I write with regards to the anger poured out in the last issue of Pulse regarding how our referral letters are triaged.
I completely agree with Dr Clare Gerada that we should reflect on and manage our referral letters through in-house audits and peer review rather than a protocol or a guideline-driven process that does not take into account the many external and not-so-obvious factors that make a GP decide to refer a patient.
All referrals deemed inappropriate should be fed back to the referring clinician with clear reasons and the patient should be seen unless the referral is better managed by another speciality, in which case it should be redirected.
It is not just the managers but also the clinical staff and, in some cases, consultants who decline referrals based on a letter and guided by their own protocols.
And why only blame them, and not also our commissioning colleagues?
A GP has made a decision to refer a patient and this should be respected in all cases. Sadly, we cannot capture our entire holistic approach in a referral letter. Will our commissioning colleagues care to look at this issue?
From Dr Kamal Sidhu
Peterlee, County Durham
