Primary and Secondary Care Interface Consensus

The Interface Consensus is a set of principles to guide NHS staff across North Central London, when they are working across the interface between primary and secondary care.

This document covers the four nationally required interface priorities in the Primary Care Delivery plan.

1. Onward Referrals 

2. Complete Care

3. Call and Recall 

4. Clear Points of Contact  

There are also locally agreed areas for further improvement in:

• Medicines Optimisation

• Waiting Well 

• Clear and Complete Referrals.

The Interface Consensus has been developed by the Interface Steering Group (ISG) with engagement and feedback sought from each local acute/borough Clinical Interface Group (CIG). 

Communication and engagement on the original draft, with an online survey for input, took place across:

• North Central London Integrated Care Board (NCL ICB)

• local provider trusts: University College London Hospitals (UCLH), North Middlesex University Hospital (NMUH), Whittington Health (WH), Royal Free London (RFL)

• General Practice Provider Alliance (GPPA)

• primary care networks (PCNs)

•  GP federations

• Londonwide local medical committees (LMCs)

• HealthWatch.

Feedback has supported updates that inform the agreed consensus.

An overview of the Interface Consensus:

In 2017, NHS England highlighted the need to improve how we deliver NHS services across the primary and secondary care interface within its Key Messages for NHS Clinicians and Managers, saying: 

"Good organisation of care across the interface between general practice and secondary care providers is crucial in ensuring that patients receive high quality care and in making the best use of clinical time and NHS resources in both settings".

In 2023 further guidance was published identifying four national priorities to reduce bureaucracy at the interface of primary and secondary care: Delivery Plan for Recovering Access to Primary Care (PCARP) 2023.

As North Central London (NCL) Integrated Care System (ICS) develops, it is important that barriers that challenge care at the interface between service providers are addressed. ICS partners are in agreement that they need to consolidate and grow supportive relationships across the system to enable the workforce to deliver to their best and patients to receive high-quality care and outcomes. 

Local NCL interface groups and leaders have worked together to establish a baseline of principles in our own Interface Consensus that they aspire to deliver, aligning with and adding to the priorities NHSE highlights in the Delivery Plan for Recovering Access to Primary Care (PCARP) 2023. 

The NCL Interface Consensus has now been finalised by the NCL Interface Steering Group, following a wide consultation period and incorporation of feedback received from partner provider organisations as well as HealthWatch.

This document was agreed and signed off through the NCL Clinical Advisory Group (CAG) in December 2023 as well as through necessary governance forums in the signatory organisations: 

• General Practice Provider Alliance (GPPA) 

• NCL Londonwide local medical committees (LMCs)

• North Middlesex University Hospital (NMUH)

• Whittington Health (WH)

• University College London Hospitals (UCLH)

• Royal Free London (RFL).

It should be noted that the items within the consensus are not as yet consistently in place or possible system wide, however this document signifies an agreement to continue work towards this in future as a partnership in NCL. This document will be reviewed and developed as relationships flourish and priorities at the interface progress.

The Interface Consensus was launched in January - March 2024, through a programme of communications across the partner organisations.

Communication material has been provided to all organisations involved. NCL ICB is working on ensuring wide communication at a system level with senior leaders, training leads and lead professionals in each organisation as well as through system level forums.

All organisations are progressing work towards delivery.  It should be noted that the items within the consensus are not as yet consistently in place or fully possible system wide, however this document signifies our agreement to continue to transform our culture towards one of working in greater partnership in NCL.  

The Interface Consensus is being launched to formally acknowledge the principles all partners are aiming to work towards between primary and secondary care. The launch of this document does not constitute confirmation that partners are already achieving consistently against these principles, but that they are committed to improving against them as working practices are refined, both individually and as a system.

It is expected that the agreed statements within the consensus are standards that more detailed patient pathways, processes, policies and operating processes across NCL ICS are aligned to.

More detail on how to deliver in line with the consensus will be part of organisational and system wide protocols and policies such as the NCL Consultant to Consultant Protocol or the NCL Consolidated Access Policy.

Delivery of the consensus is not easy to assess. The goal is to work towards the consensus being simple routine working practice throughout north central London at the interface between services.

The consensus document is a first-step to establishing a baseline from which ICS partners can support more streamlined, effective and high-quality pathways of care for the population, addressing interface issues. As partners transform towards greater integration, they expect these principles to be further reviewed and developed. The ICS is keen to receive feedback and thoughts from colleagues on future updates, to ensure the consensus remains live to the current position.

It is proposed that feedback and suggestions are provided through established Interface Groups (see table).     

GP Liaison support services at partner organsations can provide a route for feedback about specific interface issues, acknowledging that delivering to the consensus is a work in progress.