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May 10, 2024

The primary and secondary care interface: improving visibility for everyone involved in a patient’s care

Communication between primary and secondary care remains a fundamental but often overlooked driving force of patient care in the NHS today. Everything from GP referrals, to Advice & Guidance, to assessments for elective care, and discharge from hospital, relies on quick and easy communication between these two care settings. 

But there’s no cohesive national story to tell when it comes to cross-care setting communication in today’s NHS. To a degree, this is the story. One of variability and inconsistency. One of limited information sharing and siloed communication methods that don’t translate effectively between NHS organisations. Two healthcare professionals caring for the same person are likely to interact with both the patient and each other in completely different ways. And if it involves back-and-forth phone calls and letters, this inconsistency can become an everyday blocker to the swift and seamless coordination of care.

But as it stands, the system’s hybrid and often antiquated communication infrastructure obstructs this. For example, when commencing a patient on a new medication, important information such as a patient’s chronic renal failure may remain buried in a record that’s not accessible to a professional in another care setting. Put simply: poor communication leads to poor visibility. In this blog, we’ll look at the effect this has on patients, NHS staff and the system as a whole, before discussing what better cross-care setting communication looks like.

How poor cross-care setting communication impacts patients

In recent years, NHSE has made strides toward empowering patients; one that puts more control and autonomy in patients’ hands. But this sort of advocacy on the part of patients simply isn’t possible if patients don’t have visibility of who is involved in their care, how different aspects of their care are being managed and by whom and what next steps are needed (many of which will depend on the patient themselves being aware). 

Visibility of this kind hinges on communication. Often when a patient is referred from one care setting to another, it’s not uncommon for communication to fall off the radar. The patient might not know where they are in this process, how long they’ll have to wait and whether there’s anything they can do to expedite their care  or what they can be doing to manage their health whilst they wait. It can be an unsettling experience and leave patients feeling lost, moving frustratingly around the system with little control.

Poor cross-care setting communication can also have significant implications for patient health. Take a patient on anticoagulants awaiting elective surgery. If you’re a surgeon hoping to operate, you’ll expect the patient’s medications to be optimised or withheld beforehand to reduce their bleeding risk during the procedure. But this often isn’t the reality. The patient may come in for surgery unaware of this need or without having been in contact with their GP or perioperative team, forcing the surgery to be cancelled on the day. The communication delta across primary and secondary care means we struggle to support patients with their most basic needs and coordinate effective delivery of the care.  

How poor cross-care setting communication impacts NHS staff and the system at large

If many patients feel left in the dark, they’re not alone. Across the system, health and care professionals also often have to operate in a vacuum of information. On any given day they might have to waste time resolving issues that should have already been resolved and make the safest, most clinically sound decision possible with limited information. 

If we use paediatric care as an example – the specialty I trained in – it typically takes a multidisciplinary, cross-NHS team to coordinate care for a child with a complex long-term condition. It may not be unusual to have a GP, a Community Paediatrician, a Community Physiotherapist and Speech & Language therapy (SALT) involved in caring for that child. Let’s say there's been some interaction between the Community Paediatrician and SALT about this child’s ability to tolerate liquids and swallowing risk, but this information isn’t shared with – or even visible to – staff in hospital. The child might later be admitted to hospital where that highly relevant information is missing, meaning the team are reliant on an informed parent sharing what they believe to be relevant clinical information. It places an unfair burden on the parent to piece together what they believe to be salient information from the context they hold, because we lack the basic communication infrastructure that joins up clinical context across the health system. 

These may sound like relatively small examples, but when you scale them up, they can have a huge impact on the operational efficiency and delivery of patient care across the healthcare system. If we can achieve incremental changes to improve the primary and secondary care interface at an Integrated Care System (ICS) level, we can make a transformative shift in the functioning of the system as a whole.

What better cross-care communication can look like

Poor cross-care communication across the NHS is a deep-rooted and systemic challenge, complicated by the cultures of different NHS organisations. But the solution starts with a simple principle – one that speaks to the very vision of Accurx – that everyone involved in a patient’s care should be able to communicate easily with each other and the patient. Of course, it’s easy to dictate on paper what this should and shouldn’t look like. Making it happen is another thing.

But that’s exactly what we’re doing at Accurx and, excitingly, we’ve already made tangible progress in the right direction. One example is Accumail, our instant messaging product that lets clinicians and admin staff interact quickly and easily with one another, whether they’re based in pharmacies, hospitals, hospices, care homes – anywhere that care may be taking place. We developed Accumail to join up ICSs and Primary Care Networks (PCNs) and support more efficient and seamless patient flow and care coordination across care settings.

We’re also helping patients and staff to access and share information from one part of the system to another. You can see this in our Record View product, which allows patients to share a read-only, time-limited summary of their GP record with other NHS professionals (this taking place with the GP’s prior agreement). Record View complements existing methods of sharing records in the NHS, such as the Summary Care Records and Local Health and Care Records and allows an easy flow of information to take place around a patient, with everyone’s consent. 

As Accumail and Record View both show, we’re care setting agnostic at Accurx. Or to put this another way: we give patients and NHS professionals a shared digital platform for communication wherever they are in the healthcare system. What makes us unique here isn’t just our adoption and connection with healthcare professionals, it’s our ability to tune into their needs on a micro level, while keeping an eye on the big picture. 

And better cross-care setting communication is the big picture change we’re striving for. For us, good cross-care setting communication doesn’t just mean having the right contact details on hand or managing referrals in a timely and responsive way. It means creating a seamless, free flow of communication that, little by little, grows the visibility of patient information across the entire system in a safe and secure way. It means treating every interaction as an opportunity to build a singular, up-to-date view of a patient’s care which everyone can draw from including – most importantly – the patient. This one source of truth follows the patient wherever they go in the system and can be found simply and quickly with their unique NHS number. 

No-one would say that joining up healthcare communication is easy – but it is needed. Over the last eight years, we’ve seen what can happen when you put simple, user-friendly communication tools in the hands of NHS professionals. So whenever the challenge of improving cross-care setting communication seems like a mountain to climb, we’re encouraged by the healthcare professionals we work with every day, driving forward a better way to communicate about patient care.