Discharge Letters (9)
The current scope for Transfers of Care includes:
- Acute inpatient discharges
- Emergency care discharges
- Mental health inpatient discharges
- Outpatient letters
To comply with the requirements of the NHS Standard Contract for ToC, organisations need to ensure they are sending messages:
- Electronically (no paper or fax) – 2015 NHS Standard Contract
- Using PRSB standards (AoMRC headings)
Have the capability to send messages:
- Based on FHIR technology (structured message)
- Containing coded content when capability available (SNOMED / dm&d)
PRSB (Professional Records Standards Body):
NHS organisations will be expected to have aligned their acute inpatient discharge, emergency care discharges, mental health discharges and outpatient letters with the nationally published specifications and have the capability to send by 1 October 2018. (Sending electronically (no paper or fax) was part of NHS Standard Contract 2015)
As a minimum, organisations must have plans in place clearly setting out developments and delivery of capability in line with GP vendors implementation of the receive capability.
NHS Standard Contract Technical Guidance Section 39.22 for ToC: https://www.england.nhs.uk/wp-content/uploads/2016/11/7-contract-tech-guid.pdf
There is implementation guidance and advice available on the PRSB website specifically relating to electronic discharge and clinic letters.
An Excel document is available that details if fields are Mandatory, Required or Optional.
Not all headings will be applicable to all settings/services and the guidance will clarify. For example, not all eDischarge summaries will have the requirement for a Procedure section, therefore that section is optional. However, if the eDischarge summary does include a procedure section, there are subsequently a number of mandatory, required or optional elements.
Electronic discharge guidance:
Outpatient clinic letter guidance:
24 hour discharge would normally be followed up with 5 days with a full discharge summary – in that case do organisations need to push out 24hr discharge electronically, or just full discharge summary?
Section 3.1.2 http://prsb-dev.riviam.com/wp-content/uploads/2018/02/Implementation-Guidance-from-Discharge-Phase-2-To-be-read-with-Mental-Health-Report.pdf states “the practice of sending an initial brief summary and following up with a later more detailed letter should be deprecated”, i.e. the 24hr discharge becomes the full discharge summary
Community Mental Health discharges – we cannot see any guidance on these, are they included in the requirement?
The NHS Standard Contract (2017-2019) states that a discharge summary should be electronically issued to the Service User’s GP within 24 hours. If test results are not available to meet this deadline, then it should be issued to meet the deadline and a further “results letter” rather than a Transfer of Care discharge letter sent at a later point
Does the discharge need to be a formatted document or just coded text that drops into the GP record?
Transfer of care FHIR structured messages need to comply with the specifications found by following the URL https://developer.nhs.uk/transfer-care-specification-versions/
The message will be structured when it leaves secondary care. NHS Digital are asking GP IT suppliers to put the received structured message into first level GP workflow as a human readable object. GP IT suppliers have the opportunity to innovate and distinguish their solutions from competitors with this flexible approach.