There's also a systems problem.
For instance, if you see NHS patients (through 'choose and book') at a private hospital, you have no choice but to ask the GP to prescribe. The private hospitals can't do NHS scripts. Seems rather stupid to me.
Another issue is drug budgets, secondary providers want as much as possible of the drug cost to come out of primary care budget.
In relation to referrals, for a long time we actively told NOT to refer directly to other departments other than for red flag symptoms. The rationale being that the primary care may not wish for the patient to be referred and they're the purchasers!
In relation to blood tests and ultrasounds, partients often prefer these tests done closer to home and ask for them. Indeed many GPs prefer that community diagnostic services are used in preference to hospital ones (often because they're running them).
Bottom line is that this is a very complex issue. To make out that secondary colleagues treat their primary care colleagues as some sort of subservient service does both group a great disservice.
I personally believe that this is primarily a systems issue and many of the systems are deliberately structured to shift work into primary care. The fact that resources haven't followed is down to short-sighted policies in the DOH.
What people say they're going to do and what they actually do are quite different.
For example UK doctors continue to grumble about their working conditions, pension issues, litigation, expenses, etc and say they want to take action but in reality only a minority ever do. Talk is cheap.
UTI causing bacteria can double every 20-minutes.
To delay treating a clinically apparent UTI seems contrary to both the SIGN guidelines and common sense. Everything we know about sepsis tells us that early treatment of infection is key. Furthermore, standard urine cultures are often so unreliable, it seems illogical to delay treatment waiting for one.
This latest advice from NICE strikes me as bizarre and inconsistent with most other advice....
I cannot believe that after the last DDRB report and the whole debacle with the junior contracts, the BMA is still engaging with the DDRB.
The DDRB is not an independent body and not fit for purpose. They produce highly flawed reports where the evidence that they themeselves present doesn't support their own conclusions. For the BMA to continue to engage with the body is royal stupidity.