Transfer of Care Policy

We are seeing increasing numbers of patients who are asking for us to take over their care following a hospital consultation.  Some also come to us asking for us to take over care that has been directed by a private provider. There are times when we may able to help with this, but more frequently we are not in a position to provide the tests or follow up that has been requested.

Where a clinician has to decline to take over care from specialists or private providers it is because we are often being asked to provide care which is not within the remit or clinical sphere of knowledge of a GP.  It is not appropriate or safe for a GP to undertake monitoring or follow up for conditions normally looked after by specialists.

It must also be remembered that we just do not have access to some of the specialist tests and monitoring that is available at hospitals or via private providers.

It is not possible for us to list in full what we can and cannot provide by way of testing and follow up, however we ask patients to understand that where we do decline to take over follow up or monitoring it is for their own safety.

To provide some guidance we can list the following points –

• We DO NOT undertake blood tests or blood monitoring that has been requested by anyone but the GP’s within the practice.

• GP’s must be able to interpret the results of any tests requested at the practice, in many cases we are being asked to carry out tests and follow up on results that the GPs are not trained to interpret.

• We DO NOT have access to the same range of blood tests as they do within hospitals – just because your specialist can get a certain test does not mean that we can.

• We can’t prescribe any and every drug – Birmingham and Solihull ICB provides GP’s with a formulary of drugs which they can prescribe from. Just because your specialist or private provider wants you to have certain medications does not mean we are able to provide it.

• We appreciate that some patients have to travel long distances to access highly specialist care, unfortunately this does not mean we are able to take over follow up unless the GP feels they are clinically safe to do so. This decision is for the GP, even if the specialist is happy to hand over care it, the final decision rests with the GP.

• Private providers especially may suggest treatment or procedures that simply are not available via the NHS. There are sometimes routes that can be taken to apply for specific funding but this is for a very limited range of conditions, however this funding is extremely difficult to secure and it is not within our gift nor can we influence the decision of the ICB.

The above are just some examples of how we might not be able to take over care initiated by specialist or private providers, but these are only some obvious examples.  Please understand that if we have to decline to take over specialist care, follow ups or monitoring it is not to make your life difficult.  Any refusal is made for reasons of safety or because we just do not have access to what is required to provide what is needed.

We are also experiencing patients returning from surgery abroad with no correspondence covering the procedure that has been carried out and what after care is needed.  You need to return to the UK with all of the information you need to ensure your recovery, which you will need to arrange with another private provider in the UK.  They can’t provide your follow up without hospital or clinic letters covering your procedure.  We are not able to take over routine surgical follow up for procedures carried out abroad.  Acute issues such as post-operative infections can be seen on the NHS by a GP or hospital as appropriate.

Bariatric or Weight Loss Surgery (gastric bands/sleeves/bypass)

Alongside plastic surgery these procedures are by far the most common reason that patient’s travel abroad for cheaper access to surgery that isn’t widely available on the NHS.  Patients need to be aware that NHS GPs do not provide surgical follow up and monitoring for any patients who have had bariatric surgery, they simply don’t have the expertise.  This needs to be provided by a specialist, at least until the patient has stabilised a year or two after the procedure.  If patients have a procedure of this nature on the NHS they are often followed up by the specialist for 2 years post op, before they are stable enough to return to routine GP care.  You need to make similar arrangements for follow up and monitoring where you have your procedure carried out privately.

We ask all patients to understand that we are a primary care general practice and that is what we are funded and trained to provide, there will always be times when specialist input is the only thing that is safe and appropriate.