Medical evolution: Measures to improve the interface between primary and secondary care (Policy Exchange, 29 June 2023)

Summary

Recent polling from Healthwatch England shows that a fifth of patients referred by a GP for consultant-led care end up in a ‘referral black hole’, with more than two million patients each year having to make four or more visits to their GP before a referral is accepted. The result is that tens of thousands of patients could be on a ‘hidden’ waiting list, meaning that GPs are managing greater clinical risk and a greater number of patients whose conditions are often worsening in primary care, whilst communication between providers and access to diagnostics are often not up to scratch. 

This report by the think tank Policy Exchange looks at reforms that could be made to the interface between primary and secondary care in order to improve care and prevent patient harm. It considers how improved flows of information and expertise can:

• better support growing demand in general practice
• reduce unwarranted variation in service provision
• enhance care coordination – particularly for those referred for elective procedures
• enable opportunities to boost generalist medical skills for a new generation of doctors
• create opportunities for hospital specialists to deliver a greater proportion of care in primary or community care settings, reducing waiting times and the use of more expensive settings for care.