Operating A Two Tier Framework?

Main Category: Primary Care / General Practice
Article Date: 07 Jan 2008 - 3:00 PDT

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The NHS Alliance welcomes the recently published NHS Operating Framework with its greater emphasis on local decision making and acknowledgement of the central role of practice based commissioning. It also includes targets for prompt discharge information, initially to be provided to GPs within 72 hours of patient discharge, but within 24 hours by April 2010.

The NHS Alliance has campaigned strongly for this over the past three years. Doctors and GP practices have consistently said that delayed and incomplete discharge information regularly puts patient safety and quality of care at risk.

However it is disappointing that the new discharge obligations will not apply to most Foundation Trusts. Those with existing three-year contracts will not have to meet the new targets until their current contract runs out. This will create a two-tier system for a critical safety issue, the NHS Alliance says.

In the interests of patient safety, quality of care and equity, the NHS Alliance believes these existing contracts should be varied so that all hospitals and secondary care providers are required to meet the same standards.

NHS Alliance chairman Dr Michael Dixon said:

"Discharge summaries are as much a part of patient care as a surgical procedure or diagnostic test. It is unacceptable - and potentially dangerous - to fail to ensure that all patients receive the same standard of care.

"It is impossible for GPs to treat patients properly when they do not know the results of diagnostic tests, what treatment has been given in hospital or what medication has been prescribed. Yet we are in danger of accepting a two-tier system. Foundation Trusts, meant to be the best, can avoid meeting the most up to date standards in providing essential discharge information.

"Existing Foundation Trust contracts were often negotiated with PCTs that no longer exist and pre-date practice based commissioning: additional reasons for varying contract provisions."

Notes:

1. The NHS Alliance is a collaboration of professionals who put patients first. Values based, it is the only organisation that brings together PCTs with GP practices, clinicians with managers and Board members, and NHS primary care with its patients. The Alliance membership and its hard working national executive is fully multi-professional.

2. A national NHS Alliance survey of GP practices, carried out in February 2007, found that 56% of doctors had experienced instances where, as a direct result of late discharge information, patient safety had been compromised over the previous three years (39% within the previous year). In addition, 78% of doctors said the clinical care of patients had been compromised over the previous three years. Of these, 58% said this had happened within the previous year. These results were consistent with previous NHS Alliance surveys. Press copies of the full survey report: A very present danger, are available from the NHS Alliance.

3. The new Standard Contract becomes operative from 1st April 2008. It requires secondary care providers to ensure that each patient receives a discharge letter at the time of discharge, and that the provider must issue a discharge summary to the patient's GP:

- Within 72 hours up to 31st March 2009;
- Within 48 hours between 1st April 2009 and 31st March 2010;
- Within 24 hours from 1st April 2010 onwards.

http://www.nhsalliance.org