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Independents' Day

The nine-step plan to driving a GP mad

Copperfield

1. Send out a memo to local GPs telling them that because of Covid etc etc, the system for requesting X-rays is different ie GPs should not send up patients with X-ray forms as per usual; instead, they should send requests electronically, with contact numbers, and the X-ray department will contact the patient with an appointment time.

2. Get the X-ray department to revert back to the original system a few weeks later without telling anyone.

3. At the same time develop a new default cut-off for non attendance for X-ray of six weeks.

4. Alert GPs to this by sending an X-ray report stating that because the patient has not attended for X-ray within six weeks, the request is now invalid and so the patient will need clinical reassessment and resubmission of X-ray form if it is still required.

5. At same time collude with rest of hospital to ensure that any follow up X-ray requirements post A&E attendance, inpatient discharge etc are delegated to GP.

6. Thereby achieve overall effect of giving GPs more work to do, which is then not done because the X-ray department the GP refers to is not sending out appointments, enabling that same department to claim that the patient has defaulted, and that the only way to rectify this is for the GP to re-enter this cycle of futility.

Ensure that any follow up X-ray requirements post A&E attendance are delegated to GP

7. Ensure that when this situation becomes clear and GPs are about to lose it, all three available telephone lines to the X-ray department are rendered useless by line 1 ringing endlessly with no reply, line 2 cutting caller off after three rings and line 3 inviting a message to a voicemail that is full.

8. Sit back and bask in the knowledge that, while GPs would currently be expecting an acute-on-chronic workload dump involving referrals not being seen, sick notes not being written, blood tests not being done, etc, they would not be anticipating anything quite as Geneva convention-busting as this.

9. Consider contacting colleagues in microbiology about a similar idea involving stool specimens.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield

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Readers' comments (9)

  • Have you tried getting making a dietitian referral recently? Their plan is even more dastardly:

    While this patient was on the hospital ward, the hospital team referred them to the dietitian. Unfortunately we didn't see them before they were discharged, so you (the GP) must now re-refer them to the community team (who are closed). Any referral that doesnt contain weight, MUST score and the reason for the referral (which we are not going to tell you) will be rejected anyway. The patient's daughter is livid that she is having to buy fortisips for her Mum and had lodged a formal complaint. You must not prescribe fortified drinks unless recommended by the dietitian who will not be seeing the patient.

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  • Get your community HF referral rejected because you didn't attach the Echo, which you don't even have! But they're dying, so we'll twiddle thumbs then.

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  • local hospital does near me consult then asks gp to arrange bloods x-ray and report back to them local x-ray refuse to do as no clinical info on letter round and round

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  • i put on the form "x-ray requested by dr (insert name) at (insert hospital). please refer to him/her as i do not have further information,"

    send photocopy (with name blanked out for data protection purposes (and also to make it more awkward for them)) to consultant and to hospital manager, together with snotogram explaining this ios a waste of everyone's time, for which THEY are responsible.

    send copy to patient with further (standard) letter explaining why IT IS NOT YOUR FAULT, and inviting them to contact hospital directly on (insert xray dept number).

    they soon get fed up with this.

    when the hospital phones the surgery to whine at you, they will be advised you are in the dealing with patients (reember them ?), and that you will ring them back.

    unfortunately, when you do, the "line was busy and i couldn't get through" etc etc etc.........

    rather time consuming initially - but i promise you it does workk !

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  • Mad? Or rationally, maybe thinking that a private service driven by profit and competition MIGHT be more efficient or patient satisfaction oriented?

    Maybe mad angry if you imagine YOU are the patient, and you've paid decades of taxes, to be f*cked about like this

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  • why can't patients book their own xray/scan by phone or online. works in other countries. you give them the form, they book. if dna they pay for the missed appt. simple.

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  • Nailed it!

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  • The other one is radiology constantly rejecting referrals for CXR and Abdominal ultrasound scans by saying “ not enough information “ - well the man is an ex smoker with SOB on exertion, weight loss. Swollen feet.? Malignancy? CHF.
    GP putting a stethoscope to his chest is not miraculously change the world but a CXR would!

    My other gripe is Two week wait referrals- which insist” rectal exam is mandatory by GP before referrals “

    Guess what if a patient has been bleeding PR , poor GP has no choice it’s a medico- legal case for not referring and it’s secondary care fobbing for referring.

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  • Richa Singh - spot on, your pt. clearly needs referral 2WR; PR by GP in thsi case will make no differnce to management, will not stop a referral regardless of PR findings and is frankly bordering on abuse to the patient . Time to re-think this - unless solid evidence shows addiitonal PR by GP pre-2week colorecatl refrral changes outcome significantly, there i sno need to do. For example, ee stopped doing coccyxgeal and toe # Xrays,for similar reasons (pointless and no evidence base).

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