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Tom Rothwell of Medisec Software argues that the new NHS targets for forwarding patient discharge information from secondary to primary care do not go far enough. The new national service targets set by the Standard NHS Contract for Acute Services for clinical correspondence are a step in the right direction – but they do not go far enough. Secondary Healthcare Trusts must now theoretically deliver discharge documentation to the GP within 72 hours of a patient leaving hospital by March 2009, with the target rising to 24 hours by April 2011. A three day turnaround sounds laudable – in theory the GP will be armed with all the medical information he needs from the consultant to be able to offer high quality follow-up care when his or her patient arrives at the surgery.
The new targets miss two critical points, however. Firstly, they fail to offer any support or guidance as to how a Trust’s performance against the targets should be measured. Given that the majority of secondary healthcare trusts have no idea how or when clinical correspondence is being generated or issued within their medical secretariats, this is the proverbial ‘elephant in the room’. For those PCTs who are already penalising Trusts for late delivery of discharge documentation, the only way to measure this currently is to use the traditional five bar gating, extra clerical hands or sampling methods. Indeed there are many NHS staff whose single role is to count the very things which could and should be reported on routinely and automatically using technology. With Government research recently revealing one NHS manager for every five beds and £15k spent on a management consultant for every NHS employee, this exemplifies the NHS approach to problem-solving. Throw people and resource at an issue, rather than solve it from within. Secondly, there is a total lack of mandated content for the documentation. What the documents look like and what information they contain is left up to the individual healthcare trusts to agree locally. The administrators have missed a golden opportunity to cure one of the biggest communications headaches afflicting the NHS: namely that GPs still receive handwritten, often illegible and sometimes inaccurate carbon copies of discharge documentation, containing only the most scant patient information. The more detailed notes from the consultant often do not arrive until weeks, and sometimes even months, after the patient has been discharged, far too late to be of any real use in terms of patient care. What is the point of mandating turnaround times if what actually arrives in the GP practice often borders on useless in the first place? This is a core problem which has a direct and long lasting affect on patient care.
GPs need detailed and relevant information to offer the best quality of care, yet they often have to take over the care of patients who have had a major illness with very limited details. GPs cannot rely on quizzing sick patients about their hospital treatment in order to manage ongoing care! Some would argue that consultants are likely to baulk at having templates imposed on them from above. This may well be the case but the point is that the discharge notification forms are developed in consultation with both the clinicians and their GP partners – so both sides can input into the process to create the most effective end product. This approach has been followed to great effect at Central Manchester and Manchester Children’s Trust where Consultant Stroke Physicians and GPs have worked together to create the first standardised electronic discharge summary template to gather clinical information on stroke patients during hospital stays. The information includes a detailed diagnosis of the type and severity of stroke, the results of all tests carried out during the admission, medication at the time of discharge and a description of the effects of the stroke in terms of disability, as well as input from therapists, details of follow up arrangements and investigations and an overview of risk factors such as diabetes, hypertension, dietary habits and general lifestyle. The system mandates hospital staff to fill in all the compulsory fields – the software will not allow users to progress with the discharge form unless all the essential data has been supplied. Because it has been developed in collaboration with all the parties concerned, the extra effort involved in completing the template has not been called into question by clinicians – there is a taciturn recognition that it’s worth an extra couple of minutes for the massive improvements in the quality of data provided – and the positive impact on patient care in the wider community. These facilities have been extended into Paediatrics and Vascular specialities and currently work is in progress on Manchester Heart Centre patients. Instead of hospital doctors telling GPs what they think they should know, collaboratively formed templates give general practice the opportunity to say what they actually need. Only by getting the quality of discharge information right in this way, as well as the timeliness of its delivery, can we hope to improve standards of follow up primary care for patients, surely the aim at the heart of the Standard NHS Contract. |
