The discharge summary write-off

The Radio 4 programme You and Yours had a news item recently about how hospital doctors changed patients' medications and then did not tell the GP. The result is that the GP's patient record is wrong – and therefore the summary care record will be wrong too. The report, by the NHS Alliance, also complained that even when the hospital clinicians did say that they had changed the medication, that information was so buried in other verbiage that the GP had difficulty in finding the changes. This all rang a bell with me. I have made a habit of checking with my GP whether he has received alterations made by my endocrinologist following my annual visit to him. He sometimes has and sometimes hasn't. And, after my major surgery last January, the oncologist's report and discharge summary did not seem to reach my GP's record at all, which was odd because, thankfully, I got my copy. Perhaps there was a postal strike going on at the time. The moral here may be that snail mail is unreliable, and it is high time the NHS entered the 21st century, and adopted email. That the important fact is hard to find in the verbiage of a doctor's letter is another problem for the GP and any patient who is privileged to see his own record. The terseness of email correspondence would help, compared with the stately phrases of a consultant's letter. And consultants should learn to break up their letters into paragraphs, with headings, to help the reader grasp the contents rapidly. Recently, I was talking to a father whose daughter had a rare chronic auto-immune disease, and had been in countless private and NHS hospitals, and was grumbling that there was no consistency in the reports he received from these hospitals: in the length of the reports, their format, their comprehensibility and the presentation of figures. Some were overlong. Some were too short. He longed for some standardisation in the way these reports were presented and the quality of their content. This ties up with the survey of GPs by the NHS Alliance, which claimed that GPs thought that hospital discharge information was getting worse, with 57% claiming that patients had been put at risk by poor quality reporting, and 70% saying that discharge information was late, incomplete or both. Strong stuff. And all this is happening when all hospitals are, since the deadline of 10 April, supposed to get discharge summaries to GPs within 24 hours. Also it is happening when hospitals are beginning to boast about their marvellous in-house electronic patient records (EPR) systems. And GPs' patient records systems have been pretty good for some years. The trouble is that the hospital EPR systems seldom tie up with the GP systems. Worse still, as this survey shows, even if they did tie up, the hospitals can't be bothered to provide accurate discharge data. I gather that the problem is that consultants and registrars are too high and mighty to do the chore of writing these summaries. They delegate the task to junior doctors, who may be covering the patients of several consultants, and who may not actually know the patients they are writing about. It is not surprising that the resulting summaries are garbage. A chain is only as strong as its weakest link, and the weakest link is right here at the interface between hospital clinician and GP. This is a people failure. The consultants must get a grip. Perhaps, in Andrew Lansley's brave new GP-centric world, the GPs should withdraw commissioning from hospitals which serve up dodgy discharge summaries! That might concentrate the consultants' minds.