‘Inappropriate’ workload transfer to primary care poses ‘crucial risk’ for patients, ICB warns

An ICB has warned of the ‘crucial risk’ to patient safety caused by ‘inappropriate’ workload transfer from hospital trusts to primary care.

North Central London (NCL) ICB’s primary care committee said ‘long-standing interface challenges’ were creating a ‘crucial risk to end-to-end patient pathways’.

The ICB also revealed NHS England’s medical director of primary care Dr Claire Fuller had visited the ICB area three times in a bid to address these workload issues.

The committee said the Royal Free Hospital trust in particular ‘has adverse outcomes and scored the worst for inappropriate task transfer’. It cited ‘ongoing concerns regarding lack of engagement from the RFH hospital group’.

Pulse understands some examples included referrals to secondary care being rejected due to formatting differences and disagreements over scans causing longer waiting times for patients.

The committee said that the ICB would receive £40,000 from NHS England in ‘interface improvement funding’ to address interface issues, but this would be dependent on a trust appointing a ‘PCN navigator’. 

Committee board papers said: ‘The long-standing interface challenges pose a crucial risk to end-to-end patient pathways. This is also exacerbated by NCL’s geographical complexity, increasing referral demand, winter pressures and workload issues arising from inappropriate task transfer between care settings.’

Dr Fuller’s visits mentioned in the papers were part of the PCN test site programme – a national pilot of 22 PCNs to ‘further deliver’ on the Fuller stocktake – with findings on interface challenges ‘shared across the PCN test sites’. 

The papers added: ‘Claire Fuller (National Clinical Director of Primary Care) has visited NCL ICB on three occasions over the last year as part of the Primary Care Network test site programme. Each visit has had a focus in interface challenges and learning has been captured and shared across the PCN test sites.’

GPs in the area confirmed interface issues but said they have had ‘some successes’ with addressing them.

North Central London medical director for Londonwide LMCs Dr Vicky Weeks told Pulse: ‘LMCs in North Central London have been working on interface issues with the Royal Free and have had some successes, such as the rollout of electronic prescribing in their A&E.

‘We are now pushing for Electronic Prescription Service to be made available in outpatients and at any other point a patient is discharged.

‘The Pan-NCL GP alert pathway went live in March, this will facilitate a single point of access to raise quality alerts, patient safety and internal onward referral process issues through one portal.

‘Data on inappropriate workload transfer is patchy, and much of the feedback LMCs receive is through notifications from individual GPs, which are then raised at the Clinical Interface Group meetings.

‘However, we believe the new quality alert pathway will make identification of such issues easier. This will also be assisted by the new response times to quality alerts and issues raised.’

A spokesperson for NCL ICB told Pulse: ‘We are committed to continually improving the experiences of patients and staff, including the interface between different parts of the NHS system.  

‘We know that our partners share that commitment and dedication. We are working hard, as are all our local trusts and providers, along with colleagues in primary care, towards that shared aim.’  

A Royal Free London spokesperson told Pulse: ‘We are incredibly proud of the care we provide to patients and we continue to deliver some of the best clinical outcomes in the country. 

‘We are fully committed to working in close partnership with our primary care colleagues and together we have agreed a list of priorities to strengthen communication and collaboration between the trust and GPs.’