Most GPs are very aware of the importance of good communication with colleagues involved in our patient’s care and the principles are very well laid out in Domain 3 of the GMC guidance to all doctors. We need to share all relevant information with our colleagues, and we need to be clear about where clinical responsibility starts and finishes.
Ideally, we would send a quick note to the NHS GP each time we see a patient who is registered with an NHS practice. This will include any problems that have been raised, any data from examining the patient that might be relevant and details of medication prescribed. The NHS GP will then be aware and will hopefully enter the data we send; they may be pleased if this forms part of the QOF data, but they will prefer to receive it in a form that is easy for them to transfer to the record. It will also reduce the risk of management issues such as double prescribing or drug interactions. Any important diagnoses will hopefully make their way onto the summary care record.
The CQC are very keen for independent GPs to communicate with the NHS GP as they are wanting to ensure that all healthcare practitioners avoid fragmentation of care. And for very good reason.
Private GP
There are a few problems that private GPs can encounter in the process of transferring this data, the first being that often patients don’t tell their NHS GP that they are seeking GP care from a private provider; they may not want to jeopardise their relationship with their NHS GP and feel disloyal going elsewhere. Or they may have other reasons such as wanting to avoid revealing certain diagnoses to the family doctor. It's quite common for patients to decline an offer for the private GP to send a summary to the NHS GP for these and other reasons.
There are a few other practical issues that make communicating with the NHS GP quite tricky. For a start, some software packages make printing or exporting a single consultation summary almost impossible. However, anyone using EMIS knows that on the bigger systems this is pretty straightforward. If you can print consultation notes, one option is to give this to the patient if you are seeing them face-to-face, or if seeing them remotely, export the consultation printout and email it to the patient. This avoids the need for consent to share information. However, you need a secure way of emailing if this is your chosen method.
The GMC are keen for us to avoid using anything unencrypted. The ideal is a PDF attached to a SMS text message, which has some security so that it can only be opened by the receiver – ideally, this would be deleted after 30 days so it cannot be opened later. Failing that, you can use encrypted email, which can be frustrating, especially if you are accustomed to NHS email, which simplifies processes.
And by the way, every independent GP can request an NHS Mail address, and if you are sending to another NHS doctor, there is no requirement for additional encryption – so this is ideal.
Some practices have found a way to use Docman Connect which sends messages directly into the NHS software task system. That is a pretty good solution as it is safe and direct. It requires patient consent and an NHS number but works well.
The absolute ideal, which many private GPs are hoping for, is to be able to write back into the NHS record. Certainly, in the patient’s best interest, but various independent forums have been advocating for this for a while without much success. But who knows? If GMC standards are to be upheld, there is a real case for making this an option for private GPs.
"Why can't we do this already?" It’s a question on the lips of many private practitioners who see the benefit of such integration but understand the complexities involved.
Private GP
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