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Independents' Day

GPs should have right to contact consultants directly, Government review finds

GPs’ right to pick up the phone and freely communicate with consultants should be protected, concludes a Government report that found evidence of hospitals ‘gaming’ the system to boost the number of appointments patients were expected to attend.

The review from the Cabinet Office found that patients were being inconvenienced because the lines of communication between medical professionals were not being preserved and called for this right to be protected by regulators, or enshrined in the NHS Constitution.

It also called for patients to be given the right to consultations by Skype, if GPs agreed, and for patients who move house to have the right to remain with their GP practice, irrespective of catchment area.

The review was commissioned to look at the barriers to patient choice in the NHS and found that hospitals favoured face-to-face appointments and were discouraging phone and email consultations - for which they received less revenue - even if this would save time and the patient would prefer this type of consultation.

It also found evidence that one hospital banned GPs from talking to consultants in case they discouraged them from arranging an appointment with a patient, when a quick phone call might save both patients and doctors time and create more capacity for the NHS as a whole.

The review was led by former Liberal Democrat candidate Mr David Boyle, and included roundtables across England, a call for evidence from stakeholders, a literature review and a survey by Ipsos MORI.

The review found about 36% of the population still found exercising choice difficult and that patients without internet or a car were ‘doubly disadvantaged’. Choice in healthcare was more accessible to the educated, confident and articulate, the review found, with women, non-white patients, renters and the unemployed identified as the groups most unable to exercise choice.

It recommended that hospitals were prevented from ‘gaming’ the system in order to increase their income.

It said: ‘Long term hospital outpatients are often expected to travel to see their consultant at regular six month intervals when they are quite well, but are unable to see them when they really need to.

‘Some kinds of behaviour may also need to be ruled out by NHS regulators under the NHS constitution. In particular, free communication between doctors and patients and between professionals, needs to be protected.’

After the review heard of perverse incentives such as hospitals gaining revenue by referring patients back to their GP rather than straight on to a specialist within the hospital, or booking patients into phantom appointments which are later cancelled so as not to breach waiting time targets, an evaluation into the prevalence of gaming in the Choose and Book system was also recommended.

The review recommended that patients who move house should have the right to remain with their GP practice, irrespective of catchment area, though said that decisions about this issue would need to wait until the results of the GP Choice pilots were published.

It says: ‘Consideration should be given to drawing up town or city specific catchment areas for this purpose while lessons from the GP Choice pilots are being learned.’

Where both sides agree it is appropriate, patients should have a right under the NHS Constitution to ask for consultations with GPs using a range of communication methods, such as telephone or Skype, it added.

Dr Peter Holden, a GPC negotiator and a GP in Matlock in Derbyshire agreed that GPs should be free to talk to hospital consultants.

He said: ‘GPs need to consult with consultants as much as patients. The pen pushers should stick to pen pushing. Managerial greed is inappropriate to come in the way of healthcare, and that is what this is: managerial and trust greed.’

He added that the proposals for removing all practice boundaries were unworkable.

He said: ‘What the policy wonks don’t understand is that there is a good reason for boundaries. If I’ve got a patient 25 miles away, then going to visit them will take time and degrade the service for all.

‘General practice is a team activity and I might require the opinion of a team member who may not have the geographical freedom a GP has.

‘The bottom line is that choice costs resources and implies a surplus of resources which currently the NHS just doesn’t have.’

Readers' comments (12)

  • Common Sense for GP's to contact Cons. direct and also to increase the number of Consultants, as too many Sen. Regs.await dead men's shoes. ?
    "Jobs for the Mgt boys (without any care qualifications)" would become obsolete, so there is the funding.

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  • As a GP I would welcome the opportunity to have better access to Consultants. However, Consultants, like us, have a soaring number of responsibilities and time pressures and this needs to be done in a careful way that respects their workload. I also suspect that hospitals will want some kind of tariff for things like telephone or email consultations.

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  • As a consultandt I often find is very useful to talk to GP colleagues. I'd be happy to expand this service, but clearly it should be properly costed and funded, I would agree this could save patient's time.

    Equally, it can be very challenging for us to try and phone a general practice. We have no dedicated phone lines, so we get put in the patient queue and fobbed off by stroppy receptionists, or find the surgery is shut from 11am, or all the GPs are too important to come to the phone.

    We are all busy clinicians, who could be more flexible in dealing with each other

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  • It is heartening to see that there is "talk" of addressing "the[truly] perverse incentives such as hospitals gaining revenue by referring patients back to their GP rather than straight on to a specialist within the hospital, or booking patients into phantom appointments which are later cancelled so as not to breach waiting time targets". I recently took issue with a consultant Orthopaedic surgeonat a local hospital because he reviewd a patient of ours at his clinic and discovered that the patient had post -operative infection [following his own surgery] and advised the patient to contact his GP to be re-referred back to secondary care.Admittedly this is a more extreme example of such truly perverse practice nevertheless it is now very rife.It is hardly any wonder that the cost of care in secondary care continues to soar. One can only hope that our secondary care colleagues refuse to bow to pressure to participate in this despicable practice

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  • Hold on guys, we've been bulldozered over a more important issue here.

    GP to keep Pt who moves out of the catchment area? Hold on, I'm not about to start visiting patients who are 40-50min away. I hope they realize this means I could spend 80-100min on the road (there and back) just to see one patinet. Are they going to fnd this? I doubt it, it will just be "cost absorbed by the GPs"

    P.s. I hope annonymous consultant @ 10:58 realizes GPs are often in clinic with patients booked every 10min (average consultation length few years ago was 12min/patient) with visits, telephone consultations, letters (i get about 150/week), results (ditto), prescriptions (about an hour's worth each day) as well as guiding my nurses, receptionists, business decisions and now comissionning. That's why we can't pick up the phone at the moment of your call. Perhaps if you left your personal number with us (consultants seem not to do this, I only ever had one consultant who was happy to disclose his number), you might have a better chance of getting it touch.......

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  • To anonymous 12:18

    Touché, my friend, when you ring me. That's why it needs to be properly funded so that time can be ring-fenced.

    I don't doubt we are all working under extreme pressure and that hampers communication. But it is equally frustrating when we ring you to be told you're 'on your day off', 'not back in surgery till Friday' and 'no, I can't give you her number'. This was today, when ringing back a GP who had requested the call!!! What a waste of my time

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  • GPs do have the right to contact consultants. It is protected under Article 10 of European Convention: Freedom of expression.

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  • Of course, GPs have the right to contact consultants. It is protected under Article 10 of European Convention on Human Rights: freedom of expression.

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  • I have communicated with consultants on a number of occasions where I think some expert advice would obviate the necessity of a formal referral. I do this by e-mail which has the advantage of succinct communication at times to suit both parties.

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  • Of course GPs should consult 'amenable'Consultants by phone. In my specialty of Acute Medicine I would advise appropriately from: simple advice to GP, see patient in MAU, See in rapid access medical clinic, see at home or see PP, ie whatever is most appropriate or wished for by the patient. In most cases I would endeavour to see patient myself. I speak as an experienced Generalist who believes in doing what is in the patient's best interests( not the hospital's or mine). All the above are easy to carry out.

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