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Picture this referral


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Dismiss this as the croak of a dribbly, drooly dinosaur if you will. But things aren’t what they used to be.

Especially with referral. I have just tried to refer a lady using our ‘mandatory’ system-embedded two week referral proforma. She’s had a few months of progressive back pain with weight loss, raised CRP, compression of thoracic vertebrae on XR, CXR fine, electrophoresis fine. Bony secondaries until proved otherwise, right, and primary unknown? (Feel free to claim a CPD credit at this point).

So her full work-up has to start somewhere, and I opt for orthopaedics, given the presentation and the X-ray. Can’t do. The only orthopaedics proforma is sarcoma. She doesn’t fit any ‘available’ two week pathway despite clearly needing urgent assessment. A beautifully ironic two weeks of going round in circles later, my loss will be A&E’s gain as, bereft of any better ideas, that’s where the orthopod I spoke to said to send her. Remind me again what we’re supposed to be doing about unnecessary emergency admissions?

It's almost a relief to hear that there are other maddeningly restrictive referral pathways available

Anyway, it’s almost a relief to hear that there are other maddeningly restrictive referral pathways available. Such as the scheme Up North whereby consultants are insisting on GPs providing photos of ‘query skin cancer’ referrals to help them to decide where to bestow their two week appointments. Obviously an outrageous slur on our clinical skills and another stupid bureaucratic hurdle etc etc. Except, actually, it’s not a bad idea, the only flaw being that GPs are even worse at happy snaps than they are at dermatology.

Then, to cap it all, yesterday I had my first referral request for gender reassignment from a teenage patient and his mother – presented with the assumption that I’d rubber stamp rather than explore the request. Though actually that came as something of a relief. I imagine he wants to become one of those trans people they have these days, and I know when I’m out of my depth. I’m guessing the referral will involve vast amounts of time, box-ticking and swearing, and who knows, a camera.

All I can say is, it wasn’t like this when I was a girl.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (7)

  • Careful or you might be hunted down for transaggression (regardless of your mufti)?

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  • mri spine?
    mcas spinal?

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  • Why don't they make gender reassignment
    a self referral number
    like self access physio

    Like termination requests I am not comfortable
    being involved in these in anyway

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  • Annoyingly gender reassignment clinics assume that gps will be happy to initiate and carry on prescribing their advised medications..

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  • Ironic... some are
    We are on the look out for FGM /
    Genital mutilation
    others want to get this on the NHS

    If the NHS will not provide safe circumscisions for religious grounds ..
    then transgender medication and operations should also fall under the remit of private care..
    in these times of financial austerity

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  • So true 4:46pm
    'Genital Mutilation' (by definition irreversible), is not something I wish to participate in.

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  • Let us medicalise everyone as if we are not busy enough. Statinise them, gender change them and what next? The minority gender bandwagon has caught on and I am already out of my depths with just female hormones, much less male to female or female to male hormones or somewhere in between genders. That is why we need specialists. Self referrals are needed as it really is rather pointless seeing GPs as we cannot cure them. I can refer them for counselling when they regret. NHS money well spent?

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