Last week saw the publication of important guidance from NHS England setting out Standards for the communication of patient diagnostic test results on discharge from hospital. The document proposes clearer lines of responsibility and accountability for investigations requested in hospital settings, one of the many areas in which we as GPs routinely find ourselves the recipients of inappropriate and unresourced work.
The crucial explicit principle in the guidance is that ‘the clinician who orders the test is responsible for reviewing, acting and communicating the result and actions taken to the general practitioner and patient even if the patient has been discharged’. This reinforces joint guidance between the BMA general practitioners committee and consultants committee, and also supports our Quality First document, in which we produced a template letter for practices to push back on inappropriate requests to chase up hospital-initiated requests (see Appendix 3).
The guidance is clear that reviewing a hospital-initiated investigation can only be delegated to the GP if s/he has agreed to it, and if reached by consensual agreement by the GP and the hospital team. This principle is vital for clinical governance standards and patient safety. Currently, GP practices not uncommonly receive copies of results from hospitals, often with no clarity regarding whether they have been acted upon, and with the patient-safety risk of results slipping through the net unactioned.
In other cases GPs are requested to chase up hospital investigations, which they have had no direct involvement in, and which this guidance clearly states should be the responsibility of the requesting clinician. Worse, at a time of inadequate GP capacity to meet patient demand, considerable numbers of GP appointments are booked by patients specifically to request the results and interpretation of hospital-initiated investigations, further reducing our availability to ill patients. A recent NHS England commissioned report Making Time in General Practice revealed that up to 27 per cent of GP appointments are potentially avoidable, and GPs being asked to deal with such hospital queries accounts for much of this.
This needs to be urgently addressed and I have accordingly written to NHS England to direct all CCGs (clinical commissioning groups) to implement the above guidance. I have also called for hospitals to stop routinely copying hospital-generated test results to GPs to avoid any ambiguity regarding responsibility for reviewing these results, and also given that current technology already allows GPs to directly access hospital investigation results data.
What practices should do:
– Make sure, that as a member of your CCG, you require that the CCG implements this guidance (you can use your LMC for support)
– Use our existing template to reject inappropriate requests to follow up hospital investigations
– Use our new template to send copies of test results back to hospitals to ensure/confirm they have been actioned by the requesting clinician
– Use our new template to let the CCG know if the above principles are being breached, so that appropriate commissioning levers can be applied
– Copy your local medical committee into the letter to your CCG.
This guidance is a small, but significant step in addressing a wider area of inappropriate workload shift on to GPs so that we can release capacity to be more available for the core needs of our patients.
BMA calls a crisis conference
BMA council voted at a recent meeting to call an SRM (special representative meeting) in response to the crisis in funding and capacity engulfing the NHS, and its effect on patient safety and doctors working within excessive pressures across the branches of practice.
The SRM will be held on 3 May and follows on from the special LMC conference earlier this year, which discussed the increasing pressures facing general practice. I will update you as more information becomes available.
With best wishes
BMA GPs committee chair
Revalidation: Guidance for GPs
Earlier this month, the Royal College of GPs published new guidance for GPs on appraisal and revalidation. The new RCGP Guide to Supporting Information for Appraisal and Revalidation aims to reduce inconsistencies in interpretation of requirements and simplify and streamline the appraisal and revalidation process.
General Practice Nursing in the 21st century
The QNI (Queen’s Nursing Institute) has launched a free online learning resource, ‘Transition to General Practice Nursing’ to support nurses who are new to general practice, which can also be used to support revalidation, since it has a cloud based portfolio, and student nurses in GP placements.
More than 1,200 people have already accessed the resource since it was launched on 18 January and the feedback has been very positive. The QNI is committed to updating this as required and plan a full review in two years. Read the QNI GPN report.