Primary (GP practice) and Secondary care (including Harrogate hospital) interface agreement:
This sets the standards for what should be expected by both parties in the transfer of patient care between primary and secondary providers locally.
It states that Harrogate hospital will:
- Ensure clear and timely communication to the GP following patient contacts, remembering patients read their primary care records.
- Organise and follow up blood tests to be undertaken within 28 days of consultation or discharge.
- Organise, interpret, and follow up specialist tests which are deemed necessary.
- Provide a prescription or the medication to cover the first 28 days of medication when commencing a new medication to start within 28 days of a consultation.
- Undertake the appropriate pre-treatment assessment and counselling for new medication if necessary, and ensure this has been communicated with primary care
- Provide patients with a Fit Note for the whole reasonably expected duration of their illness or recovery
- Where possible, arrange necessary onward referrals relevant to the original referral issue without expecting patients to go via their GP for this.
If this does not happen for your care you may receive a message from Leeds Road Practice explaining that we have declined the request and referred the issue back to secondary care to for their input or are requesting you to do so. You should also challenge the hospital if you feel they are not meeting their contractual duties as above.
For patients requesting follow on NHS care after private consultant lead care
At Leeds Road our overriding principle is that, whether patients choose their secondary care to be in the private or NHS sphere, they are choosing their primary (general practice) care to be with us under the NHS. We aim therefore to not positively or negatively discriminate against patients who decide to use NHS or private secondary care in terms of what we provide to patients under the scope of our contract as their NHS GP primary care provider.
If general practices receive requests from private providers to arrange tests or investigations, it is important to note that complying with such requests – regardless of the GP’s management and treatment of the patient – is outside the scope of NHS primary medical services.
The NHS GMS Regulations define essential services as services which are delivered in the manner determined by the GP in discussion with the patient. Therefore, a GP provider should only carry out investigations and prescribe medication for a patient where it is necessary for the GP’s care of the patient and the GP is the responsible doctor.
If the GP considers the proposed investigations to be clinically appropriate, is competent to both interpret them and manage the care of the patient accordingly, then the GP may proceed with arranging the tests or investigations.
However, if the GP does not have the knowledge or capacity to undertake these actions, they should decline to organise the investigation and advise the patient and the provider that the services do not fall within NHS primary medical services and to make alternative arrangements.
Patients are of course entitled to access their medical records, so GPs can provide access to the results of any such investigations for the patient to take back to the private provider.
GMC Good Medical Practice states that doctors in the NHS and private sector should “prescribe drugs or treatment, including repeat prescriptions, only when they have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.”
If requested by a private consultant to initiate or continue prescribing medications, and if the GP agrees with this advice, then this could be appropriate. However, if the GP does not feel competent to prescribe the requested medication, or they do not know if the medication best serves the patient’s need, the GP should inform the private provider that the prescriptions should be provided by a specialist.
Private providers can make referrals to NHS services, without referral back to the GP, provided the patient would be eligible for NHS referral. It is known that Harrogate Hospital may not accept referrals made outside of eRS (electronic referral system) and hence this is being worked on currently. Any patients referred should be treated based on clinical need.
General practice responsibility in responding to private healthcare (bma.org.uk)
Care for patients who have had private treatment abroad
Patients can transfer their care from private to NHS as per the NHS Constitution. Thus, if a patient would normally receive follow up in general practice following specialist treatment, they should receive this if they transfer from private care, whether in the UK or not.
However, if follow up is of a specialist nature, or not within normal general practice remit, the patient should be referred to the appropriate service in the UK for this follow up (this does take time so needs to be factored into decisions for treatment).
If an appropriate service is not available, or rejects the referral, this should be directed to the local commissioner whose responsibility it is to commission the service.
General practice responsibility in responding to private healthcare (bma.org.uk)
Please remember that monitoring post bariatric surgery is NOT part of GMS contract for primary care and must be done performed through a specialist clinic which requires referral on the NHS or must be conducted in private care. Leeds Road Practice will not undertake any monitoring post bariatric surgery as this would not be carried out in primary care.
NHS prescriptions and shared care drug protocols:
All prescribable medications are classified into three categories; red, amber and green.
- Red medications are ones that should only be prescribed in secondary care (“hospital only”) – examples are chemotherapy agents and anaesthetic agents. Initiation and ongoing prescribing should not be undertaken in primary care.
- Amber medications are ones that should only be commenced after recommendation by consultant care at secondary care level. Initiation and continued prescribing in primary care should only be undertaken under auspices of an agreed shared care protocol.
- Green medications are products for which primary care practitioners may take full responsibility for initiating and ongoing prescribing however, prescribing guidelines apply (both local and national).
Shared care protocols are used for amber drugs that are:
- Required to be initiated by a hospital consultant/specialist and
- Require a period of stability and monitoring under the care of the hospital consultant/specialist (Secondary Care) prior to prescribing responsibility transferring to the GP (Primary Care).
- The impact for the patient is that initial prescriptions will be provided by the hospital consultant/specialist until stability is achieved.
- Monitoring of the drug and/or condition is shared between the hospital consultant / specialist and Primary Care (the GP), however the patient must remain under long-term review with the hospital consultant / specialist.
A shared care agreement is not valid until this has been requested by the specialist in writing AND the shared care protocol has been agreed, signed and returned by ourselves. Until this point the responsibility for prescriptions, monitoring and follow-up rests solely with the initiating specialist.
All shared care arrangements are voluntary (shared care is outside the scope of core contracted NHS primary medical services), so even where agreements are in place, GP practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the consultant/specialist.
Generally, Leeds Road Practice will not enter into shared care agreements with private providers. Requests will be examined on an individual basis. As a minimum, any shared care request from a private provider must be at least in line with other NHS shared care agreements and be within the workload capacity of the practice.
There is new specific guidance around prescribing and the role of the GP in transgender care of patients. Please look at it carefully if you think this might affect you. https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care.
Prescribing unlicensed medicines
The term ‘unlicensed medicine’ is used to describe medicines, which are used outside the terms of their UK license (ie. for an unlicensed indication or at an unlicensed dose or in an unlicensed patient population) or that have no license for use in the UK. Unlicensed medicines are commonly used in some areas of medicine, such as in paediatrics, psychiatry and palliative care. They are also used, albeit less frequently, in other areas of medicine.
Some such instances of this prescribing fall into the remit of general practice but in some cases ‘unlicensed prescribing’ may be recommended by secondary care consultants. In such cases ongoing prescriptions will only be provided by ourselves in primary care where we are satisfied that prescribing meets the GMC guidance for unlicensed medication prescribing, and where we feel we have the necessary skills and competency to take over prescribing of these medications.
Prescribing unlicensed medicines – professional standards – GMC (gmc-uk.org).
Prescribing on the recommendation of a colleague
At times GPs are asked to prescribe medications for patients at the request of other colleagues: this may be other medical clinicians in primary or secondary care but could also be a nurse or health care professional (e.g. podiatrist, physiotherapist, dietician).
The GMC guidance states that the GP retains the responsibility for any such prescription they issue and as such the GP needs to be satisfied that the prescription is needed, is appropriate for the patient, adequate patient assessment has been made and that the prescription lies within the limits of competences for that GP. Requests that do not fulfil these criteria will be declined and returned to the requester.
Shared care – professional standards – GMC (gmc-uk.org)
Summary
Leeds Road Practice is dedicated to maintaining the highest standards of patient care and clinical responsibility in line with NHS and GMC standards. Policies as listed ensure that communication between primary and secondary care providers is clear and timely, and that the prescription and management of medications are conducted with utmost diligence and in accordance with established protocols. We are committed to providing equitable care within the framework of the Primary Care Contract. By adhering to these guidelines, we aim to deliver safe, effective, and patient-centred care while upholding the principles of good medical practice.