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A faulty production line

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When a contract isn’t a contract


As I wrote my comment under the original article of this matter(with expletives): (1) The GP hospital referral system has become an egregious caricature of itself; (a)Enormous number of GP referrals are being rejected and bounced back everyday( we already have stories of two teenagers who died during referrals to children mental health services) . (b) It is getting more unpredictable and user-unfriendly as far as electronic referrals for patients are concerned. The risk of failing to get the referral through increases as the referral process becomes more and more cumbersome. (c) Then one has this highly suspicious incompetence of mislabelling patients as ‘DNAs’ (of course , benefit of doubt being reserved as some patients DNA without good reasons) and immediately discharging patients back to GPs , incidentally against the hospital contract with NHSE as reported by Pulse . (2) Incompetence is worse than malevolence. I am questioning the intentions , conscious or unconscious , of NHS England on this matter , especially not too long after the infamous resignation of Dr Madan( I called it Madangate) .Am I right to say that the consequences of this totally dysfunctional referral system include driving a big wedge between primary and secondary care in NHS ? Do not forget that the new ideology of PCNs is also about developing integrated care systems (ICSs) with multiple integrated care teams (ICTs) ; PCNs/GPs are supposed to form alliances with their local service providers where acute trusts/hospitals are ‘big players’ . The harm and hypocrisy of this referral system is already well rooted before one can consider any ‘integration’ . Based on the trilemma theory , the system is totally obsessed with ‘integration’ while it is willing to sacrifice either democracy or sovereignty of both primary and secondary care . (3) We are heading towards a historic Christmas general election (incidentally on my 20th marriage anniversary!) , the political fiasco goes back to the starting point : Brexit or no Brexit , hence , sovereignty together with democracy but no integration Versus integration with sovereignty but no democracy (could be with democracy but no sovereignty in some instances ). It is ironic that we have a similar mess in NHS between primary and secondary care under the watch of this government and its Ministry of Plenty .

Posted date

30 Oct 2019

Posted time