independent.co.uk/news/heal...
What do we think of this idea, good, bad, unworkable? Its an attempt to reduce long wait times and try and get people seen more quickly. However concerns have been raised about lack of capacity and staff.
GP's To Refer Patients For Tests Directly. - Thyroid UK
GP's To Refer Patients For Tests Directly.
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Sparklingsunshine
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TiggerMeAmbassador
Presumably the wait comes after the test when a Consultant needs to access the results before treatment as GP won't know which way up to look at the results? Will there be some kind of triage system to fast track people with the worst results?? The mind boggles 😵💫
Feels like building a dual carriageway to rush you into a grid locked city centre 😕
i assume the intention is to clear the 'nothing abnormal found' cases (which will be a lot) thus those people don't get put on consultant list, leaving more consultant appts free for the cases where something abnormal was found ?
Just seems a bit worrying when rather a lot of us have received the 'Normal' response to results only to find them to be far from... who is going to be checking the results?
The clinics simply won’t be able to cope with the numbers. Yes it looks good on paper but the staff will be overwhelmed by it. The new government like to talk the talk but they will soon have to rethink this. I have worked in a couple of busy outpatient clinics and you need time to get all the various tests in place you cannot rush people in for tests. What about the people who are on the two week fast track for suspected cancer will they have to compete with others whose treatment isn’t as urgent as theirs. I will be watching this with interest.
At our hospital where I work at whoever sends the patient for the test a Radiologist reports it and if there is anything then the Radiologist will email the secretaries email inbox saying REPORTS to be reviewed by a consultant ASAP then we pass it on to the consultant of the week
Interesting, so I wonder who picks up and runs with it, presumably the consultant's department but Radiologists report should at least show on patient records if sent to GP or does that not happen until after speaking to a Consultant?
The consultant of the week picks it up and if it's the GP they will dictate a letter recommending the next course of action
Yes that's right one of us secretaries will scan it on the hospital records.
Hospital records seem to run on a different system to patient access ones, so presumably still not accessible unless GP uploads?
As I understand, in England, there is little linking between hospitals in different areas, or between hospitals and GPs. You could end up in a hospital in a different area and they do not have access to the records at the first hospital.
In Wales, the hospitals all use the same system which is fully linked. And authorised healthcare people can access the hospital records for individuals but they are still not linked to GP systems. But there is no patient access to their own GP or other records.
There will always be exceptions such as when a system is changing - some might be ahead of others.
You would think this is key to getting the whole system working properly, saving time, money and lives🤷♀️
Are you talking about the NHS app?
Yes or SystmOnline which my surgery uses
No you can get blood test results but you can't get access like that. We are asked to send patient report to their email address and we are not allowed to unfortunately. You can have a copy of your medical notes but you have to put the request in writing. It's sad I know
Thanks, it really helps to understand the peculiar system 😵💫
Fully agreed.
And we have major issues if we move country. Even move nation within the UK. Yes, records can follow us in the UK but I am not convinced that any hospital records do so.
I can imagine us each having something like a USB memory stick. And everything can get stored on that. If travelling, working abroad, or emigrating, we can submit our records to the new healthcare system with that.
And, if we return, new records could be added to it from the foreign system and imported to the local system.
Of course there are security and privacy issues. After all, we wouldn't want the possibility of losing it. Nor of just anyone having access to all the records. But the basic idea seems reasonable enough as a start point for discussion.
We used to put old medical records on microfilm for storage. I wonder if they have now transferred them to computer files that would have been a big job. There were lots of boring jobs in medical records. I only did it when my children were at school because everyone worked flexitime in Medical Records so I could work hours that suited me.
Hospital records don't follow you....thats correct. Infact if you have treatment at another hospital out of your area the record from that hospital is not sent to your local or current hospital. I had surgery funded by my ICB but the local hospitals have none of the record or the GP. GP has several letters sent to them from the surgeon. Given it involved 3 surgeries over a 3 yrs period.....very little is on my record.
I had to wait 8 weeks to find out if my Cortisol levels were ok after having a bladder MRI. They found something just above my kidney. Luckily all was well, it still isn’t on my GP account, I just got a phone call from the hospital after having to chase it.
Jaydee1507Administrator
Just wondering if it will just move the bottleneck from the consultants to the scanners.
Do the scanners, MRI's etc have the capacity for this?
Nice idea though.
Do the scanners, MRI's etc have the capacity for this?
I’d say there’s definitely theoretical capacity as far as access to the machines goes—most hospitals seem to completely wind down their access to them in the evenings, at weekends and on bank holidays.
So the issue is going to be around whether you can get enough staff to operate the machinery—and then whether you can get enough staff to accurately interpret the scans etc. And whether you actually could get a patient to attend an appointment at 2am…
Plus of course there does need to be some downtime for machine maintenance.
Got a horrible feeling it’s going to be one of those, “We’re telling you to make this work living within your existing budget” initiatives—which surely isn’t going to work. And you can’t magic up staff from nowhere.
I’ve had a routine ultrasound scan on a Saturday, I was sort of worried when I turned up that it was a typo.
I’ve also been offered a routine ct scan on a Saturday, though was busy that day so went for one the following Tuesday.
I used to work for RCR and there is a chronic shortage of staff at all levels, particularly radiologists.
I think that might be changing, my son works for the NHS dealing with operating theatres and they are very busy, working over the weekends for elective as well as emergency surgery.
I had an ultrasound on my shoulder, non urgent, on a Saturday recently and I know someone who had an eye dept appointment on Sunday. Again just routine. I think the days on Mon- Fri NHS care might be over, at least whilst there is such a backlog of cases.
I’ve also had several hospital appointments over the weekend during the past few months.
One was a routine breast scan on a Sunday, and two were picking up heart and blood pressure monitoring equipment on a Sunday that had to be fitted. Also my initial sleep apnea appointment was on a Sunday.
My hospital have theur scanners running through the weekends. There's a shortage and much demand.
I had a bone scan. It was a 15months late. I did not need to see a consultant first. Referred by GP. I'm still waiting for the results 4 months later.......apparrantly theres a back log of over 4 months because they don't have the staff to analyse and write the results. By the time I get them they eill be at least 16months late.
Do I think this stradegy will resolve the backlog.? No! Not unless its staffed properly and there's enough scanners and enough radiologists to assess and write the reports.
My DIL 37 has a brain scan every six months to check growth of tumour already detected. Sometimes she waits three month for the results as there is no one to interpret them. There is a shortage of radiologists of all classes.
There's already a bottle neck to get a scan Jaydee. It's not just lack of scanners but lack of technicians and consultants to assess the results. I know because my scan was over a year delayed.....4 months on still waiting for results. Am told the second backlog is due to insufficient staff to analyse and write the reports.
Wez has a lot to do to address all of this.
Oh goodness I'm very sorry to hear that. Its worse than I thought!
Where I live in far NWEnglandseem to begetting this protocol already. Over the last 5 years I have had numerous ecgs, X-rays, echocardiogram, 24 hour holster monitor, tilt table tests and respiratory tests in a manner that in the first 4 egs never seemed to involve a hospital dr. except afterwards when they reviewed the results, but again passed me back to the GP without seeing me largely. But although tests/ scans could take a few weeks it was 2-3 months to get the results ie there are the technicians but not the medics to interpret results, so no treatment , or reassurance, till months later.
A friend of mine who thankfully survived a brain aneurysm a few years ago recently told me about the checks on his eyesight that he has annually (the aneurysm caused a detached retina). He said that each stage of the test was separated into multiple stages, he thinks so that it could be undertaken by the lowest grade of staff possible. But he couldn’t see how it could be cost effective overall and the disruption to his week was enormous, with him having to attend multiple appointments when previously it would all get done at once. That’s maybe ok if you’re retired but if you’re still working, how are you supposed to get the time off?
And as you say, it then took several weeks for the results to come back.
I get annual eye checks ie photographs of back of eyes for diabetes though have problems ( retinopathy, cataracts) so in fact have them every 3 months : I’m told we have a very sophisticated system that other regions of England don’t , and are being trained up to do. Two technicians one to do eye reading letters test and dilating eye drops , another to use camera. Last time a new second camera with better 3-D colour one…. Get results and next appointment within a few weeks. But never get to see eye dr, , which I would have liked to see with about 18 months of these extra 3 monthly appointments being problematic as I would have liked to have a discussion about whether I could do something about my them!
Believe me, even if you're retired, unless you live near the hospital, you will have to be able to afford to drive there, unless they send an ambulance. Either way, it all costs money. And being retired doesn't mean the retireee doesn't have obligations.
Hi Sparklingsunshine
In theory it's a good idea, I've lost track of how many appointments I've had moved, cancelled or ended up seeing a clueless registrar once I've been given a consultant appointment. It's no secret that a lot of consultants do private work and I think that has a knock effect with appointments being cancelled in the NHS. I worked for the NHS for a couple of years early 2000's in a back office function, it was widely known back then that clinics were cancelled as the Consultant was 'chasing the money' doing clinics in the private sector. So if you're concerned about you're health and visit your GP why should your health & life be put on hold because the consultant has slowed things down and maybe caused a backlog in the NHS for that health concern because he's chasing the money?
Maybe there should be rules where they're either NHS Consultants or Private Consultants? Employ specialised consultants that are extremely knowledgeable in certain fields where it might mean once tests are done the Consultant gives a clear plan and prognosis of treatment instead of being fobbed off with registrars who can't be understood or talk to you as though you're a completely different patient? In my experience with an RA & Endo clinic having phonecalls with registrars who don't have a good command of the English language, it's very hard to make clear to them they've got the wrong patient info and the wrong descriptions. Next thing you know you're discharged or put on back-burner and have to start all over again! This too causes backlogs. We need fast tracking for possible life threatening conditions or symptoms that could be cancer and stop all this cutting back to save money but not people's lives it's madness! No wonder a lot of Consultants have a god complex.
They do have a god complex because they hold your health in their hands and it is a power trip for them. Not all consultants are like this but there is a lot in NHS. My husband dealt with their demands all the time. In the 80s we both worked at the Royal Shrewsbury. Managers decided staff were eating too many chips in the canteen which wasn’t healthy so a new menu which had jacket potatoes and salads was introduced. No chips or greasy food I thought it was very tasty. However one top surgeon was not happy and my husband was summoned to his operating theatre. He shouted and wagged his finger at him and said when he was operating all day he needed his sausages and chips! My husband said he was quite intimidating standing there with blood on his gown. So the menu was changed back with immediate affect so Mr iamsoimportant could have his sausage and chips. In those day consultants were in charge not Managers. I think they still are.
Hi Lora7again
Thanks for your reply,
You are absolutely right that consultants are in charge!
To some degree they are but you will be surprised at what they have to comply by......Managers have a much bigger say than you think. I sometimes think that's why some consultants kick the can down the road so we get it instead......lolHaving said that I've met and been treated by some incredibly skilled and kind consultants/surgeons who have been lovely, consultative, reflective and left me in awe of their work. The gems are there. I've found the rude God like ones often not great at their jobs so I see that type of behaviour as a red flag!
Hi Sparkling sunshine, I work in admin for a university medical school. I'm pleased to see any money go into the NHS but have recently seen cuts and jobs lost at the med school.
We get thousands of applicants for only hundreds of student places. So many more students could train to be medical professionals if the med school had the capacity. Sadly the ability to run these courses is diminishing.
I recently had a bone density scan and the technician apologised to me saying it could take 6 months for my results to be analysed as two people had retired and there weren't enough qualified people to do the job.
I was lucky that my endocrinologist asked for my results to be fast tracked as he urgently needed to review my medication. It still took 3 months.
helvellaAdministrator
At its simplest, people get referred and attend their appointment. At which the consultant looks for recent blood test results which don’t exist. Hence they have to request blood draw and tests.
Although occasionally some test results could be back within the day (early appointment and willing to hang around for hours), almost always this requires a second appointment. With all the waiting for that to arrive. And the blood test results might be well out of date by the time that happens.
It always seemed fairly simple for a consultant to respond to the referrer (usually a GP, I assume) saying “Please run TSH, FT4, FT3, TPOab, TGab and FBC a few days before the appointment.” And, if the lab is iffy about doing them for a GP, make the consultant the requestor.
This trivial level should have been resolved decades ago. It doesn’t require anything complex. The difficulties are primarily the GP knowing what is needed, when, and doing it. Plus, possibly, some aspect of funding for the tests - out of which budget does the lab get paid?
If this is being addressed, I applaud. But until we know more detail, it seems impossible to judge.
I you are right helvella
Please phone Streeting and tell him you have some suggestions
I am sure he will listen to everything he has to say. Have you listened to this man his only experience is he was a patient of the NHS. He has no idea how the NHS system works he needs to appoint an ex consultant to oversee this
Here is Wes Steeting bio
Rosena Allin Khan is a Labour MP and doctor. Whilst she might not have the time or inclination to be Health Minister she could at least advise.
I don’t trust any of them they don’t have the experience to run the NHS imho
Ministers in every dept. have very many advisers and consultants. Being a patient with a brain and some good ideas is probably ideal, I'd have thought. This forum is full of such people. 😀
When I visit the vets ( with my dog!) they order tests,x rays, scans etc and the results are available the same day and treatment commences the same day.
So I don't see why a simplified system that enables doctors to order tests shouldn't work too.
OK some conditions will require specialist treatment but 80% won't and can be dealt with quickly by a GP. The remaining 20% can be referred to specialists who aren't clogged up dealing with the 80%.
Can the diagnostic facilities cope? I don't know - but if this becomes the rate limiting factor then clear it. The vets can advise - I'm being serious.
Not sure how new some of this is. I was referred on a two week cancer protocol recently and received a scan appointment in days plus quick follow-ups. But for non cancer it may be an improvement. Will scans and tests then have lengthy waits and no one to look at the results? Just get a GP appointment ............
I have limited experience of private healthcare for atrial fib and they seem to manage to arrange an echocardiogram to be done immediately before the consultant appointment (ie 5 mins before) and blood tests just before cardioversion (again when attend for procedure) so it does not have to be a multiple appointment process. Or could be arranged in advance by g.p. if they are told tests to order
Not all blood tests can be done within hours - even if they can do the blood draw and commence analysis immediately.
We quite often see people receiving their results in what appears to be random order. I suspect many of the labs from which members get private blood tests simply defer the earliest results in order to avoid them arriving in dribs and drabs and customers asking why they have not received them all!
In the NHS, quite a number of blood tests are transferred between labs within an area. This avoids the costs of setting up every lab to do every possible test.
Yes, GP needs to be told which tests, and the lead time required to get them analysed and results arrive with the consultant.
Indeed I was only using that one small area as an example of a well oiled process. But with a bit more forward planning, it could result in a more efficient system in the NHS for other conditions/ specialities too. Doing the tests that are needed before an appointment is only common sense and not too taxing to plan a schedule of required tests/ time for results before seeing a specialist.
I'm currently seeing an private Neuro Otology specialist for tests for ear/ balance issues. All my tests and they are extensive, including MRI, hearing, posture and balance tests will be concluded by 13th Jan.
I saw the consultant on December 23. If it hadnt been for Xmas then it would have been even sooner. That is the difference between NHS vs private care.
Sounds good but in practice I'm not so sure. For instance, you get your direct GP referral MRI, it's reported as 'normal no further action'. What next? Your GP (Jack of all Trades) won't have the experience to look deeper and as your scan was normal will likely not refer you on to a consultant at that point. Scans are read and reported on by radiologists, and sometimes they miss things. If you had a consultant on board they may well look at your scan themselves and pick something up or if an initial scan is clear decide to go down another route of investigation/imagining. Sometimes it takes and Multidisciplinary Team to work out what's going on.
Another issue is that sometimes variances are reported on by a radiologist. They may or may not be relevant, it's the bigger picture that needs to be considered. It takes a consultant to look at this, in conjunction with your history and symptoms to decide what a scan is telling them. Scans are not always black and white - normal vs abnormal. Can a GP follow up on these types of scans?
It sounds like time would be saved but does your GP have the knowledge when to send straight to scan or when to send to a consultant? Plus, without the resource for more doctors, consultants, equipment, appointments, this plan is just a different route into a system that cannot keep up anyway.
Does this leave the already overworked time-pressed GP with more decisions they cannot handle? To me, this plan is not a clear-cut win. Beneficial in some cases and detrimental in others.
Seems to me that that happens even when you have a Consultant. I've lost count of the number of times I've been discharged from care, cos the test the Consultant insisted was relevant, came back as negative.
The new proposals sound ridiculous (especially if you have no faith in GPs) but SOMETHING has to change, and if NHS is broken, there is no point in continuing down the same road.
Indeed and this will get worse if the GP is reading the results! Agree, a proper reform is needed not a Band-Aid to shift responsibility.
It’s propaganda., in the main. A blanket statement, designed to grab the headlines and placate voters.
The referral and testing protocols across medical disciplines is immensely complex, involves many layers of expertise, and at the moment prioritises life threatening conditions over quality of life.
That’s why you can wait years for a hip operation - because arthritis per se won’t kill you - but you will see a consultant within 2 weeks if you have a suspect skin lesion - no matter how tiny.
When I was diagnosed with breast cancer, I saw a consultant within 7 days of the biopsy and at that appointment he gave my surgery date, which was 5 days later. It was a faultless protocol.
By contrast, since May 2023, it has taken till now (tomorrow in fact) to get an MRI , a SPECT CT scan and see a Consultant about an orthopaedic problem which severely impacts my QOL.
In the system from both ends, I couldn’t suggest a solution.
And god help us when the assisted dying lobbyists get involved in the debate.
Good idea. Then the consultant, will have the information to make the correct diagnosis and treatment plan. Just the issue of test capacity to address, which I believe is being by the allocation of more resources.
To give a personal example, on 3rd december my gp thought I needed an mri. The 'consultant' appointment took fourweeks, confirmed i needed an mri. Requested MRI is scheduled for 3 days later. The potential condition I have benefits from early intervention and the wait for a consultant caused a four week delay.
First off, I’m in the US. When I had a lingering cough, my nurse practitioner sent me for an Xray - same day (a Thursday).Before I left the imaging facility, the front dest caught me to say I had an appointment for a CT scan the next morning. (A radiologistmusually does a quick read before you’re out of the X-ray room.) CT next morning - I was in a pulmonologists office the next day, sent to the cancer center to see several docs right after the weekend. Had a biopsy on Thursday (one week in), on Monday next I had a temporary line and started chemo.
Without the imaging ordered by my NP (not a doctor) it might have been several weeks to see the first specialist - who would have ordered the same tests.
Patti in AZ
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