BMA report

COVID-19: effective collaboration between primary and secondary care

We explore the challenges facing doctors as they deal with the backlog of care built up during the pandemic, and the role of effective collaboration across primary, secondary and community care in tackling this.

Location: England
Audience: All doctors
Updated: Thursday 1 October 2020
Topics: COVID 19, NHS delivery and workforce

Prior to COVID-19 the NHS was already struggling to cope with increased activity, capacity constraints and financial pressures. It now faces a huge uphill struggle to deal with the inevitable backlog of care that has developed since March.

Building on the work of the BMA’s caring, supportive, collaborative project, this paper sets out what needs to happen to empower doctors to work together.


Our key recommendations

  • Bring together local clinicians to establish a local approach for how to review and process the backlog of referrals to help to achieve effective prioritisation.
  • Empower CCGs, including financially, to establish and increase the commissioning of locally based diagnostic services in the community, and to allow all clinicians to book these tests and monitor results.
  • Invest in IT systems, especially in secondary care, which respond to the need of clinicians, including information sharing and an ability to continue remote consultation.
  • Develop locally agreed joint prescribing budgets and open access to EPS to secondary care clinicians to enable them to issue prescriptions more easily and reduce GP workload.
  • End the PBR national tariff payment mechanism and replace it permanently with less complex funding arrangements– such as block contracts – designed to empower NHS bodies to work together.
  • Bring together local clinicians, health leaders and patients to agree a radical new shared approach to designing and funding care pathways.
  • Develop clinically-led quality improvement programmes focused on supporting clinicians and other healthcare professionals to come together to input into service redesign.
  • Engage with local health economies, including commissioners, integrated care systems, sustainability and transformation partnerships and trust leadership teams to improve adherence to the NHS standard contract requirements.
  • Backlog of referrals
  • Routine diagnostics in the community
  • Investment in IT infrastructure
  • Joint prescribing budgets
  • Collaboration not competition
  • Designing care pathways
  • Quality improvement programmes
  • Implementing changes to the standard contract
  • Priorities, timescales and responsible organisations