Consultants don’t need A&G to bounce referrals

Copperfield on how mandatory A&G is the least of GPs’ issues, as consultants can – and will – still bat referrals back to them

Of course, we’re all completely correct to be terrified of the ongoing A&G imposition, and suspicious of bland reassurances that it’s not quite the Armageddon we’re anticipating.

But I also think we shouldn’t forget that hospitals are already unbelievably proficient at batting back referrals to us – A&G leverage or not.

This was brought to my attention recently by a referral rejection so depressing that it would have had me begging my own GP to refer me to psychiatry for ECT but for the fact that it was psychiatry that had rejected my referral in the first place, so there was no point.

Obviously, by now, we’re all immune to low-grade risible rejections involving, for example, a patient’s borderline basophil count precluding them from a memory clinic assessment until it’s been, er, ‘treated’. The treatment here, in case you’re wondering, being contempt.

But, locally, the Department of Referral Rejection – currently the only functioning part of the NHS – has really upped its game. Hence, a dermatology referral for a bedbound patient bounced (after a year, obviously), because: ‘We cannot accommodate a bedbound patient in our department.’ That’s a department in a hospital, by the way, where I believe they already have a lot of beds. The corridors are full of them.

Or a paediatric referral for an ailing child with very anxious parents rejected on the basis that: ‘Your very full and detailed referral letter suggests you have done everything required here, and we see no role for our department.’ Possibly the first referral letter ever deemed too good to be acceptable, hence all my subsequent paeds referrals comprising: ‘Ill child, please see.’

But this latest example trumps even these masterclasses in referral rejection: a patient with a long history of severe, complex and refractory depression currently suffering a worrying, progressive escalation with suicidal ideas, tried CBT, various antidepressants at proper doses, yada yada.

Mental health team referral a no-brainer, right? Apparently not. The response I received, which sounds dangerously like a new policy, insisted that the patient had to be reviewed by the Community Mental Health Practitioner (CMHP) prior to referral.

Now (as I wrote in an exuberant email response) I don’t want to sound all arsey, and I’m sure CMHPs have their role; though being non-prescribing, non-Med3 signing and non-patient facing, I haven’t found it yet, what is clear is that their remit doesn’t cover seeing a patient where a GP with 37 years of experience, including a psychiatry post, has reached the end of the road.

That’s the equivalent of the crew of Apollo 13 being told to try the AA first.

As I pointed out in my response, if the patient was seen by a CMHP, he would simply be sent back to me for being well beyond the CMHP’s pay grade. And the fact that this is exactly what happened gave me no pleasure, but did give me a tension headache.

So NHS Mission Control, we have a problem. And it goes way beyond A&G.

Dr Tony Copperfield is a GP in Essex