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LMC Publishes Report on Primary-Secondary Interface

Publication date: October 2021

A new report published by the LMC highlights continuing issues with the interface between primary and secondary care which are causing significant extra workload for GPs and practice teams. 

The report, 270 Appointments a Week: A report on the Primary-Secondary Interface, is based on a survey of GPs, practice managers and other practice staff conducted over two weeks in August 2021. 401 responses were received, highlighting a number of areas where there is a significant impact on primary care including:

  • requests for primary care to arrange follow up tests or investigations on behalf of secondary care (these were most commonly blood tests but did include radiology investigations also)
  • issues with onward referral to another team
  • medication issues

The responses received from this survey are likely to represent a small number of cases involving interface issues across the area. As expected, the majority of responses came from those practices on the North bank of the Humber whose main interaction is with Hull University Teaching Hospitals NHS Trust (HUTH). However responses were received for all hospital trusts in the area as well as some community providers, mental health providers and tertiary referral centres.

We asked survey respondents to estimate how long addressing each interface issue had taken them, and which role within the practice had needed to deal with it. Over the 10 working days of the survey, the total time spent addressing interface issues in general practice by all roles was almost 101 hours.

The total time spent by clinical staff on resolving these was almost 54 hours. This equates to at least 270 appointments every week in primary care being lost to managing interface problems that should have been dealt with by other providers in line with their NHS standard contract.

Primary care reception staff are losing 70 hours a week to dealing with interface workload – this is time when they are unavailable to answer patient phone calls, arrange appointments, and respond to email queries, or support their clinicians in delivering care.

At a time when demand is exceeding pre-pandemic levels in primary care, and patient access is a high priority for the system, this represents significant and unnecessary inefficiency for the local NHS system.

Under the NHS Standard Contract, Secondary Care Providers must continually review and evaluate services including interface requirements and must act on lessons learned. Providers must work with their local commissioners to assess compliance by the end of September 2021, and annually thereafter. The commissioners and providers will agree an action plan to address any deficiencies identified by their assessment and ensure that this action plan is informed by discussion with and feedback from the relevant LMCs.

Humberside LMC covers an area which includes four CCGs, three acute hospital trusts and seven other providers. Interface meetings take place across these organisations on a regular basis, and it was agreed that the LMC would conduct a two week snapshot survey of interface issues in August 2021. This initial data collection is intended to help inform the action plan and priorities of local trusts over the coming year in line with their contractual obligations. A similar data gathering exercise was undertaken across North and North East Lincolnshire CCG areas in 2019 so while the survey was open to all practices, the expectation was that the responses would be weighted towards those practices in Hull and East Riding of Yorkshire CCGs.

We’d like to thank everyone who took the time to respond during an incredibly difficult time for primary care, and our trust colleagues for being willing to engage with this process so constructively.

Download 270 Appointments a Week: A report on the Primary-Secondary Interface report. 

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