Improving General Practice Sustainability Group: 2019 Report

Annex B Case Study: 2 - Primary/Secondary Care Interface

Around 50% of medical errors can occur at interfaces with up to one-third of this occurring at the primary secondary care interface. A poorly functioning interface can adversely impact patient safety and the patients experience of the healthcare system, leading to increased patient complaints, damaged inter-professional relationships and morale. It can also lead to poorer clinical outcomes for patients.

RCGP have been funded by the Scottish Government to lead on the interface programme, with a newly appointed clinical lead working within each Health Board in Scotland to establish a dedicated interface group. The objectives of these groups are to rebuild inter-professional relationships, act as a professional advisory forum on issues relating to interface, and undertake pieces of work to improve systems and learning across the primary-secondary care interface. E.g. Significant Event Analysis (SEAs) from both primary and secondary care to help identify issues and work together to improve procedures.

RCGP Scotland have also established a Cross-College Interface group which has created a SOAR^[29] template for work-shadowing which will be formally launched during 2018. Other areas of work-in-progress include improving the IT infrastructure by introducing generic email addresses for all specialities for clinical advice, improved functionality for SciGateway for email advice and dedicated professional to professional phone lines in both primary and secondary care. A quality improvement module, "Effective Interface" has also been designed and piloted by RCGP (case study below)

Barns Medical Practice, Ayr volunteered during May 2017 to use the RCGP Scotland Effective Interface learning module and were asked to look at their interface with psychiatry. They already had a good relationship with the local Consultant Psychiatrist and some excellent systems in place at the interface. The Module prompted a dialogue about unresolved quality issues. The priorities chosen were communication between CPNs and the GP practice, monitoring of physical health issues in patients with chronic mental health problems and ECG monitoring during initiation and on-going administration of antipsychotics. Both parties had collected relevant data to aid the process.

The Effective Interface Module had a beneficial impact on the interface between this particular GP Practice and their local Psychiatry service. Alterations to processes and changes in current practice, which will improve patient care, have been agreed. These include improved communication from CPNs to the practice and agreement as to who does what part of the monitoring required when a patient is receiving antipsychotic drugs. Mutual respect was confirmed and enhanced. The likelihood of further collaborative communication and opportunities for future beneficial change was increased.

"The Effective Interface process is an excellent way to stimulate dialogue and bring about improvements in patient care by encouraging ownership of the primary care secondary care interface by both parties. It does require a willingness to get involved from both parties, however."^[30]

Contact: Leanne Brown, RCGP Projects & Initiatives - Leanne.Brown@rcgp.org.uk