Case study summary
Frimley Health NHS Foundation Trust has a long history of working to improve the patient experience by focussing on communication and relationships between primary and secondary care, bringing together clinicians from both sides. Over time, the outputs of these interactions have resulted in significant efficiencies to patient handover.
The ultimate aim was to improve the day-to-day interactions of GPs and hospital consultants, helping them to streamline the patient pathway and improve the patient experience through a seamless handover. The CICs’ explicit objective is to ‘improve and maintain open communications and strong working relationships between hospital consultants and local GPs’.
Frimley Health NHS Foundation Trust has a strong tradition of clinicians and managers working together in order to deliver high quality, clinical services. Prior to the Clinical Interface Committee, there was an Editorial Board, a meeting designed to bring together clinicians from both primary and secondary care to discuss, develop and edit clinical guidelines for referral and treatment pathways for specific specialties or conditions. Although a relatively informal forum, the value of bringing together clinicians from primary and secondary care in a constant dialogue was apparent. It is within this environment and culture that the Clinical Interface Committee (CIC) was born.
There are now two CICs; one in the North, based around Wexham Park Hospital, and one in the South, at Frimley Park Hospital. The focus has extended from the original Editorial Board beyond editing the referral and treatment guidelines, to a wider remit of looking to develop and implement clinical pathways within and across the system. The emphasis is still on having a clinically-led, managerially-delivered approach and the aim is to continually address problems that may arise between primary and secondary care which affect patient care, through the resolution of day-to-day clinical interactions across the system.
Whereas the improvement in relationships through regular dialogue was always a by-product of the Editorial Board, each of the CICs now has an explicit objective to ‘improve and maintain open communications and strong working relationships between hospital consultants and local GPs’.
The meetings themselves are now supported by Terms of Reference outlining the objectives and clearly identifying the governance. The agenda is shaped by the GPs and consultants through a ‘priorities-first’ approach and the groups look to highlight and address two key issues within a two hour meeting once every other month.
A great deal has been achieved so far, including:
- the development of a community glaucoma service;
- the interpretation of cardiology diagnostics being reported back to primary care;
- joint education events for GPs and consultants defining what makes a good referral;
- the development of key contact telephone lists to allow better communication.
The CIC has improved day-to-day working and relationships across the divide. While there is still progress to be made, the maintenance of good relationships will be vital to ensure that future developments will be easier to implement.
There are a few key ingredients that have made the dynamic work:
- A shared objective
- The right people in the room with the motivation to make it happen
- There is much to do but the maintenance of good relationships will ensure that future developments will be easier to implement as we move towards the new world of Integrated Care Systems.
Updated guidance from NHS England and NHS Improvement and changes to the NHS Standard Contract over the last few years has placed new requirements on hospitals to reduce inappropriate workload shift onto GP practices to allow GPs to effectively serve the ever-growing demand for primary care services.
Six key areas have changed within the contract; local access policies, discharge summaries, clinic letters, onward referral of patients, medications on discharge, and results and treatments. These issues form the backbone of what the CICs are currently focusing on.
Members of the CICs are working to resolve these issues so that there is a mutual understanding as to where the responsibility lies in the primary – secondary care spectrum. The vast majority of issues have been relatively easy to resolve and, in truth, had already been worked out through a mixture of professional guidelines and common sense. However, others have been more contentious and have reversed years of custom and practice in our system. Although contentious and a significant change in culture, we envisage that, through constant dialogue with colleagues in primary and secondary care, these can and will be resolved and the new methods of doing things will become the custom and practice of the future.
Danny Bailey,Associate Director of Strategy and Marketing, Frimley Health NHS Foundation Trust