NHS Dumfries and Galloway's Primary Secondary Care interface policy

The primary secondary care interface requires the transfer of patient care between teams. It is high volume, safety critical activity. Failures of communication at the interface lead to duplication of work and inefficiency. Healthcare teams are often unclear about roles and responsibility at the interface and this impacts patient safety.

The NHS Dumfries and Galloway interface team conducted a survey of clinicians to understand more about issues in their area. Secondary care clinicians, practice pharmacists and 13 GP practices completed the survey, which identified over 200 individual incidents at the interface. The survey also identified numerous examples of good communication. 

The results highlighted several recurring problems in the provision of care at the interface:

• Uncertainty about follow-up plans and onward referral responsibility following inpatient/outpatient assessment 
• Lack of clarity about medication and prescription management roles at the interface
• Confusion about responsibilities in result and investigation handling
• Inconsistency in discharge letters and plans
• Unreadable handwritten discharge letters
• Use of medical abbreviations in communication
• Variable quality of GP referrals and concerns about the role of active clinical referral triage (ACRT)
• Variable responses to GP requests for advice

The results were used to develop NHS Dumfries and Galloway’s first primary secondary care interface policy, which was implemented in March 2026. This policy is notable because, similar to other Health Boards, it clarifies roles and responsibilities at the interface. 

The stated aims of the policy are:

• To provide clear, consistent standards for communication and transfer of responsibility between primary and secondary care in Dumfries & Galloway
• To improve patient safety, reduce avoidable workload, and support a collaborative, patient-centred approach.

A summary of the key requirements of the policy is:

• Tests and results: The clinician who orders a test is responsible for ensuring results are reviewed, actioned, and communicated.
• Prescribing: Prescriptions for new urgent medicines to be issued by secondary care, and the appropriate script provided to the patient. Specialist medicines to remain with secondary care unless covered by a shared care protocol.
• Private care: Patients monitored by private providers to continue private prescriptions. GPs not to prescribe specialist medications in shared care with a private provider.
• Referrals: Consultants to complete onward referrals directly (with limited exceptions) where this is their management plan. Primary care referrals to meet NHS Dumfries and Galloway RefHelp standards and include frailty/functional status where appropriate.
• Advice requests: Consultants to respond within 1 week, with cover during leave.
• Discharge communication: Letters to include diagnosis, rationale for medication changes and clear follow-up plans, including any investigations requested and pending.
• Patient communication: Patients to receive clinic/discharge letters in clear language and be told how and when results will be provided. Patients not to be redirected to GPs for results or to upgrade a referral.
• Outpatient communication: Clinic letters should clearly state Plan for Patient, Plan for GP and Plan for Specialist Team

The work of the primary secondary care interface team in NHS Dumfries and Galloway demonstrated how dedicated focus on communication and care at the interface can drive meaningful improvement. The implementation of the interface policy has created board-wide standards that make it easier for colleagues to escalate issues through the right channels, embed good practice early and strengthen the culture of communication across services. 

This promotes a more consistent, collaborative and patient-centred approach that are likely to improve the patient experience along with the efficiency and safety at the interface. The challenges identified in Dumfries and Galloway mirror those seen across other Health Boards and in other parts of the UK, making the learnings from this work relevant and transferable across Scotland.

Both the Primary Secondary Care Interface Survey report and Interface Policy are available on request. Please contact scotland.interface@rcgp.org.uk for more information.