Introduction Primary and Secondary care exist in separate silos. Patient pathways have developed within specialties over time, usually in isolation of other disciplines, but patients see one NHS. During the Covid 19 pandemic, a pilot role for a GP working within the hospital at Harrogate Foundation Trust, was trialled. This was established to offer a primary care view to strategic and operational function, and to input into acute trust decisions.

Aims and objectives of the research project or activity The role has developed over time being strongly supported by senior management at the Trust and ICB. Building trust with colleagues (clinical, managerial and operational) within the Foundation Trust and establishing clear pathways of communication for developments, joint working and dealing with issues arising. Clear communication with local GP’s and Practice managers has been essential in the development of this role over the last two and a half years.

The fundamental aim is to bridge the widening gap between primary and secondary care and reduce the patient risk that exists at the primary/secondary care interface.

Method or approach Regular meetings between the GP interface lead and the Deputy Medical Director have led to discussion and signposting to the correct individuals enabling conversations to enact change. Building ‘thick trust’ between the Deputy Medical Director and the Interface GP and been supported by regular liaison with acute trust managers, senior clinicians and ICB clinical leads, local practice managers and GP’s, the LMC and PCN clinical directors. Meeting face to face with trust colleagues to address over 150 issues, then communicating outcomes regularly to GP’s and practice mangers. Visiting all practices in the locality and identifying concerns and being a key contact for all colleagues.

Findings Over 150 issues have been addressed with more issues being highlighted as working relationships have become established. Examples include:

Successful development of a community medical examiner pathway

Establishing a local interface agreement between primary and secondary care

Changing pathways to be patient centred (eg. prescriptions not running out)

Developing compassionate systems (seeking feedback from colleagues in both secondary and primary care to find ‘ what works’)

Being a key source of advice in developing trust services

Enabling education events by local consultants for local GP’s

Changing discharge letters, based on clear communication and improved patient safety principles

Use local knowledge and networks to facilitate positive change

Key messages Shared vision and direct working between the Deputy Medical Director at Harrogate Foundation Trust and the Interface GP has driven changes. These are focused on a compassionate system approach (developing understanding of the challenges for other ‘partners in care’). Networking and meeting directly with those needed to address issues, driven by feedback and communication.

Trust is essential in leading together (and working with teams across the primary/secondary divide). Following the pilot, the role has been expanded and made permanent due to the tangible improvements in multiple areas.