For the latest round of negotiations, five key changes have been agreed. These are:
- Hospitals to issue Fit Notes, covering the full period until the date by which it is anticipated that the patient will have recovered.
- Hospital Trusts to respond to patient queries for matters relating to their care rather than asking the patient to contact their GP. This would put an end to a culture spanning decades of patients being told to “see your GP” for a host of issues that should clearly be the responsibility of secondary care - such as queries regarding hospital test results, treatment and investigations, or administrative issues regarding follow up, or delays in appointments etc. The new contract requires that the Provider must respond to patients (as well as GP queries) “promptly and effectively to such questions and that these are publicised using all appropriate means, including in appointment and admission letters and on the Provider’s website; and deal with such questions themselves, not by advising the patient to speak to their referrer.”
- Hospitals must not transfer management under shared care unless with prior agreement with the GP. GPs should not therefore be asked to prescribe specialist medications by virtue of a hospital letter or instruction alone. Any such shared care arrangement must be explicitly agreed first by the GP based on if s/he feels competent to do so, and which may include being resourced to do this as a locally commissioned service.
- Hospital clinic letters to be received by the GP within 10 days from 1 April 2017, and within 7 days from 1 April 2018. This will reduce significant wasted appointments when patients specifically see a GP following an outpatient clinic appointment, but without us having the relevant clinical information to manage the patient, often requiring the patient to rebook another appointment.
- Issuing medication following outpatient attendance at least sufficient to meet the patient’s immediate clinical needs until their GP receives the relevant clinic letter and can prescribe accordingly. This addresses an increasing phenomenon of patients turning up at a GP surgery sometimes almost immediately after a hospital appointment for an outpatient initiated prescription, and with the GP pressurised to prescribe without relevant clinical information, and with clinical governance risks.
A range of template letters are now available for practices to adapt for their own use if they find that hospitals are not implementing the contractual changes. The template letters are available in Word format here. The letters can also be downloaded in a suitable format for SystmOne, Emis Web and Vision here.