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Phil Peverley: Perverse referrals game

Do you have a patient you want seen quickly at outpatients?

Do you have a patient you want seen quickly at outpatients?

I'm not talking about a suspected cancer that could be seen under the two-week rule, but a patient with a chronic, serious condition who needs specialist help, but who you know would have to wait ages.I'm going to give you a valuable piece of advice. This actually works. I hesitate to share my wisdom with the rest of you, but I'm going to trust you not to abuse my discovery. Don't use it too often, though otherwise the powers that be will be on to us. Write your letter like this.

Dear Doctor Bones,

Mr X has got terrible osteoarthritis of the knees. He is in considerable pain, has poor mobility, and his life is a misery. I feel sure he will come to bilateral knee replacement eventually. I would be grateful if you could offer him an assessment. NB; please do NOT offer him an appointment during 15-28 February as he will be staying with his daughter and will not be able to attend.

Yours faithfully.

The bit about staying with his daughter is, of course, a black lie. Make sure you specify his period of 'unavailability' is just a few weeks in the future, then sit back and wait for a super-prompt appointment for a date during that period to arrive on his doormat.

This is not a joke. This is not satire. I have used this technique twice recently with excellent effect. Our local hospital is obsessed with waiting list targets, and will use any subterfuge they can think of to avoid seeing patients and keep within targets. Offering appointments the patient cannot keep is just one of many weapons in their shoddy armoury.

I found this out by accident when two patients of mine, with legitimate reasons to be unavailable on certain dates (students going home for the holidays) were offered appointments right in the middle of the dates when I had specified they would not be available. In years past I might have been shocked by the hospitals' calculated dishonesty, but now I'm cynical enough to keep schtumm and use my knowledge for the benefit of my patients.

This is the difference between us and them. The New Labour apparatchiks of the NHS bureaucratic machine care only about targets and goals. We, the old-fashioned GPs who see our patients' pain on a daily basis, still care about getting them the treatment they need. Our role is being systematically usurped.

While those who work in walk-in centres, nurse-led clinics and out-of-hours centres might well try to do their best for the people they see, one thing they cannot do is act as an advocate in the patients' best interests, over the long term. No one knows our patients like we do, and over the years, we get to care about them. We can't help it.

I am now convinced that, as a profession, our days are numbered. This is bad news for us, obviously. But it's even worse for the punters. In this Brave New World, who will try to beat the system for their benefit? And when you get old and retire and need care yourself, who will do it for you?

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