The interface between primary and secondary services is a critical element of the health system in south east London – but unfortunately, it isn’t working as well as it should do.
Too often, issues with the handover between services lead to poor patient experiences and patient safety risks, unnecessary administrative burden and frustration for everyone involved.
The NHS South East London Integrated Care Board (SEL ICB) Chief Medical Office (CMO) is currently working with patients, staff and services from across south east London to address the root causes of these issues. This work is also being supported by the Health Innovation Network (HIN) South London.
Every healthcare professional working in primary or secondary care across south east London can play a part in improving the primary/secondary care interface – helping us to create a truly connected primary/secondary care interface for the benefit of patients and staff.
This page outlines the different elements of the programme and will regularly be updated with new resources and information to support professionals working to improve the primary/secondary care interface.
Consensus Document
A co-designed Consensus Document was launched in July 2025, presenting a set of principles designed to shape a primary/secondary care interface that is patient-centred and reduces staff frustrations.
Created with the input of frontline staff and patient representatives, the Document outlines broad guidance and a vision for effective working across the primary/secondary care interface. As well as general principles, it contains domain-specific guidance covering:
- Onward referral;
- Communication;
- Call and recall;
- Points of contact;
- Principles of referral;
- Supporting patient expectations when waiting;
- Advice and guidance;
- Prescribing and discharge medicines.
This Consensus Document is the basis for all other workstreams.
Primary care issue recording
Primary care professionals are often left to pick up the pieces when processes fail in secondary care, generating additional work and compromising their relationships with patients.
To help understand where these issues are arising and provide targeted support to reduce these breakdowns in care, SEL ICB have introduced a new recording system specifically to capture instances where primary care colleagues identify interface issues such as unnecessary secondary-primary care referrals or process/communications breakdowns (e.g. delayed test results or missing appointment bookings).
This reporting form can now be accessed via SELnet’s Contact Us/Report a Quality Issue form. A version of this form will also be made available to secondary care colleagues in the future.
Local interface groups and activity mapping
Across each borough in south east London, local interface groups are helping to coordinate transformation work, share best practice and facilitate support from the ICB where required. These groups are outlined below:
- Lambeth & Southwark – led by Nancy Kuchemann;
- Bromley – led by Claire Riley / Bridget Hopkins;
- Lewisham – led by John O’Donoghue;
- Bexley & Greenwich – led by Natalia Barry.
To find out more or connect with your local interface group, contact the CMO team.
Patient and public engagement
We are working closely with patients to better understand the difficulties they experience when transitioning between clinical services, capturing the core issues, nuances, and consequences of miscommunication or disconnected processes.
Through a series of co-design workshops involving both staff and patients, we are also developing a patient-facing Consensus Document which will:
- Clearly outline what patients can expect when moving between services.
- Establish agreed principles for patient conduct towards staff.
- Provide clarity for healthcare professionals on roles and responsibilities for keeping patients informed and empowered.
Domain-specific workstreams
A number of domain-specific workstreams have begun work to address particular priority areas. Outputs from many of these workstreams are expected before the end of 2025, with ongoing work including:
- Co-development and dissemination of standards around discharge summaries, outpatient letters and advice and guidance;
- Production of a rapid report on current approaches to prescribing;
- Development of a guide to sites for blood testing in the community;
- Development of an insights report and mapping of best practices for clear points of contact for patients.
We will be publishing resources and outputs regularly on this page – please check back frequently.
