The interface between primary and secondary care has long been a source of tension within the NHS. Miscommunication, unclear responsibilities, and digital silos have historically led to delays, duplication, and frustration for both clinicians and patients. In response, a new interface liaison role has been developed in several localities to address these challenges head-on.

This case study explores how the role has evolved in Mid Yorkshire Teaching NHS Trust and Harrogate District Foundation Trust (HDFT), and the difference it is making.

Developing the new interface liaison role

Within Mid Yorkshire Teaching NHS Trust, the concept of an interface role began as part of a broader transformation programme. Initial efforts to convene an interface group were unsuccessful, largely due to lack of resource and engagement. When Laura Townend returned from maternity leave, she was asked to take the lead. With a clinical background as a physiotherapist, Laura brought a unique perspective – she is able to access systems, understand clinical language, and empathise with frontline frustrations.

She quickly realised that the key to progress was grounding the work in real-life examples rather than talking about concepts.

“ I can source real life local examples to illustrate the point – it’s a lot harder to argue against the evidence, when it’s something that’s already happening, rather than a more abstract concept or future priority.”

This practical approach helped build trust and credibility, allowing Laura to identify recurring issues and begin resolving them. Her ability to speak the language of clinicians proved vital:

“Just speaking clinical language is half the battle. They realise that as a fellow clinician, I understand what their frustrations are and want to try and find a way to resolve them.”

In Harrogate, the role was formalised a little earlier. Dr Cath Dixon was appointed in July 2021, with joint funding from the Integrated Care Board (ICB) and HDFT. Her remit was to bring a primary care lens into the trust and improve operational processes across the interface. The model has since been replicated in other areas of the ICB, with variations in structure and funding.

Scope and responsibilities

Both Laura and Cath have taken on wide-ranging responsibilities. Laura manages an interface inbox, triages issues, and works closely with hospital and GP teams to resolve queries. Her dual understanding of clinical systems and commissioning processes allows her to act swiftly and effectively, often preventing small issues from escalating.

Cath’s role includes chairing interface forums, rewriting discharge letters to make them more relevant for GPs, coordinating education sessions, and supporting new hospital doctors with inductions focused on interface principles. She also plays a key role in strategic discussions, feeding into clinical service boards and helping shape local policy.

Impact and outcomes

The impact of the role has been significant. In Mid Yorkshire, Laura has resolved over 100 primary care issues in just a few months, many of which have led to long-term changes. The volume of queries has dropped dramatically, suggesting that systems are improving and relationships are strengthening.

In Harrogate, Cath has dealt with over 300 operational issues since March 2025. Feedback from colleagues has been overwhelmingly positive, with many describing the role as invaluable. Physically based in the trust, she has also been appointed as associate medical director for primary care in HDFT which gives her a unique position and means to influence within her role, which she feels spans far beyond the official 2 days a week. Improvements have been noted in discharge processes, prescribing practices, and communication during system changes such as the Laboratory Information Management System (LIMS) rollout.

Laura reflected on the early challenges:

“At first it did feel like you’re a bit of an agony aunt… just getting all these whinges and moans. But those negatives do turn into positives.”

Cath added:

“It is challenging and there are plenty of colleagues who want change but not to ‘be changed’.”

Perhaps most importantly, both roles have helped rebuild trust between primary and secondary care. Meetings that were once adversarial have become more collaborative, and there is a growing appreciation of the pressures faced on both sides.

Finding a shared goal

The liaison role aligns closely with NHS strategic priorities, including the shift from hospital to community care, digital transformation, and the reduction of bureaucratic burden. By addressing interface issues proactively, the role supports smoother patient journeys and more efficient use of clinical time.

Laura’s work has highlighted the risks of digital silos, where different systems and workflows can lead to patient safety concerns. Her ability to bridge these gaps has been crucial in ensuring that digital tools are used appropriately and consistently.

Cath’s involvement in initiatives like the Red Tape Challenge and 28-day prescribing has positioned Harrogate as a national example of good practice.

Changes to prescribing processes

When Cath first came to the role, prescriptions requiring initiation from outpatients or following consultant results were sent as letter requests for GPs to process. This caused delays and frustration among GPs, who viewed it as hospital colleagues passing off workload on to them.

An audit in 2021 showed 42 medication requests processed this way at one GP surgery over two weeks. A patient survey revealed delays of 3 to 21 days, averaging 14 days.

Cath addressed this by requiring hospital clinicians to issue prescriptions directly, providing a 28-day supply. This enabled patients to access medication promptly and allowed GPs to manage repeat prescriptions from then on.

This simple change saved over 2000 primary care hours of time over a year and the new streamlined processes also alleviated frustration allowing colleagues to focus on other aspects of health and care.

Cath explains:

“Saving over 2,000 hours of primary care work across Harrogate released capacity which can be used to help patients. More importantly it simplified a process that was causing friction between colleagues.”

Lessons learned and recommendations

Both Laura and Cath emphasise the importance of trust, flexibility, and local knowledge. The role works best when housed in a neutral setting like the ICB, where it can serve both primary and secondary care without bias. It also requires a mix of clinical insight and operational awareness, making it well-suited to individuals with frontline experience.

Support from senior leadership is essential, as is peer support from others in similar roles. While the work can be challenging, especially in the early stages, the long-term benefits are clear.

The interface liaison role has proven to be a powerful tool for improving collaboration, reducing friction, and enhancing patient care. As more areas consider adopting similar models, the experiences of Laura and Cath from their day-to-day experience of the role offer valuable insights into what works best – and why it matters to both staff and patients.

For more information about the primary/secondary care interface work visit:

https://www.nhsconfed.org/publications/improvement-across-interface

Consensus on the Primary and Secondary Care Interface