Being referred

Saw my GP as my consultant said my GP had to do the referral to the chest physician, and my GP won't refer me as he said the consultant won't do anything differently to my asthma nurse, and will just play with medication until they find something that's right for me.

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Bronnies, confused your consultant said your GP had to refer you to a consultant??? Or do you mean a referal to a specialist centre like Heartlands or RBH?

Bex

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I have several illnesses, and my main consultant (due to funding) said my GP had to refer me to chest physician. Just spoken to AUK line and they have said that this is happening alot at hthe moment

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Sorry you're having such problems with getting a referral, bronnies. It seems like quite a ridiculous state of affairs to me. I'd maybe speak to the cons who told you to get a referral to chest cons and ask him to put it in writing to your GP. Then go back to your GP again. I dunno, it might have some effect. Good luck.

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thats what AUK suggested Becky when I rang them this afternoon x

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Ah I am with you now. Keep badgering the GP, never under-estimate pester power.

Bex

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Hello Bronnies,

You can ask to be referred by your GP to whoever you think might/could help you most re your medical probs anywhere in the EU.

It’s worthwhile doing research prior to talking to your GP. After all, they (G.P.s god bless most of them) are generalists and don’t have the time to selectively research on your behalf.

Contacting the person whom you would like to help you is helpful, and can result in a far quicker referral time for all concerned. Not to mention better working relationships and a shared understanding between interested professional medics and patients. The best of all worlds in an Aneurin Bevan scenario

Transfer of funding is a potential issue, but if the PCT have good accountants should not be a problem, EXCEPT with research meds which aren’t licensed by NICE, - National Institute for Clinical Excellence/Exclusion. (Take your pick re last two words)

However research trials are often funded by higher income level pharmaceutical companies. (They ‘need’ their equivalent human guinea pigs and are prepared to pay research and insurance costs should they not reach pre arranged budgetary targets.)

One way or another it all comes down to money. Mine and yours.

Mia

Good luck and be nice to your GP!

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hi bronnies, bex and everyone,

I am tempted out of lurkdom as I have personal experience of this one (I am an NHS consultant in ""real life""). We recently were told, as were my colleagues in another teaching hospital, that we can no longer make ""c2c"", ie consultant to consultant, referrals. If I think someone under my care needs to be seen by a consultant in a different specialty for a completely different problem, eg if I happen to see they have eczema while they are in my orthopaedic clinic (neither are my specialties, just a made up example!), I have to write to their GP who then has to see them in the surgery and decide whether to refer them to the person I want them to be referred to. A waste of time all round of course.

This is allegedly because GPs are ""in the best position to know what their patient needs"" but of course it's really because the PCT has to pay for hospital appointments so they want to decide whether someone gets one or not.....

I actually see children who havent seen their GP for years so how the GP is in a better position to assess their needs than I am when I may have seen them every week for a year is beyond me....

We have now just been told that actually a lot of referrals come under the ""related to original problem"" banner so it was a bit of a storm in a teacup for my particular practice. however if the consultant you saw recently can't make any connection at all between his seeing you and you needing asthma care, then he does indeed have to write to your GP, who then decides whether you get the referral. I agree this is RIDICULOUS and has everything to do with gatekeeping budgets. We were threatened with having our referrals returned to us if we tried to bypass the system, we sadly have no control at all over this sort of managerial issue any more. This is why senior doctors are disillusioned with the NHS - we don't feel we are ""allowed"" to do what we think is right on clinical grounds. I would just add that the GPs are equally powerless in the appearance of this system, I'm not having a go at GPs in any way, they are told they have to do this in the same way that we are.

Oh my goodness I think I have wanted to get that out for a long time! Thanks for listening anyone who got this far!

GOod luck with your GP, do let us know how you get on and if I can add any advice to the excellent advice you have had already then I will..

Em

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Hi EJ

Can I just ask you a question please? I have heard that some referrals are just to 'Dear Colleague' rather than a named consultant, so that the person with the shortest list gets the patient. I think that is really difficult, because, how do you know that you are getting the most appropriate/skilled doctor in that fiel>?

I work in a health related field and some of our clients are treated by specialists who know nothing about their particular condition. Do you have any experience of this, although I suppose if you deal with children, it may be different.

Thanks

Kathyx

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hi Kathy

It's up to the referring person to whom they address the letter. In most clinics where I work, we get letters addressed to any of us or all of us and then the most appropriate one of contacts the patient with an appointment (but we work in a small specialty where we usually ring people before sending them an appointment anyway so there is room for personal discussion!). If you want to see, for example, a particular shoulder specialist rather than a general orthopaedic surgeon, your GP needs to write to that specialist by name. It does depend on the problem - eg most orthopaedic surgeons can deal with most orthopaedic problems so a Dear Colleague letter may be fine. Feel free to PM me and we can chat more - it's a bit off topic for the rest of the thread! And we can be a bit more specific about what we do by PM than on the main board.

all the best

Em

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This issue came up when i was in clinic (as a student not patient) with my consultant the other day! similar to what kathy has said, in the past it was known that favours were done by fellow collegues with short lists or as a favour to 'squeeze' in a patient

Also as Em has said they are using GPs as gatekeepers. It's all a bit crazy but he ho!

Em x

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All too familiar!

Yup, yup, yup. I've come across this both as a patient and as a doctor, and very frustrating it is too for all concerned.

One potential way around it, at least in some trusts, is that an out-patient referral can be made to another consultant if you are currently an in-patient. For example, when I was in recently my team (ie the respiratory team) referred me to the Pain Clinic, to be seen as an out-patient. Even though it was for an out-patient appointment, it counted as an in-patient referral, cos I was an in-patient at the time, so it was allowed.

Of course, this does have the disadvantage of requiring you to be admitted in the first place, but it might be a useful loop-hole for those of us who are in and out like the Hokey Cokey, in any case!

Anyway, hope this is of some help

Em H

PS What is it on here with asthmatic doctors called Em? That's three of us now... moral of the story, don't call your child Emily if you want them to have normally functioning lungs!

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yup yup yup indeed! So someone can be referred to me while they are an inpatient, then I can _see_ them as an outpatient. Or an inpatient, of course.I have to say the bottom line is that we have managed to make pretty much all of our referrals escape this system either by squeezing them into the ""related to original problem"" box or by getting them into some sort of exemption (usually ""clinical urgency"") or by pressing the ""risk of clinical incident"" button with the managers. All a waste of everyone's time and energy though. And don't get me started on MTAS.......

BTW I'm an Emma not an Emily but I had wondered about why there are three of us Ems!

Hope things are still going well EmH

Em/EJ

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quick question em aka ej...did u post on the old AUK website or was that someone else. Ej and dr rings a bell lol!

Long live the Ems!!!

Emh - hi!

Sorry i've hijacked the thread a bit!

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yup that was me!

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I have just been in A & E obs ward for two days and have been referred to the chest clinic by the consultant who saw me on A & E.

The NHS get such a bad press and I must just say that although I admit I did have to wait for hours and hours to get anywhere, but once I was seen I got first class treatment and have learnt a lot about managing my asthma. It was my first time in hospital, (hopefully I won't have to go again) but it was a positive experience. All the doctors and nurses were brilliant, and I've had every test going!