• A GP had shared care of a patient during her pregnancy. She had last been seen by her GP at 38/40 gestation, and had a follow up appointment booked. The patient unfortunately had a intrauterine foetal death. The GP was not informed about this prior to the patient’s follow-up appointment. This lead to a difficult situation for the GP and the patient during the consultation.

Learning points: The GP has an important role in de-briefing patients after traumatic events such as this. The GP having appropriate information prior to follow up enables better patient care.

• The GP can be central to health coordination.
• The GP takes a holistic role in getting patients services and supports they need.
• JMOs may find it helpful to discuss a patient with their GP early in the admission, particularly if they require up to date medications, specialist letters, background information, and information about the social context of the patient.

• Particularly important for complex patients.
• Make sure the correct GP is on the discharge letter, with the correct contact details.
• This enables appropriate follow up and transfer of care.

• This depends on the tone and context of what is being asked.
• If the request is in the context of a well thought-out discharge process, where the GP is seen as a member of the team, this is very reasonable.

• Many practices will understand that when the hospital calls, it is important to put the hospital doctor through to the GP.
• If the GP is not available, sometimes a discussion with another GP in the same practice is appropriate.
• If urgent, it may be reasonable to contact the GP via mobile.

• 70-year-old man admitted with advanced lung cancer, who was dying in hospital.
• The patient was the primary carer for his 90-year-old mother, who was not aware of her son’s condition. The inpatient team was having difficulty getting the patient’s mother into hospital to arrange her care needs.
• Through assistance of palliative care team, the GP (who had a longstanding relationship with the patient and his mother) was contacted. The GP was able to go to the mother’s house, break the bad news to her, and arrange her admission to hospital to address her care needs.

Learning points: the value of the longstanding relationship between the family and the GP allowed a difficult situation to be navigated.  It’s important for the junior doctor to understand the role of the GP and primary carers as part of the hospital team. Early discussion and discharge planning enables effective handover when the patient is discharged.

• In many chronic illnesses, there are particular programs and funding that is available, some of which is only possible through GPs, for example, diabetes, mental health.
• Enhanced primary care enables patients to see community allied health services under Medicare, which offloads some of the hospital services.
• GP input in mental health can be particularly effective – GPs can arrange up to 10 visits with counsellors.

• GPs are eager to be involved in the care of their patients while they are in hospital.
• You don’t have to do it all – there are lots of things GPs can arrange for the patient in the community.
• The GP is often intimately involved in the patient’s social context and community.
• GPs are interested to know what happens to their patients in hospital, particularly when they have referred patients to hospital – let them know the outcome of their referrals.