditions are therefore ‘worsening in primary care’.
In February, a Healthwatch report found that one in five patient referrals made by GPs went into a ‘black hole’, and last month a think tank warned that advice and guidance (A&G) pathways could be storing up a ‘hidden backlog’ of patients.
On the development of ‘interface specialists’, the report argued that the role would suit GPs who can provide their own expert input in discharge planning and provide ‘collaborative continuity’.
It also recommended that SAS doctors, who have ‘significant clinical experience and specialist skills’ should be enabled to work as interface specialists in primary care settings, as well as offered a route to become a qualified GP.
The authors said: ‘Developing a cadre of clinicians with a remit and ability to operate within and across the interface will be a key component in enabling a more active approach to the management of the primary-secondary interface.’
They added: ‘Reform should enable doctors, nurses or pharmacists with appropriate skills to be simultaneously part of hospital specialist teams and to work within a primary care network (ideally a single GP practice) or community provider.’
Another recommendation centred on clinical research, with the authors focussing particularly on primary care where ‘high-quality clinical research activity’ should be incentivised.
The report said: ‘The enhancement of clinical research activity across primary and community settings is central to our vision for improved interface working, and we regard it as a longer-term, high-impact enabler, defined as a means of boosting the attractiveness of primary and community settings for those looking to pursue scientific research and as a means of enabling greater adoption of cutting-edge treatments and technologies.’
One suggestion to facilitate this was the development of a new Academic Primary Care Accelerator Scheme ‘to enable GP practices to apply for additional funding to operate predominantly as academic units’.
The report drew on Pulse’s own analysis to illustrate the issues GPs face with workload dump from the primary and secondary care interface, including our Best Laid Plans investigation, our analysis of A&G pathways, and our Editor’s Blog on ministers’ failing to deliver on promises.
Other recommendations focused on the digital tools used between primary and secondary care, transparency with patients, ICB accountability for interface working, and greater use of vacant NHS estates.
In May, the Government promised to stop patients being sent back to GPs where they need an onward referral from one consultant to another, and a report from the Academy of Medical Royal Colleges (AoMRC) explored the primary and secondary care interface with a series of case examples of improvements that have already been made.
Last month, the Northern Ireland Ombudsman said that GPs cannot and are not required to provide waiting list advice to patients beyond the point of referral.
And last week, a medical defence organisation’s survey found that GPs having to tell patients of long waiting lists for hospital treatment face a risk of abuse.