All Wales General Practice and Health Board Clinical Interface Standards (replacing WHC (2018) WHC/2018/014 - All Wales Communication Standards between Primary and Secondary care - AWCS)

Morgannwg LMC
5 days ago
4 min read

These standards have been designed to improve the safety and quality of patient care in NHS Wales and ensure that our patients have the best possible experience as they navigate their pathways. It is a consensus document that has been co-produced with Primary and Secondary Care Clinicians and endorsed by the All Wales Medical Directors.

They apply to all NHS Wales clinicians communicating clinical information between General Practice and Health board run services. They also apply to clinicians working in the private sector who interface with General Practice.

They replace WHC (2018) WHC/2018/014 - All Wales Communication Standards between Primary and Secondary care (AWCS)

Individual professional standards:

1 Investigations:

Any clinician managing a patient’s care who deems an investigation is necessary should:

Request the investigation

Take responsibility for actioning of the result
Communicate the result directly to the patient and help them understand it.
Delegating these responsibilities is appropriate if there is agreement to do so (see Standard 5).

2 Referrals:

Any clinician referring a patient for a consultation should:

Ensure the patient understands the reason for the referral
Ensure the patient knows who is responsible for their care
Ensure the patient knows what should happen next
Ensure the referral contains all information needed to determine the priority of the referral
Make the referral themselves when they have the competence to do so

When not making a referral themselves, a clinician should never direct a patient to another clinician to ask for a specific referral or expected timeframe for action. Clinicians should respect colleagues' autonomy and allow them to determine what is best for the patient.

3 Med3:

The clinician who advises the patient to refrain from work must:

Issue the Med3
Ensure the duration of the note covers the time period to expected return to work or the next planned review

4 Prescribing:

A clinician recommending that a patient starts a new medication must:

Issue a prescription if that medication needs to be initiated within the next seven days
Issue a prescription for a minimum of two weeks but longer if clinically appropriate
Communicate all necessary counselling of the patient if recommending another clinician starts the medication
Ensure prescribing and prescribing recommendations should be within the scope of practice of the clinician to whom the recommendation is being made
Name the responsible clinician when recommendations are from non-prescribers.
Adhere to shared care prescribing processes by retaining prescribing responsibility until the GP has accepted the request and received the stable handover letter
Take account of guidance provided in the health board’s prescribing formulary and the availability of the medicine in primary care, when initiating or recommending a GP initiates medication(s)
Be prepared to retain prescribing responsibility if the medication does not have a UK marketing authorisation (i.e. the medication is unlicensed)
Be prepared to retain prescribing responsibility if the medication has a UK marketing authorisation but it is being prescribed in a way which is outside the terms of its authorisation (i.e. the medication is licensed but prescribed ‘off-label’), where such prescribing is not generally accepted clinical practice

Organisational Standards

5 Investigations:

Organisations should have standard operating procedures (SOPs) to mitigate against clinical governance risks and transfer of clinical responsibility when requesting investigations and actioning the results
There should also be SOPs with regards communication of results to patients
These SOPs should support clinicians in adhering to the individual professional standards

6 Referral and Outpatient Communications:

Must be compliant with data protection regulations.
Must be made via the nationally or locally agreed electronic method where it exists.
Must be actioned promptly, including requests for further information
Changes to priority must be communicated to the referrer and the patient
Should be addressed to the referrer with copies to the patient and their GP if not the original referrer.
Referrals that are declined, must be clinically justified and require timely communication to the referrer within the timeframe stated in Planned Care guidance (currently 48 hours).

7 Expedite Requests:

Patients who make contact to expedite appointments should be dealt with accordingly:

Should be based on clinical need; a long waiting time does not alter priority
For patient experience, clinically valid expedite requests should be dealt with by the team who they contact, rather than directed elsewhere
Follow-up appointments for review or treatment should be brought to the attention of the specialist overseeing their care for action.

8 Did Not Attend:

Care needs to be taken to ensure reasonable adjustments are made for patients with protected characteristics under the Equality Act.
Where patients do not attend for out-patient appointments without giving notice, in line with WG guidelines for pathway management, they will be discharged.
The original referrer, the GP (if not the original referrer) and patient should all be advised of the discharge.
Where the patient has reasonable grounds to challenge the decision, they should be reappointed without a new referral.
In the case of vulnerable adults and children who do not attend refer to the local “was not brought” policy

9 Patient Discharges:

Electronic discharge advice letters (eDAL) should be completed at the time of discharge, and a copy sent with the patient
Patients should be discharged with at least two weeks of medication (which may be supplied from the hospital or from medication already in the patient’s possession. Where there may be a longer than usual time needed to source a medication in primary care (e.g. where a special formulation or unlicensed preparation is prescribed), consideration should be given to providing at least four weeks of medication at discharge
Discharges out of hours should ensure appropriate handover to Out of Hours providers e.g. End of Life Care.
Similar information should be provided for completion of an ambulatory care assessment.

10 Pre-operative Assessment Clinics

Must have named medical support
Should first use the named medical support when unexpected findings are identified. Refer internally for optimisation for surgery, or an appropriately commissioned optimisation service

If you are aware of a breach of these standards, please datix the incident and contact us so that we can ensure these standards are upheld throughout Swansea Bay.