Interface between primary and secondary care becoming too complex

Over 15 million GP appointments per year are spent dealing with issues managing care between GP practices and hospitals as the interface between the two becomes more complex.

This was the finding of a new report from the think tank Policy Exchange. It also found that 150,000 people could be on ‘hidden’ waiting lists, where a patient has been referred by a GP for further treatment, but not included on official hospital waiting lists.

It is now calling for a ‘proactive’ approach to managing care at the ‘interface’ between GP services and hospitals and the development of hybrid doctor roles who are able to work more routinely across hospitals and GP practices.

The authors also call for a massive boost to research activity in primary care to deliver the latest treatments and technologies through a new “Academic Primary Care Accelerator”.

Authored by Dr David Landau, a retired consultant oncologist and Dr Sean Phillips, Head of Health and Social Care at Policy Exchange, Medical Evolution calls on the government to target the interface for further reform.

It cites growing frustrations (from both patients and clinicians) at care management despite growing complexity of work carried out across the interface (referrals, cancer follow ups, diagnostic tests etc.)

It also cites potential risks to patient safety – such as from poor medicine management after a patient has been discharged from hospital, which they say necessitates a more proactive approach.

Recommendations for GP-hospital interface

Making 20 recommendations in all, the authors state that whilst the report focuses on the GP-hospital interface, its findings will have applicability for other ‘NHS interfaces’, such as with social care.

Recommendations in the Policy Exchange report include:

1. The development of an Interface Improvement Initiative, which reports directly to ministers, tasked with identifying key areas where national-level interventions can optimise interface working;
2. To enable patients to ‘track’ who is responsible for their care when being supported by a number of providers (via the NHS App), building on the ‘My Planned Care’ platform;
3. For ‘interface specialist’ roles to be developed for doctors, nurses and pharmacists & to be piloted in an integrated care system (ICS) in the next 12-24 months.
4. For an ‘Academic Primary Care Accelerator’ scheme to be developed – jointly funded by a coalition of partners enabling GP practices to apply for additional funding to operate predominantly as academic units (and to test effectiveness of new ‘interface specialist’ roles).
5. For Integrated Care Boards to target the development of ‘community clinics’ in specialities (such as paediatrics or respiratory medicine) which can deliver the most significant returns in value for money and improved waiting times.

Report author and Senior Fellow at Policy Exchange, Dr David Landau, said: “For too long the interface has been neglected as a key site of activity, and not proactively managed. Policy Exchange’s proposals – which include the development of dedicated roles, operating across the interface – look to ensure more people can access specialist support with a shorter wait and closer to home.

“Crucially, we want to see GPs recognised as specialists in their own right, and to draw more research activity into primary and community care through a new Academic Primary Care Accelerator scheme.”