Effective working between primary care and secondary care is critical both to the day to day
delivery of care to individual patients and to developing our plans for the best services for
the future. The LMC and GP Sub Committee raised a series of concerns about the interface
between primary and secondary care late last year. These concerns also reflect issues raised by
clinicians in secondary care. To enable us to work together to address these issues we set up a
Board-wide Interface group which has now met three times.
In our April communication about the group we described the various areas of work and this short
note is to update you on the work of the Group as at July 2013.
Community phlebotomy: One of the issues which has been a real problem for patients, hospital
and primary care doctors has been the lack of access for hospitals to phlebotomy services that are
local to patients. This autumn we will establish a pilot service covering Possil and Springburn to
enable hospitals to book patients in for phlebotomy in the community. If the pilot is a success we
will look to roll it out across the Board area.
Consultant to Consultant referrals: Guidance has gone out to hospital doctors to ensure that
where appropriate patients are referred within hospital services rather than back to primary care.
The guidance is shown below:In most circumstances if a secondary care clinician decides that onward referral is required then they should
take responsibility for this and not pass this back to the GP. The following exceptions apply:


Where the condition or symptoms requiring onward referral are unrelated to the basis for the original
referral the GP should be advised of that to enable their decision on further management
When a referral requires additional information held by primary care it would be appropriate to ask the
GP to make the referral.
When a consultant does make an onward referral they will inform the GP who will retain clinical responsibility
for the patient. If the patient does not wish to be referred on the GP will be notified of that position.
Accident and Emergency Referrals
Where a patient attending A&E requires further routine referral that should be communicated to the GP so
that a full referral can be made and supervised by the GP. With the exception of referrals required as a
direct result of an emergency presenting problem it is not possible for A&E to make routine referrals to other
specialties without the full clinical information which GPs hold.
Immediate discharge letters: The Group believe that a major push to improve the timeliness and
completeness of these has resulted in significant improvements, GP members will continue to
monitor and provide feedback and the Acute Division also routinely audit.
FIT notes: The CMO guidance has been issued to all hospital services to ensure these are issued
in hospital and specific guidance is in place for orthopaedics which was flagged as a problem area.
Cancer services: A sub group has been established to work on a number of issues about the care
of cancer patients in primary and secondary care.
Requests to GPs to follow up hospital results: The main area of problem from collation of
issues seems to be junior doctors and they have been reminded that if they order tests then they
are responsible for following up the results and must not ask GPs to do so or see the patient to
give results.
Mental Health: the joint group on this is working to:-
develop an agreed care pathway for physical health issues for mental health patients;
Describe for the key psychiatric drugs the respective responsibilities of primary and
secondary care.
Clarify relationship between primary and secondary care;
Review care pathways between primary care and addictions;
Prescribing: We expect to introduce electronic communication of outpatient prescribing later this
year and a short life working group has been established to develop this.
Reducing paper: a programe of work to reduce the paper which is sent from hospitals to practices
is underway with the aim of all clinical communication being electronic from the end of September
21013.
Managed Clinical Networks: work is underway with the leads for the chronic pain and
rheumatology managed clinical networks to look at how care pathways between primary and
secondary care can be improved.
Nursing issues: A joint survey of practise nurses is underway to provide a basis for further work
about workload and responsibilities for nurses working in primary care and the community.
If you have comments on the work of the Group please get in touch with one of us:-
Anne Hawkins, Director, Glasgow City CHP (Chair)
anne.hawkins@ggc.scot.nhs.uk
Jane Grant, Chief Operating Officer, Acute Division
jane.grant@ggc.scot.nhs.uk
Michael Haughney, Chair, LMC
michael.haughney@nhs.net
John Ip, Medical Secretary, LMC
john.ip@nhs.net
Georgina Brown, Medical Secretary, LMC
georginabrown@nhs.net
Douglas Colville, Medical Secretary, LMC
douglas.colville@nhs.net
David Leese, Director, Renfrewshire CHP
david.leese@ggc.scot.nhs.uk
Catriona Renfrew, Director of Corporate Planning and Policy, NHS Board
catriona.renfrew@ggc.scot.nhs.uk
Jennifer Armstrong, Medical Director, NHS Board
jennifer.armstrong2@ggc.scot.nhs.uk
Ian Finlay, Associate Medical Director - Surgery
ian.finlay@ggc.scot.nhs.uk
Graham Morrison, Clinical Director, East Dunbartonshire CHP
graham.morrison@nhs.net
John Nugent, Clinical Director, North West Sector, Glasgow City CHP
jnugent@nhs.net
David Raeside, Associate Medical Director - Emergency Care and Medical Services
david.raeside@ggc.scot.nhs.uk
David Stewart, Medical Director, Acute Division
david.stewart2@ggc.scot.nhs.uk
Michael Smith, Lead Associate Medical Director - Mental Health, Glasgow City CHP
michael.smith2@ggc.scot.nhs.uk_
Rosslyn Crocket, Nurse Director, NHS Board
rosslyn.crocket@ggc.scot.nhs.uk