Ensuring patient safety is a priority for all healthcare professionals. However, the patient journey is becoming increasingly complex, with a host of healthcare professionals now involved directly in their care. Multidisciplinary teams are adept at providing quality care and help improve health outcomes, whilst optimising the efficient use of resources at the same time. In order to seamlessly transition a patient from any provider of care, information and summary of care received must be relayed effectively. Hospital discharge summaries are what hospitals use to document and communicate with other care providers.
Each year NHS Digital provides information, data, and statistics relating to the NHS. The Hospital Admitted Patient Care Activity, 2017-2018, gives a snapshot of hospital admissions, a surge in the number of hospital admissions can be seen, with a 23.3% increase from 2007/8 to 2017/18. Such a staggering increase in the provision of care has to be coupled with effective modes of communication between the hospital and primary care.
The 1843 fax machine still going?
Prior to the introduction of e-discharge summaries, the sharing of information was troublesome, to say the least. The National Audit Office estimates that delays with discharges to elderly patients are costing the NHS £820 million a year. As a result, it is estimated that over 2.7 million bed days are lost due to the unnecessarily delayed transfer of elderly patients from the hospital. Delays in discharge summaries being processed via fax machines, incomplete variants of discharge summaries, unstandardised templates, and illegible information are also a major issue creating difficulties for medicines reconciliation. Staff working in hospitals would attempt sending discharge summaries via fax machines numerous times, often to no avail as GP fax machines weren’t even switched on at the weekends. Hold-ups in patients receiving appropriate treatment can lead to potentially serious consequences, with patient safety and care compromised. The Clinical Data Standards Assurance programme began a national project to enhance discharge summaries and how they are accessed, with the goal of GPs receiving the discharge summary electronically within 24 hours of the patient being discharged from the hospital.
What’s included in a Hospital Discharge Summary?
Discharge summaries include the following important pieces of information:
The hospital discharge summary will be written by the doctor who was looking after your care during your admission in the hospital. An e-discharge summary template is provided here.
You can request a copy of your discharge summary from the ward manager or request a copy from Patient Advice and Liaison Service (PALS). It’s always good to have a copy at hand, also making sure you are fully involved in your treatment and care.
Who receives your discharge summary?
NICE Guidance states that patients should be discharged from the hospital at the right time, to the right place and in the right way – whether that is to their own home or a community, or care home setting.
Why are discharge summaries important?
Discharge summaries are paramount in ensuring safe provision of care across the board in primary and secondary care. If completed correctly with the relevant information recorded, they assist your GP surgery and pharmacy of what has happened to you during your stay in hospital. In many instances, you are provided with either 7 days or 14 days’ worth of medication to take home, especially if there have been any changes to your medication. This gives you sufficient time to arrange with your surgery and pharmacy any medication requests that you may have.
Your doctor can then also change your prescriptions accordingly, chase any test results, and arrange any follow-ups where needed.
Check out our Services page, to see the many different ways that Firza is assisting GP practices, NHS CCG’s, care homes, and pharmacies in patient and non-patient facing ways, including the best ways in implementing effective hospital discharge summary reviews.
This article was written on behalf of Firza by Hassan Riaz from Pharmacy Mentor.
A CQC Inspection is a daunting experience for most GP practices, but here’s an article we have put together that gives you guidance and support in ensuring that your visit goes as smoothly as possible.
What is the CQC?
The Care Quality Commission (CQC) is the independent regulator of all health and social care services in England. It ensures that health and social care services are providing patients with safe, effective, compassionate and high-quality care, whilst encouraging care providers to improve in their services.
The CQC asks five key questions to any provider of care. These five questions are the cornerstones of any inspection: is the practice safe, is it effective, are the staff caring, are they responsive to the needs of people, and are they well-led?
The CQC also looks at the care provided specifically to six different population groups: older people, people with long-term conditions, families, children and young people, working age people, vulnerable or at-risk patients, and people experiencing poor mental health.
Every GP practice must also ensure that the CQC’s fundamental standards are met and adhered to.
Meeting the CQC’s fundamental standards at a CQC Inspection
GP practices must abide by certain standards. These include the fundamental standards – the standard below which care must never fall. Everybody has a right to expect that the following standards are met from their GP practice, these can all be found under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:
For further information and in-depth examples of all the standards, please see:
Get ready for pre-inspection
Before your GP practice can provide any services to the public, it must apply for CQC registration and meet certain pre-requisites. Guidance on how to apply for registration with the CQC can be found here.
Prior to a CQC Inspection, the CQC will provide you with a letter of notification, notifying you that an inspection will occur. In most instances a two-week window is given prior to the inspection, allowing for minimal disruption in services. The comment cards and posters signifying an impending inspection should be suitably placed.
Key documentation to prepare prior to the CQC Inspection
The CQC inspectors will request to see good clinical governance and management of the practice. Record-keeping and documentation should be made viewable to the inspectors and below are a non-exhaustive list documenting what you may be asked to present. It is always a good idea to have the following documents ready prior to the inspection:
On the day of a CQC Inspection
At the start of the inspection, the inspector and/or inspection team will meet with senior members of the practice team. This brief meeting will detail who the inspection team is, an outline of what to expect, the purpose of the inspection and how the findings will be communicated back. Ensure that on the day of the inspection, your practice is promoting the services and care it provides in the best manner.
GP practice staff will then be asked to deliver a short presentation, allowing practices to give the CQC their own view of the performance of the practice. Some of the points that the presentation can outline include: all the services that the practice provides, access to appointments and triage, examples of training, how it listens to concerns, identify specific patient cases in anonymity where safeguarding issues were raised, and the use of translators or the hearing loop system to accommodate all patients. The presentation should discuss the five questions the inspection will ask, especially in relation to the six different population groups, whilst also including any examples of outstanding patient care.
The inspection team will then focus on areas of concern and areas where the practice is performing well based on the introduction. The team will collect evidence in relation to these matters by finding out the views of the patients using the services of the practice. this will be done by using the comment cards and speaking to patients individually and in groups. They will also speak to staff and gather information relating to the five key questions. Other inspection methods include observing care, reviewing records, looking at documents and policies, and inspecting the facilities.
Feedback after a CQC Inspection
At the end of the inspection, the inspection team will meet with senior members of the practice team and give a summary of the key findings from the inspection, make mention of any issues that need addressing, identify where immediate action is to be taken, outline plans for future inspections and how the judgements and findings will be published.
GP practices will be rated for the five key questions, and finally given an overall rating based on their performance. GP practices will be rated as either: Outstanding, Good, Requires Improvement or Inadequate.
When completed, the rating will be published on the CQC’s website and must be displayed in the GP practice and the practice’s website.
How GP pharmacists can help at your CQC inspection
GP pharmacists are experts in medicines and can prove to be invaluable at a CQC inspection. Pharmacists are already accustomed to a GPhC inspection and can help your practice achieve the top rating at its inspection. The CQC will ask to see the systems in place for safe storage and handling of controlled drugs, how often patients get a medication review, medicines safety alerts, repeat prescribing processes and reviews, triage, and handling of common ailments. All of these are areas where a GP Pharmacist can offer expert support and assistance.
GP pharmacists are allowing healthcare teams working in GP practices to give better local care to patients, allowing patients to see highly trained healthcare professionals specific to their needs. Pharmacists working in GP practices make a positive impact on patients, provide excellent clinical assessment and treatment plans, are experts in the knowledge of medicines and contribute greatly to health economics. They are also experts in providing lifestyle advice to treat long-term conditions and improve patient’s safety.
Having GP pharmacists in practice allows GP’s to better manage their time and to focus their skills on where they are most needed, diagnosing and treating patients with more complex conditions. Take a look at our Services page for more information on how our Clinical Pharmacists are working in GP practices.
Interested in becoming a GP pharmacist? Then please send your CV and a cover letter to firstname.lastname@example.org
This article was written on behalf of Firza by Hassan Riaz from Pharmacy Mentor.