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Changes to Hospital contracts 2017/8

Date sent: Monday 27 March 2017

NHS Hospital Contract 

Email sent to all GPs, Practice Managers and CCGs

Changes for 2017/8

There are six new requirements in NHS Standard Contract for hospitals and other providers in relation to hospital/general practice interface.

Fit notes

There is now a requirement on providers to issue “fit notes” to patients under their care.

This includes hospitals and community providers including mental health. It includes both in patients and out patients.

If a patient has an operation and normally the person would be expected to be off work for 6-8 weeks, then the hospital should provide a fit note for this period.

Out patient clinic letters

From April 2016 OPD letters should have been produced and transmitted within 14 days of the patient being seen, from 1st April 2017 this has reduced to 10 days and will be further reduced to 7 days on 1st April 2018. A new requirement for the electronic transmission of clinic letters, as a structured message using standardised clinical headings, will take effect from October 2018.

Patient queries

The requirement for providers to communicate properly with patients about their care has been strengthened. The is an additional obligation to put in place an efficient arrangement for handling patient queries promptly and publicise these arrangements to patients, on websites and appointments/admission letters.

Discharge summaries

These should already be sent electronically as a structured message using standardised clinical headings. From 1st October 2018 this will also apply to A/E attendances.

From 1st October 2018 transmission of both discharge summaries and clinic letters to general practice must be via direct electronic transmission and not via email.

Out patient prescribing

Providers must supply the medication following a patient’s attendance at a clinic, where clinically indicated, for a period required in local protocols, but at least sufficient to meet the patient’s immediate needs.


By October 2018 the new NHS Contracts states that NHS Trusts will only be paid for when a referral is made by e-referral and any not sent via this route can be returned to the referrer.

Clearly from the LMCs point of view this is totally unacceptable as C&B is not 100% reliable, there may not be appointments available and occasionally the system is down. This issues have been raised and are being addressed nationally.


Changes that we included in the 2016/7 contract

There were six new requirements in NHS Standard Contract for hospitals in relation to hospital/general practice interface

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 referral.

Hospitals must publish local access policies and demonstrate evidence of having taken account of GP feedback when considering service development and redesign.

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.

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.

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.

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).

Results and treatments

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 cost-effective manner, for example, telephoning the patient.


The LMC is pleased to inform you of these nationally negotiated changes to the NHS Standard Contract that is used with all NHS providers.

We will be asking the Commissioners and Trusts to confirm that the changes to the 2016/7 contract have been put into place and also ask for their plans to comply with the 2017/8 changed.

We will also ask them to inform us of the contact telephone number patients can contact within the Trust if they have any queries or suggest if this is not available we will direct all patients to the hospital PALs service.


Best wishes


Dr Nigel Watson

Chief Executive

Wessex LMCs

Churchill House, 122-124 Hursley Rd

Chandler's Ford, Eastleigh

Hants. SO53 1JB (Registered Office)

Tel: 02380253874

Mobile: 07825173326


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Updated on 27 March 2017 1593 views