Primary Secondary Care Interface

The interface between primary and secondary care was voted as a priority by our members for the 2017/18 priority year. The interface describes the journey and communication between primary care doctors such as GPs, and secondary care doctors, such as hospital consultants.

Problems across the interface can disrupt a patient’s journey, and create extra workload for doctors on both sides of the interface, while they are trying to get the best outcomes for patients. We have undertaken qualitative research with GP focus groups on what could help improve the interface. We found that our members feel that the interface could be improved by access to expert advice on referrals; better user-friendly IT systems; and building relationships between primary and secondary care colleagues.

Working on the interface as a priority means that we are aiming to make the patient journey smoother, faster and easier for patients and clinicians alike. This requires working with other Royal Colleges, professional bodies, the NHS and clinicians in local areas to improve relationships and develop practical solutions to the problems facing healthcare professionals.


In England the college sits on the NHS England Interface Working Group alongside the BMA, NHS Clinical Commissioners, NHS England, the Academy of Medical Royal Colleges, patient groups and secondary care bodies.

The group is developing practical solutions across the interface to the challenges faced by doctors, with the College is leading on Best Practice and Innovation. As a part of our work with this group we have produced our report Quality Patient Referrals, Right Service, Right Time which looks at the benefits of referral support over referral management systems. Our social media campaign #KnowingEnid highlights how essential clear and effective patient pathways are. We have also used the findings of the report to engage doctors in some local areas in events centred around relationship building and work-shadowing.

NHS England have also commissioned the College to deliver a programme of awareness raising and engagement activities on service transformation relating to new models of care. This means the College will be looking to engage local authorities, frontline GPs and patients in new structures of care to help improve patient care and decrease workload for GPs.

At Labour and Conservative party conferences in 2017, we hosted a joint roundtable with the BMA called Mind the Gap: Navigating the Interface between Primary and Secondary Care. 30 key stakeholders from charities, medical royal colleges, health bodies and parliament attended the events in Brighton and Manchester. Panellists discussed positive solutions to improve relationships across the NHS to make services better for patients, and relieve workload for our members.


RCGP Scotland is pushing the interface to the forefront of their work with a cross college working group in interface. This group has spearheaded an initiative to introduce a cross college training module on work across the interface. There is a campaign underway to push for a working group in every health board area.

Scotland is also pioneering in interface relationships, there is a work shadowing pilot in operation that has been developed for Scottish Online Appraisal Record, which other nations in the UK are currently looking to learn from for their own interface work.


In Wales, we have led the way on improving working across the interface. Dr Jane Fenton-May leads the Welsh Academy of Royal Medical Colleges’ Interface Working Group, which has produced guidelines on professional working behaviours across the interface.

Northern Ireland

In Northern Ireland our #DearColleague social media campaign aims to collectively acknowledge the barriers at the primary/secondary care interface and to commit to showing respect and understanding across different medical specialties.

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