Helen Salisbury: Recommendation and steerage for all referrals

This week I learn a report within the Well being Service Journal a couple of baffling plan to reform the method of referring sufferers to hospital outpatient clinics.1 Below the proposed new scheme a GP would not be capable of refer on to a guide however would want to ask for “recommendation and steerage” first. On the similar time, plans are afoot to allow sufferers to self-refer to hospitals.

Once I first turned a GP, after an admittedly circuitous route, I knew lots of the medical doctors within the native hospital. I used to ring them up for casual recommendation if I used to be caught with a medical drawback my quick colleagues couldn’t remedy, and I’d then confer with a named guide, selecting them for his or her experience but additionally their method, matching physician to affected person. I now don’t have any selection however to refer into an nameless system. This has the benefit of night out ready lists, nevertheless it does so on the expense of affected person selection.

The brand new proposed system—which is already operating in some locations—requires some forwards and backwards between guide and GP, during which the attainable outcomes appear to be: (1) Sure, that is simply the precise case for my clinic; (2) I do need to see this affected person, however first please organise these blood checks and scans; and (3) No, this affected person doesn’t must see me; I counsel you do that therapy as a substitute.

It’s attainable that sufferers in that third class will profit from receiving therapy sooner with out having to attend an outpatient appointment, nevertheless it’s additionally attainable that rarer diagnoses can be missed or the affected person will really feel dismissed. And the second choice appears to be as soon as extra dumping work on GPs, who’re frankly fed up with being handled like group basis medical doctors. It will require a switch of sources into basic follow to make it viable, so I hope that almost all referrals will simply be accepted.2

Anybody who’s been basically follow for some time will keep in mind a earlier try to scale back outpatient waits, during which we had been obliged to debate all our proposed referrals with no less than one different GP. It was a monumental waste of effort and time which, in our follow no less than, had completely no impact on the variety of referrals despatched.

It’s laborious to not really feel cynical and see this newest proposal as only a ploy to make ready checklist figures look higher—in any case, in the event you don’t settle for the referral it might probably’t be added to the checklist. And it’s weird that, concurrently a GP’s gatekeeping position will get beefed up with a further hurdle to cross earlier than a affected person is added to the clinic checklist, NHS leaders additionally suggest to open up alternatives for affected person self-referral to secondary care. It’s starting to look as if they belief the sufferers’ personal evaluation of their want for a hospital appointment greater than that of the GPs.

Might obligatory use of recommendation and steerage work? A very slick IT platform, fast responses with the affected person stored within the loop, and time freed up for the additional work concerned would possibly make it attainable (has anybody but seen the magic GP tree?), though a lot of that extra effort would serve no helpful objective. In the meantime, there are fascinating medicolegal implications: if the GP says that the affected person wants a specialist opinion however the specialist says no with out seeing them, who’s then accountable if the affected person’s situation deteriorates?