The acute sector is showing 'institutionalised contempt for primary care' by its failure to provide GPs with prompt discharge summaries, the NHS Alliance has claimed.

Trusts should not be paid until GPs get the data they need, it argues, following a survey of 650 practices which reveals problems with the information GPs receive about patients who have just left hospital.

The survey, released to HSJ, shows that 70 per cent of GP practices have either 'very' or 'fairly' often experienced late summaries, with many also citing problems with their quality (see GPs' comments, below).

As a result, over the past year 58 per cent say the clinical care of patients has been compromised and 39 per cent report patient safety has suffered.

Alliance chair Dr Michael Dixon said: 'This widespread problem reveals an institutionalised, though unconscious, contempt for primary care and the patient in primary care. It demonstrates the weakness of commissioner-provider relations.

'Some primary care trusts such as Heart of Birmingham are taking effective action but we need changes at a national level too. Commissioners should be able to determine what services they expect from secondary care. That may already be the case in theory. Too often, it is not so in practice.

'The answer is to make sure payments to providers depend on their delivering what is required, including timely, accurate discharge information to a minimum standard.'

The survey says that patients are being put at risk by the system: 'GPs are plagued by delays in essential information and by inadequate detail even when it is provided. Scarce funds are wasted on avoidable readmissions.'

The alliance is also calling on the Department of Health to ensure that the prompt provision of all essential discharge information is required through the model contract. It says:

  • the contract should include minimum standards for the content of immediate discharge summaries to be provided within two or three days of discharge;
  • detailed discharge letters should be provided within a maximum of three weeks;
  • the discharge letter should include the full payment by results healthcare resource group coding and the costs that will be invoiced;
  • GPs involved in practice-based commissioning and primary care teams should insist PCTs
    take this action and that payments are validated.

A 63 per cent majority of GPs said they did receive prompt summaries from at least a few of their local trusts and departments. But despite these areas of good practice, 'the overall picture is chaotic', alleges the report.

It says: 'Why is it that, at one hospital, the cardiology department provides a first-class service but, elsewhere in the same hospital, discharge information is given such a low priority that at least one adverse incident has resulted?

'Why is it that one department regularly sends discharge information up to three months late when other departments in the same hospital are able to provide letters within two to three weeks? And why does the NHS tolerate failures like these?'

A DoH spokeswoman said: 'Improving the quality of information provided to GPs is part of a six-point action plan developed with senior GPs during a Downing Street summit. The plan acknowledged the need to drive up the quality of information available to practices, ensuring it is meaningful, in a format that is useful, and striving towards data that is available in real time.'

The alliance says GPs depend on prompt discharge summaries for prescribing information about medication that has been stopped; diagnostic test results and information on any results that are pending; details of procedures; the names of the consultant responsible for the patient's care; the discharging doctor, and contact phone numbers in case of queries.

Three trusts were regularly praised in the survey: Bradford Teaching Hospitals foundation trust; Winchester and Eastleigh Healthcare trust; and the Royal Berkshire foundation trust.

In particular, the James Cook University Hospital (part of South Tees Hospitals trust) in Middlesbrough was mentioned by seven respondents, four in favour and three critical.

Royal Liverpool and Broadgreen University Hospitals trust, Royal Devon and Exeter foundation trust and Oxford Radcliffe Hospitals trust were criticised most frequently.

What the GPs said

'Some hospitals send handwritten discharge notes that are often illegible, full of ambiguous or unknown acronyms. These may come promptly - but then mean full discharge summaries rarely come at all - so no idea which clinic, consultant, blood test etc.'

'Not only are we plagued with late summaries, when they do arrive some are incorrect, some with no diagnosis and others without the patient's name. Some never arrive.'

'One discharge summary failed to mention that a patient had spent a week in intensive care following a heart attack and stroke.'

'Patient admitted with jaundice and ascites secondary to unknown alcoholic cirrhosis. He attended surgery having been discharged earlier that day, accompanied by a friend who was very concerned that he had been discharged with a sedative not to be taken with alcohol, with no dose instructions.'

'Notification of deaths very poor. In two instances in past year we learned of patients' deaths from other patients mentioning it when they came to
the practice. Not acceptable.'

'Several instances lately about discharge of terminally ill patients. Saw someone last night with lung cancer who was discharged two days earlier with lots of new meds and neither GP nor nurse notified. Patient has side effects of meds and was feeling awful. That was just this week. Also consultant's name was illegible on summary, I ended up speaking to medical registrar on-call.'

'The hospital only gives a seven-day prescription. Patients request prescriptions and we do not have the information. It upsets patients and causes work for reception staff, who have to phone the ward. Doctors who do not have a diagnosis when the patient is in front of them do not look professional.'