Skip to main content

Improving how secondary care and general practice in England work together: the NHS Standard Contract

Due to the increasing pressures on general practices within the National Health Service in England, the interface between primary and secondary care, and the division of labour between these, has become an important issue. This has long been an area prone to difficulties and conflict, the consequences of which can directly impact the quality and safety of patient care, particularly for patients with chronic conditions who regularly transition between these two sectors. In an article published in the Journal of the Royal Society of Medicine, Amy Price and I explore the measures recently implemented in the NHS Standard Contract which aim to target common issues at the primary–secondary care interface, with an aim to reducing inappropriate general practitioner workload in England. We discuss the context behind the implementation of the NHS Standard Contract as well as current concerns and areas for further consideration.

The current crisis in primary care means the NHS Standard Contract is needed to clearly define responsibilities between primary and secondary care. However, initial experiences and anecdotal evidence suggest that these standards are not currently being rigorously enforced, resulting in little beneficial impact for general practitioners, their teams and for patients. Further work is needed to fully understand whether the NHS Standard Contract has been successful in achieving its aims and, if not, how best to address this.

Although improving the timeliness of clinic letters and discharge summaries to facilitate communication, and a clearer division of work and responsibilities at this interface is necessary, an important aspect to consider is that hospital doctors need to be equipped with a greater awareness of the present challenges faced by general practitioners. Hospitals also need to be given some positive incentives for meeting the aims set out in the NHS Standard Contract. These changes could then help improve working relationships between general practitioners and hospital doctors, and thereby reducing inappropriate general practitioner workload and improving patient experience in the NHS Standard Contract in England.

DOI: https://doi.org/10.1177/0141076817738504

A teaching aid on the contract is also available on SlideShare.

Comments

Post a Comment

Popular posts from this blog

Example ADHD Referral Letter

Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have
Post a Comment
Read more

Dr Curran and Partners – Clinical Update 10 August 2023

1. Measles The UKHSA has warned that unless MMR vaccination rates improve, London could experience a large measles outbreak. Measles is potentially a very serious illness with important complications - but is preventable though vaccination.  Please ensure patients and their families are up to date with their vaccinations. Please also check the vaccine status of new patients - particular migrants - and enter details onto the medical record of any vaccines given elsewhere. https://www.gov.uk/government/news/london-at-risk-of-measles-outbreaks-with-modelling-estimating-tens-of-thousands-of-cases 2. Shingles vaccination The shingles vaccine programme is being expanded. From September, GP practices will offer: - Those aged 70-79, 1 dose of Zostavax or 2 doses of Shingrix - People aged 50+ with a weak immune system, 2 doses of Shingrix - Those turning 65 & 70, two doses of Shingrix vaccine. For further details, see https://www.gov.uk/government/publications/shingles-vacc
Post a Comment
Read more

Why we need to put an end to the GANFYD culture in the UK

One of the causes of increased workload in general practice are the many requests that doctors get for letters, reports and forms from patients or from external organisations. It’s now so common that doctors have coined a term for it: GANFYD – Get A Note From Your Doctor.  It’s seems that large sections of society can’t function without these “letters from doctors”. Instead of using common sense or employing their own clinical advisers, external organisations make repeated requests to NHS doctors for letters which are often not at all needed. Often the worst offenders come from the public sector – e.g. universities who seem to look upon NHS general practice as a source of free occupational health advice for their students. Universities never – of course - offer to pay for this advice they get from NHS GPs. Instead, university requests will come with a mealy-mouthed statement that any fee is the responsibility of the student. Like doctors are going to impose heavy fees on impoverished s
Post a Comment
Read more