Lothian LMC / is it my job?

Is it my job?

Secondary care has asked the practice to do something. A quick way to work out whether it's covered by your GMS contract — answer two or three questions, or use the flowchart. Endorsed by Lothian LMC.

Walk it through

The seven rules of the interface

  1. Whoever orders a test owns the result.Requesting an investigation means reviewing it, acting on it, and telling the patient. This is a patient safety principle endorsed by the Scottish Government, the BMA and the GMC — not an opening position.
  2. Whoever proposes a referral makes it.If a hospital clinician decides the patient needs another specialty, they refer. "Ask your GP to refer you" is passing their decision to someone without their findings.
  3. Whoever starts a treatment prescribes and monitors it.Until the practice has accepted a resourced shared care agreement, prescribing and monitoring stay with the initiating service. A draft or "in principle" agreement counts as no agreement — and a practice can opt out, at which point full care returns to the specialty.
  4. Whoever does a procedure owns the aftercare.Wound checks, sutures, post-op review — and the fit note covering the episode and recovery. The operating team knows what was done and what recovery should look like.
  5. Advice is not a transfer.Specialists can and should recommend things for patients you manage. Whether to act is your clinical decision — and if you order the test or start the drug, rules 1 and 3 now apply to you.
  6. New work moves only with agreement and resource.The GMS contract is not elastic. Work beyond its scope transfers through commissioning — an enhanced service or an accepted agreement — not through a clinic letter.
  7. Return the task, never the patient.Declining work is not declining care. Say what should happen instead, make sure the patient isn't left in limbo, and use an LMC template letter so the message lands consistently.

The flowchart

Print it, laminate it, stick it by the workflow screen.

An ask arrives from secondary carea clinic letter, a discharge summary, or a patient sent round
Did the task arise from their episode of care?their assessment, their treatment, their procedure, their waiting list — e.g. tests they ordered, drugs they started, their fit note, their onward referral
YES — it's their episode
Is there an agreed, resourced arrangement the practice has accepted?an accepted shared care agreement, an enhanced service, or a LIG agreement (e.g. SACT bloods). Draft or "in principle" = no.
YES
Yours — by agreementDo it, within the boundaries of the agreement. Nothing beyond them.
NO
Not your jobReturn it with an LMC template letter. The patient's care continues with the specialty.
NO — they're advising about a patient you manage
Is it generalist care within your competence?the kind of work GMS essential services cover for your registered patients
YES
Your callIt's advice, not an instruction. Act if you judge it right — and if you do, the work is yours (rules 1 & 3).
NO
Not your jobSpecialist work needs a specialist — or commissioning. Return or escalate.
Genuinely unsure, or the ask keeps coming? Contact the LMC office — that's what it's for. · Lothian LMC

What GMS actually covers, in one paragraph

Your contract requires the practice to provide essential services to your registered patients: managing people who are ill or believe themselves to be ill — including chronic disease and terminal illness — with generalist consultation, advice, treatment and referral, delivered in the manner the practice determines. That is broad, but it is generalist care that you initiate for your patients.

What it is not: a subcontract to complete other providers' episodes of care. Their tests, their treatments, their procedures, their lists and their paperwork remain theirs, unless a commissioned service or an agreement the practice has actually accepted — with resource attached — says otherwise. The two ideas fit on one line: GMS makes you your patients' generalist, not the hospital's registrar.

This guide reflects Clinical Work Across the Interface (Lothian GP Subcommittee & Lothian Interface Group, January 2024), the NHS (GMS Contracts) (Scotland) Regulations 2018 definition of essential services, and BMA Scotland safe workload guidance. It is guidance, not contract text — judgement and the patient in front of you come first.

Companion tools: interface template letters to return the work · ES quick calculator to price it.