Columnist Dr Copperfield responds to NHS England’s potential new strategy aimed at further increasing the use of A&G before GP referrals are accepted
Let’s be honest. The writing’s been on the wall ever since advice and guidance (A&G) was first dreamed up. Admittedly, those letters A&G didn’t initially seem to add up to much. But increasingly we’ve realised they were the start of a process that spelled AGONY. And that process has reached its natural and terrifying conclusion: mandated A&G for all routine referrals to outpatients.
This epochal change of gatekeeping the gatekeepers has so many implications, but one inevitable conclusion: GPs lose the major pressure relief valve in our system, and in doing so we also lose our minds.
Assuming that resistance will be futile, we’d be forgiven for running swivel-eyed for the hills. But wait, perhaps there is a glimmer of hope. Even the most rabidly anti-GP factions in the Government and secondary care would acknowledge that whatever way you dress this up, the loss of unhindered referral for a routine OPA is a dysenteric workload dump. Something has to give, and that something could be a proper reciprocal arrangement.
In other words, if they are going to weld metal bars across the entrance to outpatients, then we should use one of them to leverage something out of secondary care ourselves. After all, what they are clearly saying is ‘send less stuff’, and we could and should be able to apply this in reverse.
And that stuff we would bounce back – or better still, not receive in the first place – would be the usual litany of ‘GP to do’, ‘kindly chase up’, ‘repeat bloods in 2 weeks’ et al, which we have been fighting a losing war against for years. Now it really has to stop. If we are to act as pre-assessment registrars, we certainly can no longer be the post-discharge/outpatient community houseman.
So we lose some, and we win some. And at least we can now call A&G by its name – an Appointment Avoidance System. We can also spell that out for patients: the problem is the AAS. And that’s exactly where they, and we, will feel the pain.
Dr Copperfield is a GP in Essex. Read more of his blogs here
READERS' COMMENTS [6]
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Sorry disagree
We shouldn’t be taking something that is wrong to give back something that is wrong
AJ
Agree fully
Shared referral guidance eg Kernow RMS is s genuinely useful tool for systems
However any AAS (sorry a+g) system needs absolute clarity on who retains the risk?
It cannot be general practice alone
Not to mention the extra work
Just refuse to participate. Make it a collective action/semi- strike- whatever
Only one out of 3 of our local acute trusts offer a fit for purpose A&G service & where this works, it is OK but there is a limit to what you can put in an A&G letter & often the response is only one sentence. The others just send our letters into a black hole, as do our community & mental health service. These are the same services who fail to send us hospital discharges & outpatient letters, when the patients actually do get to be seen. The result is that we don’t have any clue what is going on & we need to employ a full time secretary to chase up repeatedly on these. The hospitals are running only emergency and 2WW services now & it seems that GPs are providing the outpatients service. It’s no wonder our patients can’t get an appointment with us.
It is work dump on GPs again. It is also passing and leaving clinical risk to us.
Just had an A and G from nephrology (3rd one on this patient as I finally asked for him to be seen) with 8 actions for me . I fear our colleagues in secondary care think that it is their job NOT to see patients but to make us specialists in all areas rather than generalists !