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At the heart of general practice since 1960

It's an obstacle course

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Wondering why there’s been a reduction in hip and knee replacement surgery? Here’s a clue. It’s not because patients are getting less demanding or less obese. Nor is it because of the vast range of pharmaceutical options currently available to us, which start with topical NSAIDs and end with, er, topical NSAIDs.

No. The explanation is this. To achieve a TKR, say, the following must happen.

1. My referral must fulfil the increasingly draconian criteria of the service restriction policy, ie the patient must be slim, fit, motivated, compliant, toned by physiotherapy and suicidally pain-addled.

2. My letter must be detailed and compelling enough to satisfy the referral review panel, ie the patient has knackered her hips/knees running marathons for charities which aim to ban the clubbing of baby seals, and wishes to be pain-free and mobile enough to be able to visit her leukaemic grandson in Australia before it’s too late.

3. The patient must successfully negotiate the inevitable diversion to a physiotherapy limb practitioner who will simply repeat all the assessments and therapies she’s already had and who will then say: ‘See you GP for a referral to the orthopaedic surgeon’, which is what I’d asked for in the first place.

4. If the patient somehow escapes from the Kafka-esque loop of 1-4 above, she must not be put off actually agreeing to the operation by a surgeon who seems to equate ‘gaining consent’ with ‘scaring the bejesus out of’.

5. My patient must avoid dying during any of the above.

In short, to get anywhere near a knife and a prosthetic joint, they have to get through a gruelling obstacle course. And who could do that with those knees?

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.

Readers' comments (9)

  • You forgot negotiating preassesment clinic and isolated raised bp.

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  • You also forgot: "this patient DNA her appointment and according to trust policy will be not be seen again without further referral"......But the patient never received an appointment.

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  • Incidentally, the raised BP will have been taken just after the Consultant scared them witless. And the patient will have been offered a slate full of meaningless statistical data which infers that the surgeon themselves is less capable than the norm.

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  • Our CCG wants us to use the Oxford Hip and Knee score where referral to surgeon is suggested with a score 20-29. We are told to refer only patients with scores 20 or below. we obviously discuss pros and cons/relative risks prior too referral but many deserving patients are being denied access to appropriate treatment.

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  • You could of course fill in the Oxford questionnaire for them...

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  • And the other game of seeing as a new referral, scaring them off surgery and discharging them with the GP to refer them back if they change their mind. Yippee! Another new referral

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  • and I thought this only happened to me... Thanks guys, I feel so much better now that I know we are all sharing the sme pain! Happy Christmas to all my GP colleagues out there, I appreciate you even if the government doesn't

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  • And if the surgeon leaves, before the procedure, after giving the OK ! Do we do heirs and successors in medicine !

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  • I am that slim, fit, motivated and compliant patient. It took 22 months, less 3 days, from when I tore the meniscus in my knee until I got my lovely new metal one. I am so thankful I can walk out the front door now, without waiting for the codeine to kick in, without strapping on the TENS machine under an elastic support, and without collecting the stick. Please don't let the bureaucrats grind you down!

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From: Copperfield

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