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Improving how secondary care and general practice in England work together: the NHS Standard Contract

Due to the increasing pressures on general practices within the National Health Service in England, the interface between primary and secondary care, and the division of labour between these, has become an important issue. This has long been an area prone to difficulties and conflict, the consequences of which can directly impact the quality and safety of patient care, particularly for patients with chronic conditions who regularly transition between these two sectors. In an article published in the Journal of the Royal Society of Medicine, Amy Price and I explore the measures recently implemented in the NHS Standard Contract which aim to target common issues at the primary–secondary care interface, with an aim to reducing inappropriate general practitioner workload in England. We discuss the context behind the implementation of the NHS Standard Contract as well as current concerns and areas for further consideration.

The current crisis in primary care means the NHS Standard Contract is needed to clearly define responsibilities between primary and secondary care. However, initial experiences and anecdotal evidence suggest that these standards are not currently being rigorously enforced, resulting in little beneficial impact for general practitioners, their teams and for patients. Further work is needed to fully understand whether the NHS Standard Contract has been successful in achieving its aims and, if not, how best to address this.

Although improving the timeliness of clinic letters and discharge summaries to facilitate communication, and a clearer division of work and responsibilities at this interface is necessary, an important aspect to consider is that hospital doctors need to be equipped with a greater awareness of the present challenges faced by general practitioners. Hospitals also need to be given some positive incentives for meeting the aims set out in the NHS Standard Contract. These changes could then help improve working relationships between general practitioners and hospital doctors, and thereby reducing inappropriate general practitioner workload and improving patient experience in the NHS Standard Contract in England.

DOI: https://doi.org/10.1177/0141076817738504

A teaching aid on the contract is also available on SlideShare.

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