Service agreements between primary care physicians and specialists define the list of conditions that should be taken care of in primary care, and the process for making a prompt referral to specialty care if needed. Service agreements also define the appropriate work-up needed so that the patient arrives at their specialty care appointment with all necessary tests completed and ready for review. Agreements also help to stipulate the expectations for the specialist so that he or she knows what the patient has been told about the referral, what the primary care provider suspects about the patient's condition, and when the primary care provider expects to have their patient returned to their care (possibly after the work-up and diagnosis, or after the patient is stabilized on treatment).
Service agreements benefit both primary care physicians and specialists. Primary care physicians are ensured that their patients will be treated promptly by a specialist — either by appointment (ideally within 24 hours, typically within a week) or by an immediate phone consult if more appropriate. Specialists are assured that they will see only those patients who require their services, and those patients will be ready for their review, diagnosis and treatment plan. Service agreements are not guidelines or referral criteria unilaterally disseminated from specialists to primary care providers; rather, they are built-in partnerships between primary care and specialty care.
Service agreements between primary and specialty care should also include an understanding of when a patient is transferred back to the primary care physician following a specialty referral.
Service agreements between clinical areas and diagnostic services are also very important to ensure that the patient’s journey is fast and smooth as they move from primary care to a diagnostic study, and then either back to primary care or on to a specialty referral. Because diagnostics are key in the patient’s care journey, it is essential to have agreements established to expedite the process.
