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At the heart of general practice since 1960

GP to sort? I don’t think so

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This month, by way of a little variation, I am kicking off the column with a quiz. Would you:

1 Discharge a patient found to have liver metastases from an unknown primary, and a normal oesophago-gastro duodenoscopy/colonoscopy, back to his GP, because you only do gastroenterology?

2 Decide not to follow up a 23-year-old with a diagnosis of a TIA in your stroke clinic, on the basis that preliminary investigations in A&E proved negative?

3 Return a patient with a one-off BP of 160/90mmHg in the pre-op assessment clinic to the GP to ‘establish his fitness for surgery’?

4 Ask a patient’s GP to follow up a thyroid function test you’ve arranged and which you will forget to send him a copy of?

5 Fail to arrange anticoagulation follow-up for a patient warfarinised after an admission with atrial fibrillation, and instead bury something vague in the discharge letter, such as, ‘For follow-up in the anticoagulation clinic’?

6 Diagnose sleep apnoea in an inpatient via sleep studies and a specialist opinion, then, on the discharge note, ask the GP to refer the patient to the sleep clinic to see the very specialist who saw him in hospital?

The answers, obviously, are no, no, no, no, no and no. Which is precisely the sequence of words I use while repeatedly banging my head on the desk as I work my way through this catalogue of cock-ups.

I’ve stopped at six, not because I’m short of material but because I’m worried I won’t have enough column wordage left to convey how pissed off I am.

The common thread, of course, is secondary care. Or rather, secondary couldn’t-care-friggin’-less. Imagine this: that little collection of cases was, genuinely, this morning’s contribution. I could easily double that by close of play. So could my partners. So that’s 6 x 6 x 2 = 72 episodes of hospital f*ckwittery to manage each day in my practice. Per week, that’s 360. And as your practice is no different to mine in terms of the torture inflicted by its local centre of excrement, that’s 360 x 10,000 = 3.6 million discrete examples of dumb-assedness dumped weekly in our laps, and 3.6 million uses of words such as ‘GP to chase/follow up/sort’.

And I’ve only accounted for hospital dysfunction arising from written correspondence. There are also phonecalls, emails, requests via secretaries, messages via patients and so on. However it arrives, it inevitably comprises half-assed communication from hospital half-wits doing half a job. And it leaves patients up in the air and GPs in the crap.

It simply isn’t good enough. True, it isn’t new, surprising or easy to correct. But it is getting much, much worse – to the point that I spend as much time being an unfunded hospital lackey as I do being a GP.

I’ve tried writing to consultants and the CCG and I’ve tried the GP/hospital interface thing, but it’s as much use as a tissue in a tsunami. I’ve reached the point where I have a standard, ‘Would love to help but, actually, why don’t you get stuffed?’ letter. GP to sort? Sorted.

Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield

Readers' comments (12)

  • A wise member of the United States Marine Corps once said " kill ' em all and let God sort em out ." - he is now a principal in 111 triage

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  • just send it all back to secondary care.

    eventually a clinical director or CCG dogsbody will be down to pay you a visit.

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  • Yesterday this problem lead to a complaint for me. With an X-ray done in a&e requesting a repeat in 6 weeks for me to organise. When the patient turned up 2 weeks early they turned him away suggesting that he was in the wrong and he needed re-referring again in two more weeks. These systems of a department asking me to ask them for an investigation followed up by a further request for me to ask them to perform it two weeks later than they had originally booked left both me and the patient baffled. There is surely too much scope for error and a complete loss of common sense here. Perhaps reducing these ridiculous elements of NHS organisation could save money and reduce error. Re-introduce the fact that the patient is the person that matters!

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  • Lets add some more and see how far we can go!

    7. Refusal to r-admit lung cancer patient with pleural effusion to his neck 2/52 after draining because he has been discharged from the consultant's care.

    8. Asking me to organize carotid doppler - I don't even have access to this test!

    9. Specialist nurse asking me to organize HiB antibodies in the blood

    10. Out of license prescription for pregabalin liq.

    11. Titrate up allopurinol 3/7 after discharge (don't they know I haven't developed a biochemical analysis eye sight which determines the urate level just by looking at patient?)

    12. GP to sort cause of colostomy bleed, after being admitted with MI due to low Hb

    I could go on.....

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  • We should go on... give this link more examples and let us get heard for a change. We all have multiple examples of this problem, I think they should all be recorded in these comments.
    Come the revolution!!

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  • Patient admitted with LRTI under respiratory physicians and found to have a suspicious lung lesion on CXR. Discharge summary states, you guessed it, "GP to refer to respiratory team under 2WR". You couldn't make it up.......

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  • i must add on:

    18yr old female with ADHD discharged on concerta XL from paediatric team as she is now an adult. no adult service caters for ADHD in the local area and he paediatrician knows that : hence discharged to GP to look after the controlled drug! why not pressurise the CCG and stand up for your paediatric patients who you think have turned adult on 18th birthday?

    GP to f/u urine c/s: why not action the results as we do?

    letter from psychiatrist: can you keep the neurologist informed of the psychiatric care they are giving. why not cc the letter to neurologist?

    latest from A&E : can you consider SOVA alert for the pt! if you are worried about certain abuse please write your concerns directly: I am not a secretary.

    bounced all the above back to the Drs who wrote to me.
    slightly feel better now: thanks for allowing to vent my frustrations

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  • Pt with back, shoulder and neck pain - seen by a shoulder specialist in a general orthopaedic clinic - asking me to refer the patient to a shoulder clinic as a separate referral!

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  • Pt with chest pain - sent to cardiology.

    Cardiologist discharged to GP as non cardiac chest pain - refer respiratory and rheumatology for review.

    Then the rheumatology clinic said not a rheumatoid problem - send to pain clinic who are yet to see the patient.

    Pt seen in chest clinic and guess what discharged as not respiratory cause - GP to review.

    It took almost 1 year to get appointments and be seen, and still no diagnosis and pt left in pain and no treatment offered by any on the clinics seen so far other than simple analgesia and that hadn't worked.

    Back to GP - still no diagnosis and still unresolved.

    Where are the general clinics where complex patients were seen and sorted out if not geriatric.

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  • Admitted under gynae - disharged for OP pelvic ultrasound GP to chase results. Psych Doctor has concerns about welfare of children of patient see 1 week previously. Urgent call for duty GP to refer to social services. Patient referred to gastro for severe reflux - ph studies and manometry performed - GP to refer to upper GI surgeon for consideration of lap fundoplication. And the best - urgent message for duty GP to immediately fax 2wk chest referral to clinic as pt referred to another speciality for suspected cancer and supsicious lesion on CXR. Pt was actually in chest clinic waiting to be seen but they wouldn't see them until they had 'GP referral'!

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder