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Your referral criteria rejection does not meet my referral rejection criteria

Copperfield

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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.

‘SO PLEASE JUST GET ON WITH YOUR JOBS YOU WORK AVOIDING EMBARRASSMENTS TO THE NHS, AND NO I HAVEN’T ACCIDENTALLY LEFT CAPS LOCK ON.

‘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)

  • Copied and pasted for my secretarial team....

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  • Abdo pain and bloating in a post menopausal woman - request for USS batted back due to a normal CA125. I don’t think that would stand up in court really do you?
    Maybe we should end every “referral” with JFDI!

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  • I cant wait to hear some more of these...

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  • These mindless rejection letters were a big factor in my decision to retire early.

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  • @ 10:11. This was a big reason for me to leave my partnership too. The increase in risk of having to manage patients that you either feel out of depth with or can't possibly manage in primary care due to age, illness, time restraints, workload implications, lack of continuity etc etc etc was too much for me to stomach. Its only going to get worse. It has huge patient safety implications.

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  • Brilliant! Spot on..

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  • I just ham up the symptoms so it meets the criteria.

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  • To Referral Rejector :NEVER, EVER REJECT MY APPROPRIATE REFERRAL AGAIN OR YOU WILL SUFFER CONSEQUENCES THE LIKES OF WHICH FEW THROUGHOUT HISTORY HAVE EVER SUFFERED BEFORE. I AM NO LONGER A HAPLESS GP THAT WILL STAND FOR YOUR WORDS OF REJECTION & REFUSAL. BE CAUTIOUS!
    Tic obvs ....

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  • CAMHS set a high bar for ruthless referral rejection which others now try to emulate.
    If CAMHS put the same time and effort they exert on callously bouncing our referrals into actually seeing suicidal children they would be the envy of the world, instead of the dangerously useless impregnable fortress they have mutated into.
    Still, I’m sure it keeps workload and waiting times down, so that’s alright then........

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  • My personal "favourite" from was the CMHT regarding a referral from the surgery after a patient's therapist had called in worried that the patient was at a high risk of suicide and required urgent intervention.
    The letter we were sent outlined the refusal to see him since the therapist had not contacted them directly and hence he couldn't have been at that high a risk.

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