Introduction Working relationships between primary and secondary care, and in particular, guidance around specific roles, is not always clear. This project identified a gap to improve patient experience by championing good working practices between primary and secondary care, particularly around the completion of sick notes (Med3 certificates). We noted that anecdotally there was some discrepancy in the length of sick notes provided in one Obstetrics and Gynaecology department, and a lack of clarity on the role of primary care to provide these for patients who had been discharged from hospital after an operation. As clear national guidance was available, we undertook this project to educate consultants on these roles and to facilitate potential changes in practice going forwards. Completion of sick notes in line with this national guidance is likely to improve patient experience and also improve working relationships between general practitioners and hospital consultants.

Aims and objectives of the research project or activity The aim was to educate and influence the behaviour of Obstetrics and Gynaecology consultants, which could potentially improve patient experience, enhance interdisciplinary working, and increase understanding of the responsibilities of primary and secondary care clinicians. Specifically, we focussed on national guidance from the Department of Work and Pensions which advised that patients should be provided with a full sick note at the time of discharge from hospital, reducing the need for further appointments in primary care for this reason. The objectives of this project were to improve understanding of the rationale behind why the secondary care doctor was best placed to issue a sick note for the likely forward period for patients discharged from their care after an operation, and influence the practice of consultants in the department to improve patient outcomes and ensure effective use of resources in primary care.

Method or approach The project was completed as part of the RCGP specialty training curriculum, which includes a quality improvement activity each year of training. We administered a baseline survey to all department consultants about their practice of issuing sick notes, using a hypothetical post-surgical gynaecology patient scenario as an example. We then provided information around the national guidance for sick notes via email, including screenshots and the link to a webpage, as well as the results from the first survey. During this time, informal ad-hoc discussions about the project and the guidance took place with consultants and other senior doctors, particularly when asked to issue a sick note in the department. We then administered a follow up survey, using the same hypothetical scenario, to identify whether practice or thoughts had changed in the department.

Findings Although this was a small project, the final survey showed that the proportion of consultants who understood the role that secondary care doctors play in providing sick notes increased from 46% to 80%, following the provision of information and guidance. Although this project involved a hypothetical scenario, this change in thinking could demonstrate a change in practice across the consultant body, which over time, may add up to a significant reduction in GP appointments in the local community which are made solely for the purpose of extending sick notes after gynaecological surgery. This could potentially lead to improvements in patient experience (as GP appointments are often difficult to obtain) as well as improved working between primary and secondary care. However further work is needed to expand this project to observe the effect on the issuing of sick notes going forward, as well as perspectives on working practices between consultants and primary care, and the impact on patient care.

Key messages

• Working relationships between primary and secondary care could be improved if roles and responsibilities are clearly defined and shared

• National guidance advises that sick notes for patients who have had a hospital admission should provided by secondary care providers for the full expected period that they will be unable to work, to reduce the need for GP appointments solely for the purpose of issuing a sick note. Following this guidance has the potential to improve patient experience, and improve the working relationships between primary and secondary care, as well as appropriately diverting NHS resources.

• Simple educational information and discussion can have an impact of potentially influencing changes in practice and improvements in working relationships, however further work is needed to ascertain the impact of these changes.