The introduction of clinical commissioning groups seems to require more collaboration between primary and secondary care. In this context of changes, OnMedica sought to determine where the rapport between primary and secondary care stands by asking GPs their views on the evolution of their relationship with secondary care over the past 10 years and the impact this may have had on patient care.
Sadly, the majority of GPs felt that relationships have deteriorated. An increase in bureaucracy and lack of contact between GPs and consultants were largely to blame. Patient care was occasionally thought to suffer as a result of this. With regards to Clinical Commissioning Groups, the jury was out on whether they could strengthen relationships or increase the gaps between primary and secondary care. In the future, GPs would value better telephone or email access to secondary care colleagues. Interestingly, written feedback on the quality (not quantity) of referrals from primary care was welcomed by most GPs.
Here are the key findings from the survey:
(Click here to see the full survey report. The tables in this article are referenced as per the full report)
Deterioration in relationships between primary and secondary care today, compared to 10 years ago
The majority of GPs felt that the current relationship between primary and secondary care was average, but had become worse over the past 10 years (see tables 1 and 2).
The main reasons given for the deterioration were that efficient communication is hindered by too much bureaucracy (77%), GPs and consultants are not engaging in a clinical environment (66%) and consultants are less accessible than previously (63%).
- Choose and Book was blamed for “making it more difficult to refer to a named consultant or to build up links with the individual member of a specialist team”.
- Another GP commented “Pressure of work environment has increased so much some things such as good networking have been pushed down the list of priorities. Email contact is hindered by data protection issues.”
Negative impact of communication difficulties on patient care
- The majority of GPs (53%) felt that communication difficulties between primary and secondary care only occasionally impacted on patient care.
- However, around a third of GPs (38%) felt patient care often suffered as a result and 5% of GPs complained of communication issues constantly interfering.
- Only a very small proportion of GPs (4%) felt confident enough to say that patient care was never or hardly ever affected.
GPs agree an improvement in the relationship between primary and secondary care is vital
While it is reassuring to think that communication difficulties were only occasionally causing problems to patients, the fact that it should happen at all is of grave concern.
- An overwhelming majority of GPs (89%) felt improvement was necessary.
- Popular ideas for implementing this improvement included better provision of telephone (71%) and electronic (68%) access to secondary care colleagues.
86% of GPs felt written communication needed to be improved.
- Specific ideas for improvement included the speeding up of written communication (86% of GPs) and improving the quality of discharge summaries (84% of GPs).
- Interestingly, despite a general feeling of resistance among GPs to the referral management schemes run by many Clinical Commissioning Groups, the provision of feedback on the quality (rather than quantity) of referrals from primary care was welcomed by most GPs (69%).
Jury is out as to whether Clinical Commissioning Groups will improve collaboration between primary and secondary care.
- Engaging secondary care colleagues via the commissioning process (e.g. joint care pathways) was also hoped to result in improved relationships by 68% of GPs (see table 11 above).
- However, a separate question on the impact of collaboration between primary and secondary care found the jury was split on the benefits of the commissioning, with 36% of GPs fearing it would increase the gaps, 32% hoping it would strengthen the gaps, 12% suspecting it would not make much difference and 19% stating they did not know what affect this would have.
Overall, these findings are not surprising. More effective collaboration and communication between primary and secondary care would hopefully lead to improvements in job satisfaction for us all, as well as patient care. In these challenging times where cost savings and spiraling workloads seem to dominate discussions, it is easy to feel overwhelmed and unable to look at the bigger picture. The future of the NHS surely depends on primary and secondary care to working together – we must not lose sight of this vision.