10 functions of a hospital (and interaction with GPs)
What does a hospital do? What happens there? How do they interact (or not) with GPs?
Hospitals have many functions. Most have the following 10 functions. In this article, we will focus not just on the hospital functions; but on how those functions affect GPs, and how primary and secondary/tertiary care can help each other, to help the patients.
1. Patient care
Hospitals provide diagnostic, therapeutic, rehabilitative, and preventive services to patients. This includes inpatients who stay overnight and outpatients who don’t.
These services cover a wide range of diseases and problems: medical, surgical, maternity, paediatric and mental health.
Most smaller (local) ‘secondary care’ hospitals (GP is primary care) will provide all of the above. Whereas larger (regional) tertiary care teaching hospitals, will provide these as well. But they will also provide care for rare and serious diseases – e.g. dialysis for ESRF and radiotherapy and chemotherapy for cancer, and specialist forms of surgery (cardiothoracic, neuro, plastics and transplant).
The two types of hospital should work together seamlessly with patients easily passing from one and back. They should also work with GPs seamlessly, and not pass the buck to another part of the healthcare system.
2. Investigations
Hospital wards and outpatient clinics should arrange, carry out and follow up all necessary investigations in a patient’s care and treatment (and in a timely fashion); rather than, for instance, requesting the patient’s GP undertakes particular tests, or follow-up the results of their tests.
3. Communicating with patients (and responding to their queries)
It is important that hospitals take responsibility for managing and responding to queries (written or telephone) received from patients. They are required to:
- Handling patient queries promptly – e.g. wanting to change an appointment or speak to their consultant. They should ensure they respond, in good time, to such patient queries themselves; rather than simply passing them to GP practices to deal with
- Communicate the results of investigations – carried out by themselves to patients directly, rather than relying on the GP practice to do so (except in the case of GP direct access diagnostic services).
To do this, consultants, junior doctors and support staff (secretaries, ward clerks etc) should respond to questions, and not simply say ‘it’s not a hospital problem, go to your GP’. Such interactions should be written down, and placed in the patient’s record.
4. Medication (and shared care protocols)
Inpatient. For medication on discharge following hospital admission, the minimum period that hospitals should provide medication with is seven days (unless a shorter period is clinically appropriate).
Outpatient. If a patient is unwell, and it is important that a drug is started quickly, the hospital staff should do this, so the patient leaves the hospital with the drug to take the first dose today. They should have enough (upto two weeks worth) to give them time to resupply form their GP.
If it is not that urgent, it may better to ask the GP to prescribe it, so it gets on to their GP and pharmacy computer systems. Hospital computers don’t link to GP and local pharmacy computers.
Shared care protocols
For ‘specialist (unusual or expensive) drugs’ – e.g. immunosuppression after a transplant, chemotherapy or biological agents – shared care protocols should exists.
The hospital should not just prescribe the drugs, but also provide a home delivery service, that is more convenient for the patients, and care is closer to home.
5. Onward referrals
Hospitals should make ‘onward referrals’.
Where a patient has been referred to a hospital outpatient clinic by their GP, or has presented as an emergency, hospital doctors should make any onward outpatient referral required, to any other service – without the need for referral back to the GP.
Note. This can include when a secondary hospital refers the patient on to a tertiary hospital.
6. Health professional education and training, and research
Hospitals train medical students, nurses, pharmacists, AHPs, ACPs, PAs, and many other healthcare professionals.
Research
Hospitals are often a base for clinical research. This means doctors may ask you to take part in research trials of new drugs and treatments. You only have to part in these if you want to. The consent process will explain all the pros and cons.
7. Major incidents
Hospitals plays a critical role in major incidents (preparedness, response, safety, security)
8. Fit notes
Hospitals should provide fit notes. It is important that fit notes are issued to patients in a way which is convenient for them.
Where there is an appropriate opportunity (on discharge from hospital or at clinic), doctors should issue fit notes to appropriate patients; rather than expecting patients to make a separate appointment to see their GP simply for this purpose.
Fit notes should cover an appropriate period until the patient is expected to be fit for work (i.e. following surgery) or until a further clinical review will be required.
9. Sports medicine
Some hospitals provide rehabilitative services to athletes, including first aid, nutrition, and exercise prescription.
10. Home and community nursing
Many hospitals provide home and community nursing services. This includes services for ‘antibiotics at home’ and specialist community nurse practitioners (e.g. heart failure, advanced CKD, and diabetes).
Along with their colleagues at their base hospital, they should actively work to help GPs help the patients; keeping them informed of their visiting, and especially changes to medication (many of these health professionals can prescribe).
Note. The importance of each function varies depending on the hospital’s role in the healthcare system, and their resources.
Other types of hospital
There are other types of hospital that will not have all of the functions above, e.g.
- Community/rehabilitation hospitals
- Women and childrens hospitals
- Psychiatric hospitals
- Single disease (group) – e.g. eye, cardiac, cancer hospitals. These are usually quaternary hyper-specialist hospitals. Tertiary hospitals may refer patients on to them.
Inter-relationship between primary care (GPs) secondary/tertiary (hospitals) care
There is always tension between these two parts of a healthcare system, with each other blaming the other for not doing things, or doing things in a way that is not what they want.
It is important that you as a health professional do not contribute to this tension. Specifically do not criticise colleagues, especially from another part of the system. Its ONE NHS. And we should all work together to help each other, and help the patients. Lecture over? [“Yes” MyHSN Ed]. Thankyou.
For example, if you are about to send a snipey email or letter .. don’t. Would you like to receive such an contact? How about complimenting a colleague? Or give helpful feedback (in a positive sandwich).
If you are really unimpressed with someone, go and see them F2F and give polite critical feedback. Its often good to start with “thankyou for looking after our mutual patient X (or Xs) .. how do you think our interaction is going on regarding this patient(s)?” They may be as upset with you as vice versa. Hear their side first.
Is that it? [“Yes, sorry” Ed]
Summary
We have described 10 functions of a hospital (and interaction with GPs). We hope it has been helpful.
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