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GPs go forth

Your referral criteria rejection does not meet my referral rejection criteria


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So, to continue my occasional series of useful proforma letters to be employed at moments of maximum enamel erosion, I present this: a measured response to the increasingly frequent, ‘This referral does not meet our service criteria’, as employed with maximum blithe disregard for doctor and patient, by CAMHS, dietitian, memory clinic, mental health crisis team, Early Intervention In Psychosis Team, community nursing, chiropodist, undertaker etc etc.

‘Dear whoever,

‘Your recent letter stating that my referral does not fit the criteria for your service does not meet my criteria for a sensible letter.

‘Basically, I don’t care what your service criteria are. My ethical, clinical and contractual obligation is to refer patients to you, and if your service criteria excludes them because they are too old/too young/too fat/too thin/too mentally ill/not mentally ill enough and so on, then not only are you faceless, bureaucratic, workshy and discriminatory, you are also taking on any medicolegal liability should it all end badly, in which case I will point at you and laugh loudly.

If they still don’t “fit” your precious criteria, then please change them or your criteria until they do

‘So I’d suggest you see the patient, make a proper assessment, and if they still don’t “fit” your precious criteria, then please change them or your criteria until they do, or send them on to a service which is actually willing to help.

‘If this requires you to repeatedly punch yourself in the face until you see sense, go right ahead.


‘If I can be of any further assistance, please don’t hesitate to sod off.

‘Kind regards,

‘Dr Copperfield.’

And if they don’t respond to this, I send the angry version.

Dr Tony Copperfield is a jobbing GP in Essex

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Readers' comments (14)

  • Brilliant. Clearly from an experienced GP that actually sees patients. I have the same problems here. New thing here, even bleeding in early pregnancy if deemed too early they will not see them. Do not send them to A+E we are told but the patients have to go somewhere.

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  • Rogue1

    Brilliant. Do I have your permission to forward this to my secretary so we can send a copy when necessary. Many thanks in advance.

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  • AlanAlmond

    Yes I think the answer is to lie in your referral letter so they meet what ever criteria they impose. If you judge they need review then they need review. Referral criteria have no legal basis and can be shoved up the collective jacksie. Just bullshit and prevaricate if they question you later, and lie some more. You have to do what you have to do in the interests of common sense and before God.

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  • doctordog.

    Have lied on referral forms a number of times, which have on occasion produced an early and life saving diagnosis .
    My conscience is clear.

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