ABSTRACT
Patients rarely understand the different roles and responsibilities of the primary and secondary health care sectors. However, the organization of the National Health Service (NHS) since its inception has distinguished between the primary and secondary sectors and communication between them remains problematic. Communication between doctors working in primary and secondary care sectors is largely effected via referral and discharge letters. For older patients there have been attempts to improve the quality of discharge information by the development of check lists and standardized letters. The ideas enshrined in the 1989 circular have been further developed in the Hospital Discharge Workbook developed by the Department of Health and Social Services inspectorate. A high admission rate combined with a short and decreasing length of stay may be indicative of an 'efficient' use of a scarce resource such as acute hospital beds. With the implementation of the Community Care Act there is a much greater emphasis upon locally agreed policies and joint working.
