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

Engaging with the profession

Guidance for clinicians and managers

New measures were introduced into the NHS Standard Contract for 2017-19 to help improve working practices and patient experience between primary and secondary care.

Members of the national working group have collaborated to co-produce a practical toolkit, including case studies, to support local systems to work together to implement these changes.  It has been estimated that if fully adopted, the contract measures could be equivalent to an annual saving of 225,000 GP appointments.

This briefing document describes the key national requirements, set out in the Contract, which clinicians and managers across the NHS need to be aware of.

These requirements are also explained in this joint letter from NHS England and NHS Improvement.

Guidance for prescribing

A Task and Finish Group, chaired by Dr Keith Ridge CBE, Chief Pharmaceutical Officer for England, came together to look at some of the issues around prescribing across the interface. This group have developed revised national guidance on responsibilities for prescribing between primary and secondary/tertiary care (the previous guidance (EL (91) 127) had last been published in 1991). This person-centred guidance aims to provide clarity on the responsibilities of all professionals involved in commissioning and prescribing across primary, secondary and tertiary care, and to provide support in developing shared care agreements and in the transfer of care.

Guidance for onward referrals

To further support delivery of the NHS Standard Contract 2017-19 measures, the Academy of Medical Royal Colleges, in collaboration with partners including NHS England, has published guidelines on the best practice on onward referrals. This short clinical guidance document outlines clear principles for how to avoid unnecessary doubling up of referrals and helping patients move more easily though the care system.

Engaging with patients

Members of the national working group and, specifically, NHS England, British Medical Association (BMA) and the National Association for Patient Participation (NAPP), have come together again to produce a print ready patient facing leaflet so that patients know what they can expect to happen if they are referred by their GP to see a specialist or consultant at a hospital or a community health centre.

Patient facing leaflet (colour)
Patient facing leaflet (black and white)

The leaflets are also available on the NHS website.

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