Chief Executive: Dr Peter Graves

Director: Michael Harrison

Business Manager: Carl Raybold
Practice Development Manager : Rachel Lea
Tel: 01438 880010 Fax: 01438 880013
Email: lmcadmin@bhlmc.co.uk
Website: www.bedshertslmcs.org.uk

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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).

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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

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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
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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
Please note my new email address: petergraves@bhlmc.co.uk