Dr Meena Sood describes an innovative feature of the GP practice system and how effective use can help patients who need it most
As GPs, how many of us have struggled to arrange admissions for our patients, especially those with complex medical, social, or psychological problems? Why does this type of scenario seem to occur more often on a busy Monday, or just at the close of an evening surgery?
The difficulty is in attempting to successfully impart to our colleagues in secondary care that, although an individual patient’s problems may not appear to be life-threatening or very urgent, the patient’s social, psychological, or family circumstances may impact significantly on their ability to manage their health safely and effectively at home.
High-quality communication between healthcare professionals is a key factor in ensuring safe, smooth, and seamless care for our patients.1
The delivery of a safe, effective, and responsive service is a challenge in itself, and is partly dependent on robust levels of project management and the continual cycle of audit, feedback, and reflection, which allows the quality of service to remain at a consistently high level.2
Patient needs are complex but also specific to each individual. No two patients with the same diagnosis will share exactly the same journey. It is this variety that makes GP work so fulfilling. Helping others and knowing we have taken the time and effort to ensure the patient receives the right help, from the right person, at the right time, is paramount to achieving highquality care as well as good levels of job satisfaction within any healthcare profession.
Sharing information—is it just an issue of consent?
Sharing and accessing patient information securely is the cornerstone to providing a safe and seamless service both in and out of hours. Relevant information about patients for direct care should be shared in line with General Medical Council guidance Confidentiality: good practice in handling patient information, unless the patient has objected.1,3 No personal information should be shared unless the patient has agreed to it and understands the potential pitfalls of not sharing information that may be beneficial to all healthcare providers involved with their care.3
Ultimately, it is a personal choice that each patient must make for themselves, but a brief discussion of what the choice may involve can prove helpful to patients and doctors alike, within both primary and secondary care.
Sharing and accessing patient information securely is the cornerstone to providing a safe and seamless service …
Should a patient choose not to consent to information being shared between service providers, adequate explanation as to why and how information would be shared may prove vital to patients accessing the best care for their immediate needs. Conversely, vital fragments of information that may well seem unimportant at the time and which are not shared can later prove to be essential, not only to providing patients with an efficient service but also in safeguarding their overall health and wellbeing. This is particularly true of details within the patient record, such as any allergic reactions or severe adverse responses to medication.4
The devil is in the detail
General practitioner ‘special patient notes’4 (a feature included in Adastra and SystmOne) can help to ensure the safe and easy transfer of information for patients who have consented to their information being shared among healthcare professionals in both primary and secondary care. Although the special patient notes feature is designed for out-of-hours referrals, it can also be particularly valuable when a patient is moving from primary to secondary care or where social care is becoming more integrated with healthcare.
General practitioners know their patients fairly well as they are likely to see them more frequently than colleagues in routine secondary care, and are perhaps required to take a more holistic viewpoint.
Once the GP special patient notes section of the patient record is completed and activated within the practice, the special notes act like a tag to flag up any concerns—medical, social, or psychological—and this can literally be a lifesaving strategy for out-of-hours care. These vital pieces of patient information help to complete the clinical picture and serve to directly influence how the patient is managed, for example, whether they are triaged via ambulance control 999 services, emergency department A&E, or the 111 service for non-urgent but prompt assessment in conjunction with out-of-hours services.
Routinely completing GP special notes has the potential to improve the safety as well as effectiveness of what GPs do daily for patients. This relatively quick and easy measure is just one step forward to recapturing traditional values around continuity of personal care, rather than unnecessarily complicating and fragmenting care.
- High-quality communication between healthcare professionals is key to ensuring safe and seamless care
- Patient information should be shared in line with General Medical Council confidentiality guidance
- The GP special notes feature can be used:
- to flag any medical, social, or psychological concerns about a patient
- when a patient is moving from primary to secondary care, or where social care is becoming more integrated with healthcare
- to help with the provision of safe, effective, and holistic patient care.
- NICE. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. Clinical Guideline 138. NICE, 2012. Available at www.nice.org.uk/cg138
- World Health Organization (WHO). Key components of a well functioning health system. WHO, 2010. Available at: www.who.int/ healthsystems/publications/hss_key/en/
- General Medical Council. Confidentiality: good practice in handling patient information. London: GMC, January 2017: Available at: www.gmc-uk.org/guidance/ethical_guidance/ confidentiality.asp (accessed 2 June 2017).
- Holt V, Bernstein D, Jones A et al. Out-of-hours special patient notes. London J Prim Care (Abingdon) 2013; 5 (2): 102–105.