why do I need referral from my GP: I contacted a... - Thyroid UK

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why do I need referral from my GP

Peroxideblader
Peroxideblader

I contacted a private endocrinologist who also deals with menopause as the symptoms of both overlap but they've said I need a referral letter from my gp before I can make an appointment!!! surely the whole point of me going private is because my doctors are useless and have consistently dismissed my results as NORMAL and won't refer me themselves....ive seen 4 private consultants in the past for different issues but never needed a referral..is this usual for endocrinologists?

I refuse to pay my useless gp to refer me as any letter they write is a bad start as they'll say all tests normal mostly in range and I have health anxiety because they are too useless to look into my actual thyroid problem..i wanted this lady specifically as she specialises in pitituatary issues which mine is..thank you

48 Replies
oldestnewest

Hi

Yes you should need a referral to see any specialist from your gp.

They should not however charge you.

Endos are funny bods they definitely will not see anyone without a referral.

My specialist( private’) is the only one in her practice with over 5000 active patients and 3000 that order product from her or are correspondence only. She’s full but say 8 years ago when she was taking on new patients she needed to know she could use her time to help the most needy ones.

If your gp is that bad I’d change and start a clean slate asking for a referral straight off. If yours is a complicated situation I’d expect a gp to be thrilled someone else was sorting out your problems.

Good luck.

MaisieGray
MaisieGray in reply to Howard39

Endos are funny bods they definitely will not see anyone without a referral.

That simply isn't true, I've friends who have simply phoned the Endo's PA and booked their appointment, no referral needed.

endomad
endomad in reply to MaisieGray

I saw my now endo privately first, I just called and made appt, his secretary told me to bring any blood tests i had. No referral needed and he put me straight on his nhs list after my first visit. I went to see this endo as he was recommended, t3 friendly and not tsh obsessed.

My appt was an hour long which gave us time to go through my history, i had been self sourcing t3 for a year, a 10 min nhs appt would not have covered everything. He did all my tests on nhs (bone/dexa, heart, shbg, full bloods) i would have struggled to pay for private treatment long term.

Tinacros
Tinacros in reply to endomad

How much was the cost. Xx

endomad
endomad in reply to Tinacros

I paid £175.00 for the hour and it included a prescription for 3 months of T3. It was worth it to have the time to go through all my tests and symptoms but I could not afford to stay private. I saw him at the Nuffield Leamington Spa.

Tinacros
Tinacros in reply to endomad

I would say that is worth it though. I’ might consider this myself x

Howard39
Howard39 in reply to MaisieGray

Hi

Not in my area you can’t. And that’s for most conditions unless it’s an eye problem and the optician can do it or cosmetic surgery where you can refer yourself at the local Spire hospital.

I am lucky my specialist ( 5 hours away) would refer me if I really wanted to see someone else for say a knee op. Most everything else she would be able to sort out.

I don’t think it’s any big deal - it’s fairly typical and your GP will have come across this before. I have never known a GP charge for the letter.

I think it’s a matter of courtesy in some ways as the private endo may want to contact your GP to get info on medical history and blood test results. Also they may write to your GP about their conclusions and treatments - for example, my private endo asked the GP about certain blood tests and the GP did them and he also asked him to increase my prescription of Levo, which the GP did.

I agree with Howard39 - if your GP is so terrible and your relationship with him/her so awful you don’t want to ask for a referral letter and they will charge you for a brief referral letter, I’d be looking for another GP - fast! 🤸🏿‍♀️🥛

helvella
helvellaAdministrator

It very much depends on the individual specialist.

The general principle is that one doctor should not be seen, or even thought, to be going behind the back of another, poaching patients, etc. That is, it is mostly a matter of professional ethics.

At the same time, duty to patients should ensure that a single GP is not able to block access to the rest of the medical establishment, which is what can happen if the specialists always refuse to see without refererral.

I suggest that if you are very much wishing to see this one specialist, you could write a letter/email explaining why a GP referral is an issue and asking them to consider seeing you anyway. Or find another specialist who might see you.

Of course, any doctor can refer you. Would any of the other four specialists you have seen be willing to refer you? (I can't see a specialist refusing a referral from another specialist and insisting only on GP referrals. But I could be wrong.)

Hidden
Hidden in reply to helvella

That's interesting! I'm not in the UK, but several doctors over the years have tried to interfere with my unconventional thyroid treatment (NDT) and switch me back to levo, based on my suppressed TSH, without even consulting the doctor who put me on NDT. I've always found that behaviour questionable.

It got even worse last year when I was hospitalised in a neurological unit and they brought in an endocrinologist without even informing me. I ended up with a hospital bill including an endocrinological consult that I did not request, did not want, and which was pointless as I had no intention of going back on levo only.

helvella
helvellaAdministrator in reply to Hidden

The General Medical Council says:

1 In Good medical practice we say:

15. You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:

c. refer a patient to another practitioner when this serves the patient’s needs.

gmc-uk.org/ethical-guidance...

(My emphasis above.)

MaisieGray
MaisieGray in reply to helvella

Yes, it definitely hinges on "when this serves the patient's needs", and I've always thought it interesting that given its aim is to clarify protocol, it doesn't specify who decides that. The NHS guidance about it is:

If your GP thinks you need to see a specialist and you want to pay for it privately, they can write a letter of referral to a private consultant or specialist explaining your condition and your medical history. You won't be charged for this.

Your GP will only refer you to a specialist if they believe that specialist assessment or treatment is necessary. If they don't think it is, they don't have to refer you – either privately or on the NHS.

If you disagree with your GP's decision, you can ask them to refer you to another healthcare professional for a second opinion (an opinion about your health from a different doctor).

Although you don't have a legal right to a second opinion, a healthcare professional will rarely refuse to refer you for one

helvella
helvellaAdministrator in reply to MaisieGray

I agree.

The basis of need is complex. I think it quite easy to imagine a situation in which the psychological needs of a patient require referral even if their is no obvious physiological reason in the view of the GP. (Patently that is true for psychological referrals, but I am arguing that could be the case for physiological as well.)

Further, if the GP is fully competent at assessing the patient's disorder and hence needs, what would be the point of most referrals? Almost by definition the GP is less able to assess the patient's needs than a specialist.

MaisieGray
MaisieGray in reply to helvella

Yes I agree with you, sometimes it isn't simply the case of the existing diagnosis or treatment being adequate or not; there can be allied issues, such as psychological, coming into play. If someone is seeking to fund their own care (or their private insurers are happy to fund it) then it perhaps makes senses to have an entirely free market where referrals aren't required and people simply buy their appointment in the same we do with the hairdresser say. And since some specialists already work this way, presumably they find it works for them and their patients - when I had my eyes lasered for instance, I didn't have to be referred by my GP nor my Optician, because I was fully investigated from scratch, during my appointments with the laser clinic. It might perhaps be a little less clear if the scale of the psychological need is high end, and that is driving a perhaps inappropriate or unecessary constant searching for a different diagnosis of the physiological issue.

I think your second point, whilst valid in principle, and I agree with, doesn't perhaps take account of the fact that diagnosis is partly an art, not just a science, and rather than competency alone, can depend on say, experience and good fortune. When my second son's health was on a downward projectory from the day he was born and he was admitted to hospital on day 4 very seriously ill, we were lucky that the Consultant had previously worked at Gt Ormand St with an eminent specialist in rare metabolic disorders, and something about my son's condition rang the proverbial bell and she was able to make a quick phone call, have her thinking confirmed, and my son set off on his medical journey sooner rather than later. So luck and good fortune very much played a part there; but yes to agree with you, the GP in the preceding days had been obnoxious, unhelpful and downright wrong, and felt no need to refer. Fortunately an emergency call out brought a young Chinese locum Dr who asked me if I was worried about my son and felt something was wrong - yes - then asked if I had other children - yes - and said in which case my worries and experience as a parent carried far greater weight than his training, and my son should be taken to hospital immediately and he'd phone ahead.

Hidden
Hidden in reply to MaisieGray

I cannot even count the number of doctors who've told me over the years: "I'd feel better if your TSH was in range". Recently, I just snapped and replied: "Well, I've got news for you! This is not about how YOU feel, this is about how I, the patient, feel!" She was quite taken aback by my reaction.

This must be the only disease where it's more important how the DOCTOR feels compared to how the PATIENT feels...somehow, the treatment goal does not seem to be symptom-free patients, but doctors feeling happy about the patients 's in range TSH...even if I live to be a hundred years old, I'll still not understand the logic of that reasoning!!!

MaisieGray
MaisieGray in reply to Hidden

Brilliant, well done you!

Likewise I've had Drs look at the numbers I've recorded, and say "I'm not concerned about them" irrespective of whether I might be. So when in a phone consult recently, the GP said she wanted me to have my BP and blood levels checked, I said no thank you, you don't do anything about it when I do, and I'm already getting angry just thinking about it. She was clearly taken aback.

Hidden
Hidden in reply to MaisieGray

Yes, nobody could understand you more than I...! Every time I see a doctor, that poor(?!) creature has to deal with all the aggression and frustration I've accumulated over the past 20 or so years...it's like any white coat is a red(!) flag to me nowadays...I simply assume doctors are ignorant and unwilling to listen to patients and react and act accordingly. I am not always proud of my behaviour once I get out of there, but cannot help it.

anniec11
anniec11 in reply to Hidden

I think it is a very sad sign that so many of us feel like we do about GPs. I am afraid that following an appointment with my GP about a longstanding problem, he refuses to address and simply insists that I take heavy pain killers (like opioids of one sort of another) and I refuse, he simply says Whyever Not??? I couldn't believe he actually made such a bigotted statement! I went in with a musculoskeletal problem following failed back operation and came out with with an appointment for a blood test for my thyroid function and a flu injection. I didn't mention either, nor do I want either of them. VERY frustrating indeed... so I think he would have been better to check my blood pressure at the end of this appointment !!!!

Peroxideblader
Peroxideblader in reply to Hidden

that's what has infuriated me..these bloody ranges..surekt when I'm below range and almost rock bottom range that is not good but instead of trying to get my ranges higher so I feel better...no...no further action as I'm just in range..the ladies on here picked up on my issue being secondary hypothyroidism from my bloods yet my doctors can't...well fine they don't know about pitotuary but please pass me onto someone who does no...but they won't.. grrrrrr

I was given a name for a private endocrinologist by the mother of a friend. I was surprised that I had to be referred by GP .

I agree with Helvella. It very much depends on the specialist, some require a referral and some don't. I have several friends who have seen Endos by simply phoning their PA for an appointment and indeed I recently contacted a Gynae on behalf of a friend to find out how she could see him, and again, no referral was needed. It's a rather outdated thing to want a referral and I think if we are going to see them because we want them to investigate anew, without any prejudice or bias carrying over from the Dr we've seen before and are unsatisfied with , I think it's a bad thing. However, I don't think your GP will charge for a referral if he's happy to refer, but he is not obligated to refer you.

Unfortunately with Endo's you do have to be referred. I was actually referred by my Gyne in the private sector, when I was on a private health scheme at work. I was glad I was.

Invariably when you are referred, the Endo will do their own tests anyway, private or NHS.

If you are not happy with the service you are getting by your GP, go to a different practice to get a second opinion. GP's can not deny you a referral especially if you are willing to go private, it just means you will be seen sooner.

My Endo, in the private sector was ok, was not over impressed but then I was not paying for the service. However, she did sort my medication out and introduced me to the T3 medication. Whereas, the NHS Endo tried to get me off them due to the price and I ended up reporting her for her unprofessional manner and conduct.

Good luck and hope you can get the answers you need.

Take care :)

Unfortunately with Endo's you do have to be referred.

GP's can not deny you a referral especially if you are willing to go private.

I'm sorry but you are wrong on both counts.

Perhaps it is where you live, but I know from my experience you need a referral.

As Helvella wrote, it's down to the preference of the individual specialist, whether they ask or not, for a referral.

Maybe, but I can only go on my experience MaisieGray.

Howard39
Howard39 in reply to JOLLYDOLLY

Also if you are in a private health scheme they won’t cover the cost of the apt/ scans etc without a referral letter.

In my job I am required to have one for I give treatment.

JOLLYDOLLY
JOLLYDOLLY in reply to Howard39

I agree Howard39, I had a lot of tests and scans, especially when I was under the private health scheme with work.

I am surprised that people are saying they can get to see a Endo without a referral. In my experience, that has never happened.

Take care :)

bantam12
bantam12 in reply to JOLLYDOLLY

I have seen an Endo without a GP referral.

Hi, I’ve seen a few. Depends on the endo as to whether they ask for a referral letter. My advice, tell the receptionist you have a referral letter. They just ask you to bring to the appointment. Half the time, the endo won’t even ask for it at the appointment, if they do, just say sorry I forgot it, let me give you a brief outline of my issues and give them any recent bloods. They aren’t going to end the appointment as you don’t have a letter. I think often they say they want letters, as it’s usually paid for by insurance and they usually want a letter, so it just makes sure they are getting paid. I wouldn’t bother getting a letter, waste of everyone’s time. I would say though, occasionally they want the letter before the appointment, I’d just say I’m still waiting on the GP, so will bring to the appointment. Most endos just want the cash, they aren’t bothered about the letter

If your paying out of pocket for visits,test I don't see why the doctor would care if you had a referral or not.

thanks everyone it seems I've picked the one endo who does need a referral..just to clarify my reasons for seeking help myself is I've clearly got the symptoms and the blood test results that show secondary hypothyroidism as confirmed several times by you ladies on here but because my gp knows hypo or hyper not the one inbetween as in mine which is rare and is a pitutiary problem they keep saying I'm fine and there is no issue with me. 6 years in and I'm just getting worse and worse life is pretty grim and although my 5 test results showed low t4 low t3 and mid low tsh..because out of 5 tests only one the results were all just in range my doctors ignore the others whete at least my t4 or t3 was below range. I am not taken seriously now at my doctors they refuse to acknowledge my symptoms and blood tests show secondary hypothyroidism and will not test or discuss any further. it's not one doctor I've seen 5 different ones who demeaned me said it was the menopause and that I am making illnesses up I don't have...

so if I can't get taken seriously or referred by my gp I'm lost for what I can do. my gp would only state what he believes and that is I do not have a thyroid issue end of..

my only other option is to try and buy my own NDT and see if I feel any better

helvella
helvellaAdministrator in reply to Peroxideblader

I really do think you need an endocrinologist appointment. Secondary hypothyroidism potentially is associated with other hypopituitary issues and it is usual to do an MRI.

Very much understand, after joining thyroid. .Org, then I started = had nhs BT s then medichecks BT’s , then asked for referral, 1st one wasn’t the person I wanted to see, so changed it::

Suggest you call Barry Peatfield & see him without a referral - he saved my life after Pituitary surgery! Do hope he's still with us as he was very ill & elderly but sharp as a tack re Endo matters 😎 he was training up some nutritionists to take over from him..

Unfortunately (for us), Dr Peatfield has now retired.

That's a shame for us! Is the office still open for referrals to his trainees, do u know?

pambusybuddha Biddy51

I'm sorry, but I don't know the answer for either of you. :(

Biddy51
Biddy51 in reply to humanbean

No worries I’ll look on line. I have his book.

Biddy51
Biddy51 in reply to humanbean

Is his practise still up an running?

humanbean
humanbean in reply to Biddy51

I don't know.

thank you...I'll look into mr Westfield depends where he is as the one I've tried to book is an hour away. I'll ring tomorrow and see how adamant they are for a referral plus I'll explain why I'd rather not have their negative letter and that I've got print outs of all my blood tests so we can start from scratch without any preconceived negativity.or like some have said maybe I'll accidentally forget my letter when I attend I have got an awful menopausal memory after all!!

If it was standard hypothyroidism I would just change practice but with it involving the pituitary I really think I need an endo

See above, he's retired apparently tho I do know he was training up some peeps once he stopped practising 🤔

I went private because I couldn’t make the NHS referral. I would of had to wait a further six months! I was at the end of my tether! I went to see "a recommended endocrinologist " in Oxford and I don’t think you definitely would of had to have a referral to see him. You could contact the Nuffield and make your enquiry. I think they have branches all over the country. I also went to see a private gynaecologist at the Nuffield who was brilliant. Yes you are right in the fact that with Hashimoto’s you need all your hormones to be right. I would say that Proff Wass wasn’t that forth coming on this and would advise to go well prepared. I was shoved on HRT tablets, which is not good. Only use patches with taking Thyroxine. Perhaps in the first instance going to see a private gynaecologist in a practise where there is an endocrinologist might be a better way around it. Good luck it sure is a battle through GP’s

thanks...dr mukherjee specialises in thyroid and pitutiary but also menopause..i don't want to start hrt until my thyroid is sorted hence seeing her for both issues..i don't hold out much hope as although her reviews are good we all have our own expectations and hopes so we'll see. I'm ringing them tomorrow and if I get round a referral I'm making the appointment for October fingers crossed ..did you find the symptoms of hypo and menopause were similar ?

I didn’t start to feel better until my hormones were right. They might sort both issues together. Good luck!

so would you say start my hrt and get my meno hormones sorted first then see about my thyroid?

Try and get them done side by side if you can. I’d say ultimately your thyroid levels are the most important. But can take a while to feel better.

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