BackgroundPoor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work.AimTo understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement.Design, SettingA qualitative exploration of the secondary-to-primary care communication system surrounding a UK tertiary hospital.MethodA ‘systems approach’, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n=18) of clinical and administrative staff from both sides of the primary-secondary care interface and a subsequent focus group.ResultsThe largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates.ConclusionFacilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance, such as patient complexity.