Links between primary and secondary care must be ‘streamlined’ says NHSE

The guidance for 2024-25 published by NHS England today states: “Every trust should have a designated lead for the primary–secondary care interface.”

It also asks integrated care boards to “regularly review progress” on how secondary care services are working with primary care.

NHSE recovery plans include trying to cut the number of patients effectively referred back to GP  practices by other services, in order to reduce GP workload.

The guidance states: “Streamlining the patient pathway by improving the interface between primary and secondary care is an important part of recovery and efficiency across healthcare systems”.

The planning guidance — published on Wednesday night after months of delays — also said systems should continue to develop integrated neighbourhood teams, including by trying to “improve the alignment of relevant community services” to primary care network footprints. 

INTs are intended to integrate out-of-hospital services, including by linking PCNs with other services. As well as expecting community health services to reorganise how they work, HSJ  understands the process is also expected to mean significant numbers of PCNs changing their footprints to better match other services.

The planning guidance further says ICBs should establish a “full understanding of demand and capacity” in primary care. It does not give detail on how, but it comes after NHSE plans to collect digital call data from GP practices from October to better understand demand, as part of the 2024-25 GP contract.

On community health services, the guidance told systems to develop a “comprehensive plan” to reduce waiting times for these services by June 2024, including waits over 52 weeks for children’s community services, and submit “timely, accurate data” to better understand long waits.

NHSE will work with ICBs and providers to “set a specific ambition and improve data capture” for this, it added.

Community waiting times and lists rose sharply over the covid period — particularly for assessing children for neurological development issues like autism and ADHD — with some very long waits causing major concern.

The previous two-hour target for “urgent community response” services, which was being widely met, has been dropped, but 2024-25 guidance instead tells systems to: “Increase referrals to and the capacity of UCR services, whilst still ensuring a timely response, with a particular focus on developing and standardising referrals from 999, 111, clinical assessment services and care homes.”

Discharge

This year’s guidance is more directive about systems using pooled “better care fund” money on intermediate care, with the purpose of freeing up general and acute beds.

They should “expand bedded and non-bedded intermediate care capacity… to support improvements in hospital discharge and enable step-up care in the community”, and adds: “NHS funding (including the additional adult social care discharge funding) should be focused on increasing intermediate care capacity to free up G&A beds.”

The planning guidance also calls for reductions in hospital length of stay as part of efforts to improve productivity, by speeding up discharge once patients are deemed “discharge ready”; and says the national focus of NHSE’s “NHS Impact” improvement teams in 2024-25 will be “interventions that improve patient flow”.