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Patient safety at risk, say one in four GPs

A quarter of GPs has seen the safety of a patient put at risk in the last six months because hospitals have failed to provide essential information when the patient was discharged.

More, four out of 10, say the clinical care of their patients has been adversely affected.

These are the results of an NHS Alliance national survey of GP practices, which come after a new NHS Standard Contract was introduced, requiring hospitals to provide discharge information within 72 hours of every patient's discharge.

In one of the worst cases, a patient who was being treated by her GP for clinical depression was admitted to hospital after an overdose. It was 11 months before the hospital sent any information to the doctor, who had no idea the patient had tried to commit suicide and so did not amend the treatment. "Fortunately", the doctor said, "she is still alive."

Doctors told the NHS Alliance about discharge information arriving months or even years late. In one case, a discharge letter arrived seven weeks after discharge - and six weeks after the patient had died. Then another letter arrived, about the same patient and the same admission, but with completely different clinical information.

The survey respondents told of illegible handwritten letters, discharge summaries failing to mention drug allergies or intolerances - potentially very serious - and letters that failed to give the patient's name, any contact details at the hospital, or that were sent to the wrong GP and the wrong practice.

The survey also revealed that it is common for patients to be told to go to their GP for a prescription even though the hospital had not supplied information about the recommended medication, nor the test results and diagnosis.

In one case, a junior hospital doctor had simply "scrawled" the name of the medication on the bottom of a disposable sick bowl with the note: "Ask GP to prescribe this".

NHS Alliance chairman Dr Michael Dixon said: "This is a shocking indictment of current practice in secondary care. Hospitals seem not to understand nor care that ill patients still need treatment from their family doctor when they go home.

"We have been campaigning to improve discharge information for the past three years. It was our work that led to the new requirement for prompt summaries in the Standard Contract.

"That wasn't a perfect solution - many Foundation Trusts and independent treatment centres are still operating under older contracts, so are not covered. All the same, it should have been an important step in the right direction.

"The answer is straightforward. Hospitals should not be paid until they have delivered prompt, accurate and complete discharge information. And if that is late, then there should be a financial penalty."

NHS Alliance

Do you agree with Dr Dixon? Is a lack of information from hospitals following discharge a problem? Your comments: (Terms and conditions apply)

"I agree, too many times patients arrive to see the practice nurse with no letter for continuing care, and this means often trying to telephone the hospital department, or reassessing the whole situation and making our own plan of care. This causes the patient unnecessary anxiety, and the nurse too." - Diane Carrier, Norfolk

"I agree. Illegible handwriting is a major problem, along with minimal details of the patients primary diagnosis and treatment. Discharge letters are given to patients to pass onto the GP. However, many of these letters fail to reach the GP/community nurses. If the patient is elderly, they often forget to hand the letter/discharge summary/medication list over. It is a dangerous practice. Nurses would not be allowed to act this reckless." - Angela Whittingham, Preston

"Yes, I do agree. Even operation details/information fail to reach GP practices and practice nurses to help them continue with care. People are discharged with sutures still in situ and no details at all on when they need to be removed, dressings information, etc." - Mavis Dube, London