Good organisation of care across the interface between general practice and secondary care (hospital) providers is crucial in ensuring that patients receive high-quality care and making the best use of NHS time and resources.

Onward referrals

Where a patient has been referred to a hospital clinic by the GP, or has presented as an emergency, the hospital clinician is obliged to make an onward outpatient referral to any other service, without the need for referral back to the GP, where either the onward referral is directly related to the condition for which the original referral was made (or which caused the emergency presentation), or if  the patient has an immediate need for investigation or treatment (suspected cancer, for instance). The hospital clinician is not able to refer onwards where a patient’s condition is non-urgent and where the condition for which the referral would be made is not directly related to the condition which caused the original GP referral or emergency presentation, and in that situation, the hospital clinician informs the patient’s GP. If the GP agrees, the onward referral can then be but the GP may instead choose to manage the patient’s condition an alternative way.

Managing patient care and investigations

Hospital clinics must arrange and carry out all of the necessary steps in a patient’s care and treatment rather than, for instance, requesting the patient’s GP to undertake particular tests within the practice or followup the results of their tests.

Communicating with patients and responding to their queries

It is important that providers take responsibility for managing and responding to queries received from patients. They are required to:

- put in place efficient arrangements for handling patient queries promptly and ensure that they respond properly to patient queries themselves, rather than simply passing them to GP practices to deal with

- communicate the results of investigations and tests carried out by themselves to patients directly, rather than relying on the practice to do so (except in the case of GP direct access diagnostic services)

Medication and shared care protocols

Provision of insufficient quantity of medication from hospitals care can mean that patients run out of medication, with adverse effects for their care, and have to make avoidable extra appointments with their GP, and the GP will not be able to prescribe appropriately if he/she has not received up-to-date information from the hospital about the patient’s care.

- For medication on discharge following hospital admission, the minimum period that hospitals are obliged to provide mediation with is seven days (unless a shorter period is clinically appropriate).

- Where a patient has an immediate need for medication as a result of a clinic attendance, the hospital provider must supply sufficient medication to last at least up to the point at which the clinic letter can reasonably be expected to have reached the GP and the GP can prescribe accordingly.

Shared care protocols can enable care to be provided more conveniently and closer to home for patients. However, hospital services can only initiate care for a particular patient under a shared care protocol when the GP has confirmed willingness to accept clinical responsibility for the patient in question. Where this is not the case, the ongoing prescribing and related monitoring remains the responsibility of the secondary care team.

Fit notes

It is important that fit notes are issued to patients in a way which is convenient for them, where there is an appropriate opportunity (on discharge from hospital or at clinic), provider clinicians must issue fit notes to appropriate patients, and their organisations must enable this, rather than expecting patients to make a separate appointment to see their GP simply for this purpose. Fit notes should cover an appropriate period until the patient is expected to be fit for work (i.e. following surgery) or until a further clinical review will be required.