What the Hospital Must do

Unfortunately a large proportion of our appointments are not available to you for general practice care because they are consumed to do tasks which should be done by hospital or specialist teams. 

Please challenge your specialists if they say they can not do these things, so all our patients may have far better access to our appointments.

Such are the pressures on the NHS and General Practice, that all of the NHS needs to focus on efficiency and making every contact count for our patients.  General Practice needs to focus on providing direct primary clinical care for our population.   Our team will pass inappropriate requests back to your hospital team to do.

Your hospital team must directly organise the following, for you, without passing responsibility to your GP:

This is required by in accordance with the contracts, regulations and guidelines below:

  1. The Hospital Contract since 2017*1
  2. The Delivery Plan for recovering Access to Primary Care 2023*2,
  3. Preceding guidance from the BMA, GMC and the BHRUT medical director*3,
  4. The BHR Consultant to consultant referral policy*4
  5. The Statement of fitness for work: a guide for hospital  doctors updated 6/4/2022*5
  6. The Fuller Report 2023*6

Drugs required for urgent administration should be prescribed by the hospital doctor, and if appropriate dispensed by the hospital.

Your consultant may ask us to prescribe some Non-urgent medications but only where you do not need this until at least 2 weeks after your hospital appointment.

Our team are overwhelmed by requests to expedite hospital appointments. We are sorry but the WLMC Team can not change the waiting times at the hospitals:

To see the waiting times for your appointment at your hospital click here.

The COVID 19 pandemic has meant that there are more people waiting for an operation or out patient appointment. This means that some people are waiting a long time for a hospital appointment or for treatment.

We know that it can be very difficult for many people who are waiting.

The NHS is working hard to see people as quickly as possible, but it is going to take a while before waiting times are back down to where they were before the COVID-19 pandemic began in the UK in early 2020.Our backlog of appointments massively increased during the pandemic, and while we have made fantastic progress in reducing our waiting lists, our Outpatients Call Centre and Patient Advice and Liaison Service (PALS) receive a lot of appointment enquiries.

Contact Your Specialist Team:

You can contact your hospital specialists on any numbers they have given on their letters or you can contact the Hospital PALS service:

  • WEB: www.bhrhospitals.nhs.uk/patient-advice-and-liaison-services
  • EMAIL: [email protected]
  • TELE: (Monday to Friday, 9am to 5pm)
  • King George Hospital: 0208 970 8234.
  • Queen’s Hospital: 01708 435 454.
  • 24-hour helpline answerphone: 0800 389 8324.

Hospital Contract 2017

Extract from letter from BMA 19/4/17 re new NHS Hospitals Contract 2017-19 


The new changes to the 2017 hospital contract were designed to further reduce inappropriate workload on GP practices, and also improve patient care across the primary/secondary care interface as follows:

1. Hospitals to issue fit notes, covering the full period until the date by which it is anticipated that the patient will have recovered. It is a waste of GP time, and appointments, for patients to be given (for instance) an interim fit note from a hospital discharge for two weeks and to be told to see a GP for a continuation, when it was clear from the outset that they needed two months off work after major surgery – this contract change requires that the patient receives a fit note covering the full period.

2. Hospitals to respond to patient queries for matters relating to their care rather than asking the patient to contact their GP. This would put an end to a culture spanning decades, of patients being told to ‘see your GP’ for a host of issues that should clearly be the responsibility of secondary care – such as queries regarding hospital test results, treatment and investigations, administrative issues regarding follow up, or delays in appointments. The new contract requires that the provider respond to patients (as well as GP queries) ‘promptly and effectively to such questions and that these are publicised using all appropriate means, including in appointment and admission letters and on the provider’s website; and deal with such questions themselves, not by advising the patient to speak to their referrer’.

3. Hospitals must not transfer management under shared care unless with prior agreement with the GP. GPs should not therefore be asked to prescribe specialist medications by virtue of a hospital letter or instruction alone. Any such shared care arrangement must be explicitly agreed first by the GP based on whether they feel competent to do so, and which may include being resourced to do this as a locally commissioned service. 

4. Hospital clinic letters to be received by the GP within 10 days from 1 April 2017, and within seven days from 1 April 2018. This will significantly reduce wasted appointments when patients specifically arrange to see a GP following an outpatient clinic appointment, but without us having the relevant clinical information to manage the patient, often requiring the patient to book another appointment.

5. Issuing medication following outpatient attendance at least sufficient to meet the patient’s immediate clinical needs until their GP receives the relevant clinic letter and can prescribe accordingly. This addresses the growing phenomenon of patients turning up at a GP surgery sometimes almost immediately after a hospital appointment for an outpatient initiated prescription, with the GP pressurised to prescribe without relevant clinical information, and with accompanying clinical governance risks. 

Remember, these changes are not recommendations but contractual requirements, and therefore if hospitals do not abide by these standards they are in breach of their contract.

Extract from the Delivery Plan to Recover Access to Primary Care May 2023

  1. Onward referrals: if a patient has been referred into secondary care and they need another referral, for an immediate or a related need, the secondary care provider should make this for them, rather than sending them back to general practice which causes a further delay before being referred again. This improves patient care, saves time and was the most common request we heard from general practices about bureaucracy. 
  2. Complete care (fit notes and discharge letters): trusts should ensure that on discharge or after an outpatient appointment, patients receive everything they need, rather than – as too often happens now – leaving patients to return prematurely to their practice, which often does not know what they need. Therefore, where patients need them, fit notes should be issued which include any appropriate information on adjustments that could support and enable returns to employment following this period, avoiding unnecessary return appointments to general practice. Discharge letters should highlight clear actions for general practice (including prescribing medications required). Also, by 30 November 2023, providers of NHS-funded secondary care services should have implemented the capability to issue a fit note electronically. From December this means hospital staff will more easily be able to issue patients with a fit note by text or email alongside other discharge papers, further preventing unnecessary return appointments. 
  3. Call and recall: for patients under their care, NHS trusts should establish their own call/recall systems for patients for follow-up tests or appointments. This means that patients will have a clear route to contact secondary care and will no 

BHRUT Medical Director/LMC/CCG Letter Extracts –  27 October 2015

I would like to share a problem that can be rectified quickly, with measurable benefits for our patients. Some  colleagues  and  their  team  members,  after  seeing  a  patient  following  referral  from  a  General Practitioner, request that the GP initiates the series of investigations following the consultation. Some initiate the investigations at the Trust and then request that the GP pursue and presumably act upon the results i.e. transferring ownership, responsibility and accountability of their duty of care.

These practices go against GMC and BMA standards & guidance.

The GMC provides guidance in a number of sections that help explain why this matters. I have discussed the  issue  directly  with  the  GMC  (2).  Both  the  Consultants  Committee  and  the  General  Practitioner Committees of the BMA agree this practice is potentially unsafe, and that the ultimate responsibility for ensuring that results are acted upon, rests with the person requesting the test (3). They have clarified joint guidance on the duty of care. I have highlighted a few points for reference.

  Responsibility for ensuring that results are acted upon rests with the person requesting the test.

  Responsibility  can  only  be  delegated  to  someone  else  if  they  accept  by  prior  agreement.  Handover  of responsibility has to be a joint consensual decision between hospital team and GP.

  If the GP hasn’t accepted that role, the person requesting the test must retain responsibility.


1.  Institute of Medicine. Crossing the Quality Chasm 2001

2.  Good medical practise, section on Continuity and coordination of care. Expanded in Delegation and referral 

(2013) explanatory guidance. In particular, paragraph 23.  http://bma.org.uk/practical-support-at-work/gp-practices/service-provision/duty-of-care-topatients-regarding-test-results

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