Interface between primary and secondary care

This page is under review and will be updated in line with the red tape challenge. For any feedback, please contact: policy@rcgp.org.uk

Good processes and organisations of care across the interface between primary and secondary care are important to ensure a smooth and effective transition for patients during referral and discharge. There are many tools available to help manage this interface. Some of these are available nationally. Others have been designed locally and are bespoke to the population they serve. When the interface works well, the patient experience is far more positive.

The RCGP has undertaken several initiatives to enhance the efficacy and efficiency of the primary/secondary care interface. These initiatives involve evaluating specialised tools and recommending the most effective ways to collaborate for primary and secondary care.

RCGP outputs

1. Primary/Secondary Care Interface Guidance (PDF file, 167 KB)

• This document provides locally adaptable principles and guidance for improving communication and working between primary and secondary care professionals. It is based on consensus work by Cheshire and Merseyside Health and Care Partnership.
• An accompanying template letter (DOCX file, 27 KB) has also been developed for Faculties to send to their local ICBs to help facilitate discussions on the primary/secondary Care interface. We would recommend discussing this with your secondary care colleagues initially to get their buy in and potentially send the letter from both primary and secondary care.

2. The RCGP has released a policy statement on Advice and Guidance which can be found on the policy page.
3. RCGP Scotland has been working on a project, funded by the Scottish Government. It is to support the establishment of primary-secondary care Interface Groups in each Health Board Area. The project aimed to improve efficiency, build and enhance professional relationships, address local relevant factors, and ultimately improve the quality and safety of patient care. As part of this project and to support Interface Groups, we have developed the following support materials:

• Template business case to request resource for an interface group (DOCX file, 27 KB)
• Draft remit and membership (DOCX file, 27 KB)
• Examples of things other boards/groups have done and suggested activities, guidance and signposting (DOCX file, 17.6 KB)
• Website/letter content to raise awareness of interface group (DOCX file, 41 KB)
• Work shadowing materials:
  • template invitation (DOCX file, 15.9 KB)
  • request form (DOCX file, 13.2 KB)
  • feedback form (DOCX file, 15.4 KB)
  • SOAR template (DOCX file, 374 KB)

A second phase of this project has been established to encourage and promote Interface Groups with Health Boards throughout Scotland. We are developing relationships and partnerships with secondary care and primary-care secondary care collaboration - all in the interest of best-practice care.

Other useful resources

1. The RCGP and BMA have worked with NHSE/I on guidance relating to the Advice and Guidance initiative, with direct access to investigations, to produce specialist advice clinical responsibility FAQs and specialist advice Medico-legal FAQs, which should be read alongside the above interface documents.
2. Rebuilding the NHS: Better medical pathways for acute care 2022 - a joint statement from:
   • the RCGP
   • Royal College of Emergency Medicine (RCEM)
   • Royal College of Physicians (RCP)
   • Royal College of Psychiatrists (RCPsych)
   • the Society for Acute Medicine (SAM)
3. The BMA have published a list of adaptable letter templates (DOC, 364 KB) which can be used to set clear boundaries for inappropriate workload transfer to general practice from other health and care organisations.
4. The RCGP and RCEM developed a 2021 document covering recommendations for discharge into general practice from the emergency department including patient communications, investigation results, onward referral and digital systems.
5. A collaborative interface document (PDF file, 580 KB) has been developed by RCGP Scotland and BMA Scotland which looks at whole system working in Scotland. It provides a clear and comprehensive background of primary care-secondary care interface, and details compelling reasons advocating for a stronger interface.
6. NHS Wales, BMA Wales and the Welsh Government developed this 2018 document which lays out communication standards between GPs and Secondary care (external PDF). It includes a list of standards around communication, referral and delegation of work as well as explanations and case studies of when these standards would be implemented.
7. The RCP have produced a webinar on improving the interface between primary and secondary care.