BMA Template Letters for Breaches to Standard Hospital Contract in England
13 September 2016: GPC has today launched template letters for GP practices to push back on instances where hospitals breach new requirements in the standard contract.
To recap, following lobbying by GPC, NHS England have added the following requirements to the hospital standard contract as of 1 April 2016:
1. Local access policies
Hospitals cannot adopt blanket policies under which patients who do not attend an outpatient clinic appointment are automatically discharged back to their GP for re-referral. Hospitals must publish local access policies and demonstrate evidence of having taken account of GP feedback when considering service development and redesign.
2. Discharge summaries
Hospitals are required to send discharge summaries by direct electronic or email transmission for inpatient, day case or A&E care within 24 hours, with local standards being set for discharge summaries from other settings. Discharge summaries from inpatient or day case care must also use the Academy of Medical Colleges endorsed clinical headings, so GPs can find key information in the summary more easily. Commissioners are also required to provide all reasonable assistance to providers in implementing electronic submission.
3. Clinic letters
Hospitals to communicate clearly and promptly with GPs following outpatient clinic attendance, where there is information which the GP needs quickly in order to manage a patient’s care (certainly no later than 14 days after the appointment). For 2017/18, the intention is to
strengthen this by requiring electronic transmission of clinic letters within 24 hours.
4. Onward referral of patients
Unless a CCG requests otherwise, for a non-urgent condition directly related to the complaint or condition which caused the original referral, onward referral to and treatment by another professional within the same provider is permitted, and there is no need to refer back to the GP. Re-referral for GP approval is only required for onward referral of non-urgent, unrelated conditions.
5. Medication on discharge
Providers to supply patients with medication following discharge from inpatient or day case care. Medication must be supplied for the period established in local practice or protocols, but must be for a minimum of seven days (unless a shorter period is clinically necessary).
6. Results and treatments
Hospitals to organise the different steps in a care pathway promptly and to communicate clearly with patients and GPs. This specifically includes a requirement for hospitals to notify patients of the results of clinical investigations and treatments in an appropriate and costeffective manner, for example, telephoning the patient.
It is estimated that 15 million GP appointments, staff time and expense is wasted each year due to these inappropriate demands and workload shift onto GP practices.
We have received feedback that in many areas CCGs and hospitals have yet to implement these contractual changes, and therefore at the specific request of GPC, NHS England and NHS Improvement wrote a reminder letter to all hospital providers to ensure adherence to these
Our new template letters are designed to empower practices to demand that hospitals honour these contract changes, in order to relieve some of the daily bureaucratic burdens on GP practices.
Action for practices
- I have highlighted the launch of these new templates in my e-newsletter to the profession today.
- We have produced a template letter for each of the hospital standard contract requirements, in order for practices to send any breach notifications back to the provider to take appropriate action. The templates can be embedded into GP clinical systems so that patient details can be pre-populated.
- Practices should also complete a pro forma template to send to their CCG regarding any hospital breaches, so that CCGs can be held to account as commissioners responsible for implementing these contract requirements.
- We have also asked practices to send details of the numbers and nature of breaches to the standard contract to LMCs on a monthly basis.
With best wishes
BMA GPs committee chair