Derbyshire integrated care board (ICB) is considering placing mid-career GPs in secondary care settings to improve working relationships between primary and secondary care colleagues and share specialist expertise to improve patient care.
The pilot scheme – which has not yet started – will see GPs undertake one-year placements consisting of weekly sessions in a secondary care specialty. This is in a bid to help combat deteriorating job satisfaction by diversifying GPs skillsets.
The case study comes as part of the Academy of Medical Royal Colleges’ (AOMRC) major new review into eliminating bureaucracies in the primary-secondary care interface, published on 9 May 2023 alongside the UK Government’s GP recovery plan.
First announced in September as part of the NHS’ winter preparedness plan, the AOMRC report has now been published alongside NHS England’s GP recovery plan and comprises 50 examples – including Derbyshire ICB’s pilot scheme – and key recommendations of system-level and practice-level changes to reduce unnecessary workload in both clinical settings.
Key to this is ensuring local clinicians do not have fixed ideas of ‘GP work’ and ‘hospital work’, the AOMRC said.
Easing pressure between primary and secondary care
Immediate actions detailed in the report that could be taken to take to ease pressure at the interface include:
- Provide patients with a written update on where they are on the waiting list and ask if they still need treatment
- Provide easy access to individual hospital departments and GP practices via non-public phone numbers
- Establish outpatient helplines to direct administrative queries about hospital appointments
- Establish regular ‘interface groups’ representing both primary and secondary care
- Employ a primary care liaison officer to resolve queries at the interface.
In addition, the report highlighted Leicester, Leicestershire, and Rutland ICB’s decision to move all 130 GP surgeries in the region onto a single Electronic Health Record (EHR) system, which acute providers can access.
Clinicians needing to access patient information held by other providers is often blocked by the wide range of EHRs used. This is a particular challenge for caring for patients who are moving between a GP and hospital.
The report said: ‘The A&E terminals have transformed the care of patients presenting as an emergency to hospital, improving safety and reducing the risk of medication errors. Using a single EHR in primary care has also helped drive improvements. For example, when the electronic forms used by GPs to refer into hospital were modified, these were instantly accessible to all practices through the shared EHR.’
Similarly, primary care network (PCN) clinical directors in Gloucester ICB have provided hospital switchboards with their ‘backdoor’ phone numbers to save hospital clinicians using public-facing numbers.
Operational pressures in secondary care can mean this interaction is not always possible and it can negatively impact patient care, especially for complex discharges, the AOMRC said.
The shift has increased direct communication across the interface, the AOMRC said, with local users stating it has improved quality of care.
Cheshire and Merseyside ICB’s Sefton Medicines Management Team has created a medicines management hub, staffed by pharmacists and pharmacy technicians, to review the medications of all patients being discharged from hospital.
In the previous six months, the team has reviewed the discharge summaries of over 6,600 patients, making 350 phone calls to secondary care colleagues to discuss individual patients and holding more than 450 telephone consultations with patients.
A version of this story was originally published by our sister publication Healthcare Leader.