Secondary Care Communications to Patients
To enable your healthcare journey to be as efficient and as seammless as possible, we have set out the terms and conditions affecting referrals for you and your specialist team. The following has been produced aimed at secondary care clinicians but will allow our patients to understand our process.
Interface between Primary & Secondary Care
interface-between-primary-secondary-care.pdf (england.nhs.uk)
Advice and Guidance
Following review of an A&G letter, if the patient requires an outpatient appointment, please convert into a referral, as per protocol. Please do not pass this back to primary care to convert as this delays patient care and uses NHS resources inappropriately.
Medication
In the interests of patient safety we will not prescribe from handwritten notes issued to patients and require the typed clinical letter.
Please ensure any new medication or dose change which you suggest primary care undertake is documented in your letter which needs to be promptly sent to us and includes: that the risks, benefits, side effects and monitoring required have been discussed with the patient. Without this the request may be passed back to the secondary care clinician.
If you feel medication is needed urgently, please prescribe this yourselves, using hospital pharmacy or FP10s for community pharmacies. FP10 prescription forms are available to order for all clinicians (use the following link to order FP10s)
If the medication is not urgent, please inform the patient we will endeavour to issue the prescription within 5 working days of receiving the typed letter.
Please ensure that if prescribing medication, you follow the Surrey PAD Clinical guidance on prescribing advice for both primary and secondary care. This includes if patients require stabilising on medication before transferring this responsibility to primary care. Prescribing Advisory Database (res-systems.net) . If this is not followed the request may be passed back to the secondary care team. Please note that if a medication is under shared care guidance, unless the appropriate protocol for shared care is fulfilled and then accepted by our surgery, it remains the responsibility of the secondary care team to continue to issue the medication and any ongoing monitoring requirements.
Investigations and Results
It remains the responsibility of secondary care team to order and act upon any tests required following a referral as is felt necessary. This includes explaining the results and next management steps. Please see the link below for more guidance around this. Duty of care when test results and drugs are ordered by secondary care (bma.org.uk). If patients require further or repeat investigations, this remains the responsibility of the original requestor, including relevant blood tests. We will facilitate the patient having the blood test in the surgery if capacity allows, but the blood test form must come from the secondary care clinician, in order to ensure the results return directly to the appropriate clinician.
If patients need any sedation for an investigation, this remains the responsibility of the requesting clinician and the radiology department within the secondary care setting. Please see link. Sedation, analgesia and anaesthesia in the radiology department, second edition | The Royal College of Radiologists (rcr.ac.uk)
Onward referrals to other specialities
Clinicians working for the provider should make an onward outpatient referral, without needing to refer back to primary care, where it is directly related to the condition for which the original referral was made, or the patient has an immediate need for investigation or treatment. This includes cancer pathway referrals.
If investigations require further referral onwards to another speciality, this does not need to come back to primary care to organise. This step adds delays to patient care, whilst also using NHS resources inappropriately.
Outpatient Clinic Letters
Clinic Letters should be sent to primary care within 10 days where there is information that primary care needs to act on in relation to the patients’ ongoing care. These should be sent electronically using standardised clinical headings. Primary and secondary care interface (bma.org.uk)
Discharge Summaries
Must be sent to primary care within 24 hours after every discharge from inpatient, day case or emergency department care. Primary and secondary care interface (bma.org.uk)
Did Not Attend
National requirements dictate that providers should no longer ask primary care to re-refer DNA appointments. Primary and secondary care interface (bma.org.uk)
Expediting appointments
If patients ask you to expedite appointments, please ensure they are not advised to consult us again unless their condition has changed such that a new treatment or admission might be required.
Fit notes/Fit for work
If you feel a patient is not fit for work, including after a procedure, please provide them with a fit note to cover the anticipated period of incapacity. Blank fit notes can be ordered from the following link. DWP leaflets and how to order them - GOV.UK (www.gov.uk) Information for hospital doctors is here
Statement of fitness for work: a guide for hospital doctors - GOV.UK (www.gov.uk)
Proformas / Referral forms
Referrals are requesting specialist assessment, opinion or ongoing care. In some cases an attached referral proforma may not have been completed or only partially completed. This is either because the information is not available at the time of referral, it is already contained in the referral letter, will follow or it is not deemed clinically necessary or appropriate prior to referral. Primary care will have due regard to any relevant authoritative clinical guidelines, but are not professionally or contractually required to use referral proformas. Please do not reject referrals on the grounds of an incomplete proforma for the above reasons, as this may cause unnecessary delay and potential harm to patients.
PRIVATE CONSULTANTS
Referrals to NHS pathway
As per BMA guidance, Private consultants can refer onto the NHS pathway if this is felt appropriate/necessary. This is particularly important for two week rule referrals to prevent delay of important investigations. This does not need to be passed back to primary care as increases delays and inappropriate use of NHS resources.