Improving the interface between primary and secondary care
Please note: this article is primarily for healthcare professionals.
The way in which primary and secondary care services work together can feel disjointed, leading to poorer outcomes for patients and unnecessary work for staff.
A new programme is now underway to improve the processes and relationships which define this “primary and secondary care interface”, bringing together colleagues and patients from across south east London to co-design and implement improvements.
In this blog, Adrian Ingram and Keri German (both patients from south east London), alongside Dr Riaz Jetha (GP partner from Lewisham) and Dr Toby Garrood (consultant rheumatologist and Medical Director for NHS South East London) introduce the programme and its aims.
We often talk about ‘the NHS’ as if it is one big organisation – but the reality is that in south east London alone, our NHS is made up of many different hospitals and hundreds of GP surgeries, pharmacies and other care providers.
While individually we have some world-class services and an exceptionally talented and dedicated workforce, too often the connections between those services let patients and staff down.
In particular, problems with transitions between primary care services (such as GP surgeries) and secondary care services (hospitals and specialists) frequently lead to frustration, anxiety and, potentially, harm.
From patients being left in limbo during after referral and being delaying access to essential treatment, to breakdowns in communications leading to poorly coordinated care, the interface between primary and secondary care isn’t as good as it should be.
“At its worst, trying to manage referrals, appointments and follow-ups for me and my dad became a full-time job. Because of my own ill health, I have been unable to work. Yet, all the limited energy and rest I should have had were consumed chasing missing referrals, seeking updates on results, trying to book appointments, or obtaining clarification on care plans and treatments.
During one of the most difficult periods of my life, it was deeply exhausting to feel as though the healthcare system itself was an obstacle.”– Keri German
At a time when NHS services are at capacity, these inconsistencies add administrative burden and distract staff from the job of delivering great care. They also worsen the health inequalities faced by some of the most vulnerable across our region – with patients who are unable to use digital tools, people for whom English is not a first language, and those with multiple conditions being at the highest risk of getting stuck in a tangled web of NHS admin.
There has never been a more important moment to focus on getting the primary and secondary care interface right.
Thanks to years of hard work across south east London, we have the digital foundations in place to support truly personalised care, and infrastructure such as the London Care Record capable of providing detailed, near real-time patient information covering information such as current medications, long-term conditions and care preferences.
We stand at the cusp of a new and exciting era of neighbourhood health; healthcare truly centred around the patient. We know that when we get the primary and secondary interface working correctly, it will make a huge difference in this new world – letting people take more responsibility for their own care and navigate the system in a way that keeps them healthier and happier.
“Nobody wants to be diagnosed with cancer, but clear communication and a joined-up approach to my care from my GP and the cancer teams looking after me has meant I’ve always felt in control.
The way that the interactions and transitions between services have worked has meant that I’ve been able to access the treatments and make the decisions that were right for me. I hope that this project helps to give more patients the support and empowerment I’ve benefitted from.” – Adrian Ingram
Since NHS South East London (supported by the Health Innovation Network South London) began a dedicated programme focused on the interface in summer 2025, hundreds of patients and staff have contributed to work improving experiences and efficiency.
Together, we’ve co-designed a Consensus Document outlining principles for better working across the interface, and we’ve set up teams focused on solving some of the most complex and challenging issues that prevent things from working smoothly.
“As a GP, patients rely on me to help them make sense of an unfamiliar medical world. When systems and processes get in the way of that, it’s heartbreaking. Nobody should be left wondering what’s happening with a potential cancer diagnosis, or when they are going to be seen about some symptoms that have put their life on hold.
I’m so pleased to be a part of this primary and secondary care interface work, helping to make sure those aren’t the experiences we give to our patients in the future. We’ve had some amazing engagement from doctors on both sides of the interface already and I think we can do something here that really benefits patients and saves time and stress for staff.” – Dr Riaz Jetha
We believe that every clinician working across the primary and secondary care interface can have a real impact on making sure that the experience patients get is connected. As the project continues to gather momentum, we’re asking healthcare professionals to take three actions:
- Read our Consensus Document and take think about how its principles could apply to your practice;
- Find out about our wider programme of work and how you might be able to join colleagues from across the system in improving the interface;
- Record instances where things haven’t gone right, using local quality recording systems in secondary care and SELnet functionality for primary care colleagues – to help us target areas of the interface needing more support.
For more information for healthcare professionals, see this section about the primary / secondary care interface.