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Dear Colleagues,

Delayed discharge summaries from East and North Herts Hospital NHS
Trust

By now you should have received a letter from East & North Herts Hospital NHS
Trust explaining that, since September 2017, the Lorenzo hospital IT system has not
been sending out discharge summaries to GPs. Dr Michael Chilvers, Medical
Director, came, with two colleagues, to the LMC meeting on Wednesday 5th
September to discuss the problem and explain what the Trust is doing to resolve it.
As you can imagine, there was a very heated discussion. I am now writing to you to
give the LMC perspective, our understanding of the impact on patients and
practices, and what we are doing to resolve this very unsatisfactory situation.

Summary:

48,000 patients have been discharged from the Lister since September 2017. It is
believed that 25,000 patients may not have had a discharge summary sent to their
GP. Initially, the hospital is focusing on 16,600 patients discharged since April 2018
and is undertaking a prioritisation process. It has identified 4,352 patients for
whom, almost certainly, a discharge summary was not sent directly to their GP;
1,500 of these are considered a high priority.

Dr Chilvers has guaranteed that the hospital will take full responsibility for ensuring
that any outstanding actions will be undertaken by the hospital, including one to one
telephone conversations with affected patients. However, the LMC remains sceptical
that this will actually be the case and is, therefore, discussing the impact on patients
and practices at the highest possible levels, including local MPs.

We will keep you informed of progress and advise you about what action you will
need to take.

 The first piece of advice is that practices should inform their


indemnity company or companies that this failure of the Trust has
occurred.

We will also be negotiating the resources that you will need to undertake any action
necessary.

Background:

In September 2017, East & North Herts Hospital NHS Trust, had to upgrade its IT
system and opted (on NHS Digital’s advice) to implement the ‘Lorenzo’ system
(along with many other hospitals in the country).
At the beginning of August 2018, I was informed that, at the end of July, the Trust
had formally notified the CCG, through a ‘Serious Incident’ (SI) notice, that the
Lorenzo IT system at the Trust had been failing to send discharge summaries to
GPs. It transpired that this had been going on since Lorenzo was first introduced in
September 2017. We understand that, as well as the CCG, a number of GPs
contacted the hospital back in December 2017 to tell them this was happening –
they clearly failed to act appropriately back then.

At the beginning of August, Dr Michael Chilvers, Medical Director, took a lead on


understanding the size of the problem and rectifying it. A small ‘task and finish
group’, that includes Dr Russell Hall, GP, Russell’s practice manager, and appropriate
hospital personnel was set up. As progress has been so slow, in the last week Nick
Carver, Chief Exec, has taken over the chair of this group. The group is meeting
and reporting weekly to Sheilagh Reavey and Beverley Flowers at the CCG; I have
been kept apprised of the situation.

The size of the problem:

The information we have to date is:

 48,000 patients were discharged from East & North Herts Trust since
September 2017.

 It is understood that many of these patients will have been given 2 hard
copies of their discharge summary, one to be passed to their GP.

 16,600 patients have been discharged since April 2018. Initially, the task
and finish group has concentrated on this latter group.

o Within this group, it is believed that over 7,000 summaries may


have been sent directly to GPs, although the evidence shows that
3,770 were printed and handed to the patients (however, they may
not have reached GP surgeries):

o 4,352 definitely haven’t been sent

 Despite this, most of this group have been (or will be shortly) sent another
copy of their discharge summary with a letter of explanation.

 Meanwhile, from the 16,600 discharged since April, a risk assessment has
been undertaken:

o some are known to have died,

o others (e.g. those that had endoscopy) were handed a summary


o another group of patients has been seen as an outpatient since
discharge.

 There remain 1,500 high priority cases under urgent investigation

Clearly, this is a very concerning issue that has been reported to NHS E as a ‘Serious
Incident’. I have discussed with Sheilagh Reavey, Russell Hall and Michael Chilvers,
at length the potential impact that this might have had on certain patients (spanning
back nearly a year) and what the impact will be on GPs as this unfolds.

What is being done to rectify this:

I have insisted and been given assurance that:

1. All discharge summaries are being assessed by the consultants concerned to


identify the patients that have come to harm, have been put at risk and/or
still have outstanding actions following their discharge.

2. The Trust takes full responsibility for any outstanding actions

3. The Trust ensures all outstanding actions are requested and organised by the
hospital and not passed to the GPs

4. That the patients concerned are contacted directly by the Trust – mainly by
phone – and will be reviewed in the clinic by the hospital clinical team if
necessary.

5. Any harmed patients will have a face to face consultation with the consultant.

What should practices do now?

Initially, you should be aware that some patients may come to you expecting that
you have done or will do something on the instruction of the hospital. You will have
to explain that discharge summaries have not been reaching GPs. You will need to
ask your staff to chase discharge summaries should you become aware that one is
missing.

Later, once you know which patients are involved, we believe, that most practices
will feel an obligation to review the records of most of the patients discharged since
September 2017, as daunting as this seems.

Should you discover that a patient has been harmed, within the Serious Incident
criteria, you must notify the CCG immediately through the usual SI processes.

LMC Legal Advice

We have spoken to the LMC lawyer. She has advised us to tell all practices to
inform their indemnity companies of this failure at the Trust.
Secondly, she has suggested that the LMC asks for a mandate from practices to act
on their behalf to ensure the Trust recognises the workload it has caused practices
and provides appropriate resources to work through this. You will be hearing from
us in the next couple of days to get this mandate.

Going forward:

Dr Chilvers attended the LMC meeting on 5th. Aside from the assurances about
taking responsibility for this, we heard what the hospital is doing to mitigate any
further delays on discharge summaries.

The CCG has issued a ‘Contract Performance Notice’ which sets out exactly what the
hospital must do to rectify this situation; to clear the backlog, and what information
and advice must be given to practices in the coming weeks. Most importantly, the
Trust has reaffirmed that all patients affected are contacted by telephone, and any
harmed patients have a face to face consultation with the consultants concerned.

As this situation has been so unclear during August, and the impact unknown, I was
asked to keep this situation to myself and only share it between those of us in the
office and the LMC Chairs, however, I informed the CCG and Dr Chilvers that I would
brief the LMC before our meeting on September 5th and write to our constituent GPs
after that.

I assure you we will do all we can to help reduce the impact on patients and
practices as well as fight to ensure practices are recompensed for all the time it is
going to take to resolve this issue.

In the meantime, we would appreciate being kept informed by you about the impact
this has had on your patients and practice.

Yours sincerely

Dr Peter Graves, FRCGP


Chief Executive