Rejection letter

All areas of the NHS are under great pressure.  In dealing with such intense demand it is important that we all work as effectively as possible to ensure that scarce resources are used efficiently.

When this comes to managing patients, it is prudent to adopt a one-touch approach. 

This means that when we are carrying out patient-related tasks, we ensure that our job is done thoroughly to ensure that it does not need to be addressed a second, third, or even fourth time by a colleague.  

Multi-touch approaches waste resources and increase errors. 

In healthcare, this contributes to patient morbidity and mortality.


If you have received a rejection letter from a colleague in primary care, it is not because they are being negative towards you.  Please, do not infer that this is a personal attack.  The letter has been generated with the single aim of ensuring that patients receive the right care, at the right time, at the right place.  First time, every time.


Onward referral

Can a hospital clinician make an onward referral?  YES

Contract reference SC8 specifies that for a non-urgent condition directly related to the complaint or condition which caused the original referral, onward referral to and treatment by another professional within the same provider is permitted, and there is no need to refer back to the GP.  Re-referral for GP approval is only required for onward referral of non-urgent, unrelated conditions.


Missed appointments

Can a hospital clinical send out further invites without a patient having to be re-referred?   YES

Contract reference SC6 states hospitals cannot adopt blanket policies under which patients who do not attend an outpatient clinic appointment are automatically discharged back to their GP for re-referral.


Provision of medication following discharge

Can a hospital clinician provide medicines for a patient to take home ?  YES

Contract reference SC11 introduces a requirement on providers to supply patients with medication following discharge from inpatient or day case care.  Medication must be supplied for the period established in local practice or protocols, but must be for a minimum of seven days (unless a shorter period is clinically appropriate or where a repeat prescription is already in place).


Follow up of results / investigation

Can a hospital clinician review and discuss a result / investigation with a patient following discharge?  YES

Contract reference SC12 places a requirement for hospitals to notify patients of the results of clinical investigations and treatments in an appropriate and cost- effective manner, for example, telephoning the patient.   This is also in keeping with GMC guidance which states that it is the responsibility of the doctor requesting a test to take clinical responsibility to follow up and take appropriate action on the result.


Delayed discharge summary

Can a hospital clinician provide an electronic letter directly to the patient’s GP at discharge?  YES

Contract reference SC11 and definitions requires hospitals to send discharge summaries by direct electronic or email transmission for inpatient, day case or A&E care within 24 hours, with local standards being set for discharge summaries from other settings.


Sick / Fit notes

Can a hospital clinician provide a sick / fit note?  YES

The 2010 DWP Statement of fitness for work guide: a guide for hospital doctors – GOV.UK  contains the following statements:

“The role of hospital doctors in issuing the Statement of Fitness for Work:

Hospital doctors may need to provide all certification for social security and Statutory Sick Pay purposes for patients who are either incapable of work or who may be fit for work with support from their employer. The duty to provide a Med 3 rests with the doctor who at the time has clinical responsibility for the patient.

Hospital in-patients:

Form Med 10 should continue to be issued to cover any period that a patient is in hospital. On discharge from hospital the doctor who has clinical responsibility for the patient should provide them, if appropriate, with a Med 3 to cover a forward period. This is to avoid unnecessary referrals to GPs solely for the purpose of sickness certification

Section 11 of the standard NHS hospital contract states

11.11 Where a Service User either:

11.11.1  is admitted to hospital under the care of a member of the Provider’s medical Staff; or

11.11.2  is discharged from such care; or

11.11.3  attends an outpatient clinic under the care of a member of the Provider’s medical Staff, the Provider must, where appropriate under and in accordance with Fit Note Guidance, issue free of charge to the Service User or their Carer or Legal Guardian any necessary medical certificate to prove the Service User’s fitness or otherwise to work, covering the period until the date by which it is anticipated that the Service User will have recovered or by which it will be appropriate for a further clinical review to be carried out.