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A faulty production line

The grim reality of a very grim story


The grim reality of a very grim story – bureaucratic delays in accepting a GP referral being implicated in an adolescent’s suicide – is that this is just the tip of a depressing and dangerous iceberg.

Nowadays, it’s the norm for overstretched teams to set arbitrary hurdles to referral, or develop systems that seem desperate to keep patients at an arm’s length. They’ll call it triage, multidisciplinary working, enhanced information sharing or a smoothing of the patient journey. But GPs trying to steer the patient through this obstacle course know that, in truth, it’s just an overwhelmed system trying to find ways to cope.

Which is why, each day, we GPs face:

  • The horrors of ‘straight to test’, a relatively new phenomenon meaning the nearest my patient with diarrhoea and weight loss gets to a consultant is a masked man with a colonoscope talking to his anus, and the nearest I get to help is a letter saying, ‘No sign of cancer, back to you’
  • Well-meaning missives from noctors who don’t quite provide the specialist opinion I was seeking not least because, frankly, they’re not specialist doctors, and a specialist nurse may well know less than a generalist doctor
  • Coroners’ officers and safeguarding agencies who refuse to talk to us over the phone but instead use minions/messages to direct us to online referral forms, which take ten times longer and then don’t work
  • Mental health crisis teams/early intervention in psychosis teams/whatever the hell they’re calling the team to front the psychiatry service this week refusing to take our referral because the patient does not fit their whimsical, illogical and ever-changing criteria
  • Community paediatricians bouncing back our referral letters because their protocol, which, naturally, hasn’t been shared with us, requires a full school report before they’ll even consider it

And so on. But this self-protectionism of health professionals adversely impacting on us and the patient is not something I’ll get over sanctimonious about.

After all, when I looked in the mirror the other day, I saw, staring back at me, an advanced nurse practitioner and a pharmacist.

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 (14)

  • Bullseye as usual!

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  • Yes - brilliant and true

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  • We are moving closer and closer to a privatised health system. Need an urgent CAMHS assessment : wait 6 weeks For a letter directing you to 3rd sector organisations, or go private and see a child psychiatrist/child psychologist within a week.

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  • CAMHS needing referral from school nurse, when said institution may be half the problem.
    The total lack of the "clever doctors" who would take on a complex problem and find the answer, not a "service" that only looks at one thing.

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  • Privatization is essential

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  • David Banner

    The Child Avoidance Mental Health Service pioneered the modern phenomenon of referral dodging. Their unflinching devotion to diverting, rejecting and ignoring GP referrals was a genius move now being duplicated across a grateful Secondary Care. Kick out 80% of your referrals and Hey Presto! All targets met and boxes ticked on a shoestring budget with minimal staffing.
    It’s a shame this latest tragedy hasn’t hit the headlines harder. It seems many more children will have to commit suicide before any substantial improvement.

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  • The is not about trying to care for children. It is about being duplicitous, and trying to offshift work and blame to GP’s.

    Designing a form with no input from GP’s and then blaming GP’s if the form isn’t filled in correctly is frankly shocking.

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  • RCGP fails to lead on this as with most things. Why do we let other specialists dictate to us? We don't dictate to them. As a profession General Practice needs to show more spine and tell other professions what we are doing and deciding, not the other way around. We are professional push overs as our leaders wont stand up to their cosy colleagues in London. We need a few Churchill types leading us at present.... or possibly an angry hulk like figure ripping off his cardigan and flexing his muscles! :-)

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  • Time to do what the dentists did? The commissioners clearly only want face to face general practice as a luxury service. If we are to keep it mainstream and sustainable in the long run we should consider going private and making it affordable (ie similar cost to an annual phone contract, around £200 per year per individual),and letting the NHS buy however much provision from us that it wants (and can afford, at rates we set) for those who cannot afford it otherwise.
    Even the threat of doing this would cause panic and bring them to the table to discuss properly funding the GP contract.

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  • Once privatization comes all these forms will disappear. Smug comments about a GP's stupid referrals will disappear, substituting it with a thank you card. Guidance to save money will be substituted by real patient choice. Badly behaved children and poor parenting will suddenly not be a medical problem. ADHD diagnosis and medication will suddenly plunge overnight.....unless the benefits of getting the diagnosis pays more than the consultation or medication. Patient economics....NHSexit for professional freedom.

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