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New guidance on the primary-secondary care interface



NHS England has released guidance for NHS managers and clinicians on how to handle the transfer of work between primary and secondary care.

The guidance has been in development since the GP Forward View was launched just over a year ago, through which NHS England set out a series of contractual measures to stop hospitals passing extra work on to GPs unnecessarily.  In particular the GPFV pledged to clamp down on:

  • Patients being bounced back to GPs after they failed to attend a secondary care appointment;
  • Consultants sending patients back to the GP instead of referring on to another consultant for conditions related to the original referral;
  • Trusts failing to provide patients with proper information or adequate medication.

The move was meant to demonstrate NHS England’s commitment to relieving pressure on overburdened GP practices, but Pulse revealed earlier this year that one year on, the directive had made little impact – our investigation revealed that nationally some 3,600 complaints had been made by GPs against Trusts for failing to adhere to the new contractual requirements. Out of almost 100 CCGs, not one had issued a single sanction against a Trust for these contractual failures.

The document describes the key national requirements that clinicians and managers need to be aware of, as set out in the new NHS Standard Contract for 2017-19, under which CCGs commission health services. This includes outlines of:

  • Managing DNAs and re-referrals – stressing that providers must not automatically discharge DNAs;
  • Managing onward referrals – explaining there is no need to refer back to the GP if the onward referral is directly related to the condition for which the original referral was made, or if the patient needs an urgent investigation, eg, for suspected cancer;
  • Managing patient care and investigations – pointing out that secondary care providers must arrange and carry out all necessary steps in a patient’s care and treatment and not request GPs carry out tests within the practice;
  • Communicating with patients – stressing that it is unacceptable for providers to refer questions about a patient’s secondary care to the GP;
  • Discharge summaries and clinic letters – detailing how providers must now send a discharge summary to the GP within 24 hours of every discharge from inpatient, day care or A&E care, and must provide clinic letters where required within 10 days (reducing to seven days from April 2018);
  • Medication and shared care protocols – obliging hospitals to provide sufficient medication on discharge, and to only initiate care under a shared protocol if the individual GP has agreed;
  • Fit notes – requiring secondary care clinicians to issue fit notes if needed, covering the full period until the patient is expected to be fit for work or until a further clinical review is needed.

Read the full guidance: The interface between primary and secondary care  – Key messages for NHS clinicians and managers.