Thread by @sarjuathwal

I've been trying to think how best to practically support our primary care colleagues in the face of the sustained campaign against them. After seeing that tweet about the burden of letters from secondary care, I thought it might be good to think how to reduce this burden

These are just my thoughts and I'd welcome others' opinions. Positive suggestions only though, no griping - there are other threads for that. Would be great to get some thoughts from primary care peeps

@DrNeenaJha @DrSelvarajah @Parody_RCGP @DrSimonHodes @DrJSherrington

I'm always torn between detailed letters so the GP has the full record of what's been discussed/decided, and a brief summary which is easier to read. H/t @dr_lungs for the below tip, which I have added to my clinic letter template to get "best of both"

Speaking of which, below is my current clinic letter template. To my mind it gives a clear accessible summary, with room for my waffle underneath

If requesting the GP to arrange blood tests relating to my management (e.g. if patient unable/unwilling to have them at the hospital) I will specify in the letter that I will take responsibility for checking the results, and ask the patient to let us know when bloods done

When discharging a patient who has declined management/surgery who then changes their mind, I have started saying in the letter that I am happy to receive a new referral for the same problem without the patient needing a face-to-face GP review

If they change their mind within a couple of weeks, they can contact my secretary directly and I'll work out how to get them reinstated

Onward referral: tricky one due to the mess of double negatives but I have interpreted the below statement from the Standard Contract to mean that secondary care can directly refer onwards if related to the original presenting problem

I feel this letter I received from a local GP states it better but I couldn't find this wording anywhere in the Service Conditions

If the problem is unrelated but I am able to offer an opinion, I try to add a statement that can be forwarded on by the GP

"The patient has a lesion on the hand which is clinically suspicious for actinic keratosis. Would recommend review by dermatology for further management"

My hope is that other secondary care teams would accept a forwarded referral without insisting GP review first, but would be good to know if this is true

That's all I've got (and this thread is probably too long already) so I'll stop there.

In the words of ol' Reggie, I know it's not much but it's the best I can do (but tell me if there's more I can do)

Inviting a few more primary/secondary care folks for their thoughts @Azeem_Majeed @DoctorMayJay @DrShanHussain @Dr_Ayan @ShivaniM_KC @parthaskar @DrLindaDykes @rvautrey @SteelCity_ENT @MedCrisis