hospitals breach new requirements in the standard contract. It is estimated that 15 million GP appointments, staff time and expense is wasted each year due to inappropriate demands and workload shift onto GP practices. The new template letters are designed to empower practices to demand that hospitals honour
these contract changes, in order to relieve some of the daily bureaucratic burdens on GP
To recap, following lobbying by GPC, NHS England have added the following requirements to the
hospital standard contract as of 1 April 2016:
1. Local access policies
Hospitals cannot adopt blanket policies under which patients who do not attend an outpatient
clinic appointment are automatically discharged back to their GP for re-referral. Hospitals must
publish local access policies and demonstrate evidence of having taken account of GP feedback
when considering service development and redesign.
2. Discharge summaries
Hospitals are required to send discharge summaries by direct electronic or email transmission
for inpatient, day case or A&E care within 24 hours, with local standards being set for discharge
summaries from other settings. Discharge summaries from inpatient or day case care must also
use the Academy of Medical Colleges endorsed clinical headings, so GPs can find key
information in the summary more easily. Commissioners are also required to provide all
reasonable assistance to providers in implementing electronic submission.
3. Clinic letters
Hospitals to communicate clearly and promptly with GPs following outpatient clinic attendance,
where there is information which the GP needs quickly in order to manage a patient’s care
(certainly no later than 14 days after the appointment). For 2017/18, the intention is to
strengthen this by requiring electronic transmission of clinic letters within 24 hours.
4. Onward referral of patients
Unless a CCG requests otherwise, for a non-urgent condition directly related to the complaint
or condition which caused the original referral, onward referral to and treatment by another
professional within the same provider is permitted, and there is no need to refer back to the
GP. Re-referral for GP approval is only required for onward referral of non-urgent, unrelated
5. Medication on discharge
Providers to supply patients with medication following discharge from inpatient or day case care.
Medication must be supplied for the period established in local practice or protocols, but must be
for a minimum of seven days (unless a shorter period is clinically necessary).
6. Results and treatments
Hospitals to organise the different steps in a care pathway promptly and to communicate
clearly with patients and GPs. This specifically includes a requirement for hospitals to notify
patients of the results of clinical investigations and treatments
Access the template letters here.