When you see a ‘specialist’ (usually but not always within a hospital service)
The following questions cover responsibilities stated in the ‘Standard NHS Contract’, which all organisations providing services to patients for the NHS work have to follow. They explain what should happen in common situations that can lead to misunderstanding of who is responsible for what part of your care and what you should contact us for.
What happens if I need a test or procedure?
If a specialist thinks you need any test, investigation or surgical procedure, the specialist (not your GP) is responsible for:
- arranging the test, investigation or procedure, explaining how and when you will receive a date and what to do if the date is not suitable for you; and
- giving you the results and explaining what they mean (this may be done in a separate appointment with the specialist, by phone or by letter).
Specialist services must organise the different steps in a Care Pathway promptly and communicate clearly with patients and GPs. Specifically, they must notify you of the results of clinical investigations and treatments in an appropriate and cost-effective manner, for example, telephoning you. They must not advise you to contact or make an appointment with your GP to obtain the results or to have them explained.
What happens if I need something prescribing?
The specialist is responsible for:
- giving you the first prescription for any medicine that you need to start taking straight away, not advise you to obtain it urgently from your GP
- giving you enough medicine to last at least the first seven days, unless you need to take the medicine for a shorter time.
After the first seven days, the responsibility for prescribing depends on whether your GP can accept responsibility for prescribing a medication or decides that the specialist must remain responsible.
Regulatory guidance for doctors in the UK states, “You must prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or treatment serve the patient’s needs” and “You are responsible for the prescriptions you sign and for your decisions and actions when you supply and administer medicines and devices or authorise or instruct others to do so. You must be prepared to explain and justify your decisions and actions when prescribing, administering and managing medicines”.
To comply with these requirements means we are not able to agree to every request that specialist services make for us to prescribe
Guidance for specialists also states, “In proposing a shared care arrangement, specialists may advise the patient’s General Practitioner which medicine to prescribe. If you are recommending a new, or rarely prescribed, medicine, you should specify the dosage and means of administration, and agree a protocol for treatment. You should explain the use of unlicensed medicines, and departures from authoritative guidance or recommended treatments and provide both the General Practitioner and the patient with sufficient information to permit the safe management of the patient’s condition.”
NHS England policy states,” When a specialist considers a patient’s condition to be stable or predictable, they may seek the agreement of the GP concerned (and the patient) to share their care. In proposing shared care agreements, a specialist should advise which medicines to prescribe, what monitoring will need to take place in primary care, how often medicines should be reviewed, and what actions should be taken in the event of difficulties.”
NHS England policy sets out the sequence of events that should take place,” Referral to the GP should only take place once the GP has agreed to this in each individual case, and the hospital or specialist will continue to provide prescriptions until a successful transfer of responsibilities.”
If a specialist tells you that your GP will prescribe, but has not approached us to agree that, we may have to decline and advise you to contact them for a prescription
Regulatory guidance states, “you must share all relevant information with colleagues involved in your patient’s care within and outside the team, including when you hand over care as you go off duty, when you delegate care or refer patients to other health or social care providers.” Handwritten prescription advice notes, containing no information apart from the recommendation to prescribe, do not constitute “all relevant information”. A full clinical letter explaining relevant history, any examination and investigation findings and the treatment plan is needed to fulfil the requirements for safe decisions about accepting prescribing responsibility. Specialist services should not issue these handwritten notes.
We are not able to prescribe based on a handwritten note from a specialist service
What if I need a Fit Note (previously known as Sick Note)?
The specialist (not the GP) is responsible for issuing fit notes, where required, to patients under their care. This is a requirement of the Standard NHS Contract.
If you think you need a fit note, make sure you ask for it while at the specialist service
What if I need an earlier appointment?
The specialist service is responsible for providing you details of how to contact them and for responding to your questions about your care under them, including regarding whether an appointment should be more urgent. The specialist service should not advise you to ask your GP to request a more urgent appointment.
The specialist should also discuss with you whether you should attend hospital for ongoing follow-up care or whether you should be discharged back to your GP. If the specialist thinks you do need to be seen again, the hospital will give you another appointment or tell you when to expect this. If you do not hear anything, you should contact the specialist service, not your GP surgery.
What if I need further referral?
If a specialist agrees with you that you should be referred to another specialist or any other hospital service, they are responsible for making that onward referral if that specialist or service is within the same organisation and should not ask the GP to make that referral. Re-referral for GP consideration is only required for onward referral of non-urgent conditions that are unrelated to the complaint or condition which caused the original referral.