Many patients cross the primary/ secondary care interface in the course of the management of both acute and chronic conditions. Good communication between clinicians and between clinicians and patients is an essential prerequisite for good care.
General practitioners are the first port of call for many patients seeking healthcare. Those seeking care may present undifferentiated problems without stigmatisation. GPs provide continuity of holistic care and support patients to manage long term conditions. They may act as patient advocates and signpost them or refer them to other care providers. Patients return to their GP to have their ongoing management after contact with other providers and often seek clarification, explanation and advice regarding the implications of the interaction with specialists.
Secondary care doctors are consultants, staff grade and doctors in training. They may work in hospitals or other settings. They may work as generalists or specialists. These doctors see patients who have been referred by GPs or other colleagues or who have been admitted via the urgent care services. This may involve relatively short term care for a specific condition which may resolve or be ongoing. It may involve support and care for long term conditions with multiple interactions over several years. Secondary care doctors may initiate treatments and handle all specialist decisions or may share care with a GP.
Good information must pass between primary and secondary care (and indeed within primary and secondary care) so all health care providers are fully aware of what is being done for or with the patient. Anecdotal evidence over many years suggests this often does not happen and one or more care givers are frustrated by the lack of current information as to what has been done by other care givers. There is also inconsistency in the perceived responsibility for undertaking review and follow up. Such lack of information or inconsistencies in management pose a risk to the safety of patients who may not receive appropriate treatment or who may receive incorrect treatment. Some of these failures or frustrations in communication across the interface appear to derive from a failure of one party to appreciate the working arrangements , experience or skill of the other party or just a lack of consideration for others.
This paper identifies the issues causing concern and considers to how the behaviour of doctors may contribute to the problem. It recognises that many are related to system issues and these will be looked at by a subsequent working group.