Department of Health and Social Care
HSSIB recommends that the Department of Health and Social Care ensures that the GP contract explicitly includes and supports the need for GP practices to deliver continuity of care. This is to improve patient safety by building clinician–patient relationships as well as providing continuity of information.
NHS England
HSSIB recommends that NHS England updates the GP IT standards to ensure that patient continuity of care is maintained, including the identification and prioritisation (technically known as ‘clear surfacing’) of information to health and care professionals, when patients visit GP practices multiple times with unresolving symptoms.
Electronic patient record (EPR) systems used in general practice are functionally rich and contain extensive data concerning a patient’s care over time, which makes them a valuable resource to support continuity of care. The standards to which all practice EPRs are required to adhere include a number that support continuity of care, for example capabilities that trigger alerts or provide enhanced information sharing.
We will consider how to enhance digital support for continuity of care in two ways:
- Review existing capabilities to determine how they are currently configured and used by practices, covering (for example) appointment booking and management, alerting capabilities, risk stratification (identifying patients based on different risk factors), shared care records and patient access to records. We will work with system suppliers and other delivery partners to identify areas for improvement, focused on new or improved guidance, awareness and training for frontline staff, and optimising systems to maximise usefulness and utilisation.
- Identify new capabilities. This includes looking at areas such as surfacing of alerts in response to potential lapses in care continuity (for example, alerting the GP to cases where a patient has been seen 3+ times for the same condition with no resolution of symptoms); easier integration of notes and outcomes from encounters with other care settings into the patient record; identifying patterns from electronic prescribing; and simplifying proxy access to patient records. We will work with policy and operations teams to develop an overall view of how digital solutions may most effectively support continuity of care. This may include enhancements to standards and/or new standards, as well as other digital enhancements, and have reference to guidance such as the RCGP Continuity of Care Toolkit. We will work with stakeholders, including professional representative bodies, and consider other changes resulting from this HSSIB report, in particular broader best practice recommendations (e.g. ‘Named GP’ provision) to avoid confusion or duplication, and avoid making any potentially inconsistent or counter-productive changes.
Actions planned to deliver safety recommendation:
- Review implementation of existing capabilities (April-June 2024).
- Review overall current landscape with policy/operational teams and develop improvement plan (October-December 2024).
- Deliver enhancements/new capabilities (from January 2024).
Response received on 5 March 2024.