The above lists are not exhaustive nor exclusive. There will be overlap in these problems and recommendations which will vary between different disciplines and organisations. There were differences of view between contributors to the workgroup, particularly with regard to attribution of causation between primary and secondary care. All agreed there were significant problems of communication across the primary/ secondary care interface which needed to be addressed and there was a frustration expressed that these problems had been discussed for many years with no sustainable solution in sight. Many good suggestions have been offered over the years but often by “one side or the other”. Shared mutually acceptable solutions are needed.
There was an overarching concern that doctors felt more undervalued by the health service than in the past. Doctors work in relative isolation from colleagues whose roles they felt were unclear. Generally it was felt that current working practices did not allow enough time to communicate across the interface or to get to know colleagues from other disciplines.
This report has identified some areas where doctors themselves can make a difference to ease the problem in terms of ensuring appropriate attitudes and behaviours regarding sharing or transferring appropriate information and activity round patient care. It recognises there are significant system and process changes needed to improve efficiency. These are by no means insurmountable but they will need a willingness to recognise that collaboration and good patient care requires cooperation, mutual respect and a need to give and take. Improved IT will undoubtedly help but work patterns may also need to change. Above all , clinicians and managers need to recognise the potential risks of harm posed by not addressing this important area of healthcare .