CQC Inspectors comment on Clinical Letters

In one of the latest reports from the Care Quality Commission a Practice is placed into Special Measures for amongst other things not reading and taking action on over 1,200 clinical letters that were up to one year old. Out of hours reports were also not dealt with and a non-clinical member of staff was reviewing clinical letters.

The Report  in my view opens a can of worms for practices and poses questions about who should read and process clinical letters, and how quickly such letters and reports should be read after receipt.

If you take a look at a batch of hospital letters study closely how long it has taken the consultant or clinician to write the letter and then how long it has taken to type before it is received by the practice. How urgent has the letter been treated. There are various ways a Practice can receive clinical letters, on line, by post and by courier and of course by fax. If it is marked urgent or for immediate attention then YES it needs to be dealt either the same day or no later than the next day.

Hospital records are not always very accurate. The GP to whom the latter is addressed may not be the patient’s current GP. The letter might even be sent to the wrong practice.

Taking these problems into account suggests to me that a carte blanche approach to criticizing GPs for not reading clinical mail may not be particularly fair. What is correct is that if a clinical letter is not read at all and important instructions are missed a significant even catastrophic event may have occurred.

Practices need to have open and transparent systems for reading clinical mail and reports. There need to be duty doctors and deputies who are expected to read and action mail either the same day or the next day. Excuses like we are too busy are not good enough.

There are also questions about the point in time a letter is read. Is it before or after scanning. How long is the scanned letter kept before it is destroyed and what checks are carried out to ensure that a clinical letter or report is posted to the correct patient.

 

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