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- Page navigation anchor for Transfer of work from hospitals to general practiceTransfer of work from hospitals to general practiceA key weakness of this paper is that is assumes that all requests made in discharge summaries for primary care teams are appropriate. The interface between primary and secondary care is key to the provision of safe and effective care, and it is important that both hospital teams and primary care teams carry out the tasks that are their responsibility.Some of the tasks described in this paper were the responsibility of the hospital team. This includes arranging post discharge x-rays and any blood tests that are needed in the immediate post-discharge period. As well as being in line with good medical practice whereby clinicians are responsible for dealing with any outcomes from the investigations they request, this is now also mandated in the NHS Standard Contract for England.1We are all in favour of more integrated care and better working between primary care and specialist teams. This does though require clinicians carry out the tasks that are their responsibility and not to try to delegate them onto someone else unless such delegation has been agreed in advance.Reference1. Price, A, Majeed, A. Improving how secondary care and general practice in England work together: requirements in the NHS Standard Contract. J R Soc Med 2018; 111:42–46. doi:10.1177/0141076817738504.Competing Interests: I am a GP Principal in an NHS general practice.
- Page navigation anchor for Is acting as a community house officer the best use of a highly skilled GPs time?Is acting as a community house officer the best use of a highly skilled GPs time?I was disappointed to read the paper by Spencer et al in the British Journal of General Practice, the journal of the Royal College of General Practitioners. The paper “determined the rate of general practitioner’s adherence to instructions given in hospital discharge summaries”, and documents “failures” in processing actions requested by secondary care with a view to helping “GPs improve their practice”.The continued success of the NHS will be predicated on GPs ability to deliver more care for an ageing multimorbid population, in addition to the 90% of NHS work already taking place. To suggest that using the considerable skills of GPs to transact the administrative work of secondary care colleagues by acting as “community house officers” is insulting to the incredible burden of risk and medical complexity managed by GPs and does nothing for the morale of a specialty already in crisis.1Spencer et al, make no concession to the fact that patient safety in the transition of care is the responsibility of all clinicians involved, and this paper implies that responsibility for patient safety for secondary care colleagues ends at the point of writing the discharge summary; however, there is no mention in the paper of the appropriateness of the requests for action made in the discharge summaries analysed. British Medical Association guidance cl...Show MoreCompeting Interests: None declared.
- Page navigation anchor for Prioritising work in primary care - do we really have time to track down more CKD?Prioritising work in primary care - do we really have time to track down more CKD?This is a really good topic and a nice clear article - thank you! Having sat through several significant event analyses that centred on the failures you identify, I think the main underlying reason these keep happening is excessive workload. If future research supports this anecdotal explanation, then perhaps we need to read your paper alongside the ones on CKD in this issue: until practices have enough time to process their incoming letters safely, perhaps we should postpone recommending further work to identify “CKD”, despite its (completely unsurprising) association with admissions and the potential to put more people onto statins.Competing Interests: None declared.