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Gold, incentives and meh

'All GPs should care for teens'

The story regarding hepatitis C and DNA rates at secondary care clinics took me aback (News, June 4). There are several issues to be raised in relation to this.

If the GP does the PCR and hepatitis C is not detected then referral is not indicated, only follow-up. If the patient regularly injects drugs or drinks alcohol excessively, what is the point of referral?

Many patients have had the experience of going to such an appointment only to be turned away.

These patients are very knowledgeable about the system and we must respect this. If they are not in the right position for treatment then they will not put up with the rejection.

However, I have found the biggest problem with DNAs is the patient address. These patients are highly mobile. Sofa surfing, care-of addresses and temporary accommodation are run of the mill. How do we expect them to turn up if, by the time the referral comes through, the address it goes to is an old one?

The majority of appropriate referrals will be on a regular script. We have organised with the hospital that they inform us as well as the patient of the referral. We can then give the appointment to the patient.

It has not stopped DNAs but it has certainly markedly reduced them.

The cost: the administration of two letters instead of one. A lot cheaper than a nurse chasing them up like truant school children.

Dr J McMurray



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