Columnist Dr David Turner had vowed not to complain about secondary care this year, but another patient referral saga put his resilience to the test
We are only eight days into 2024, and I have already broken my New Year’s resolution.
Admittedly, it was nothing too serious, and I had not really expected to stick to it for one month, let alone 12 months. Still, I thought I could have done better than eight days.
As I had spent much of 2023 moaning about secondary care, I had hoped not to do the same in 2024, especially in my first blog of the year. But I’m afraid that this is a pretty big moan – if I’m honest, it’s more of a leg-being-amputated-using-a-blunt-saw-and-no-anaesthetic type of scream – so here goes.
A patient with a few weeks of abdominal pain and Hb of 7.5 was referred under the two-week-wait referral to the colorectal team. So far, so good. They were then seen by a specialist nurse in the colorectal team who called the duty GP (luckily for her, it was not me) and said that they could not do a colonoscopy on a patient with Hb below 8.0 – the GP would need to arrange a blood transfusion, then refer the patient back to secondary care.
In response, the duty GP quite rightly said that GPs do not usually arrange blood transfusions and she had never arranged one in her 20-year career. The specialist nurse replied saying that there are many things she too had never done before, and slammed the phone down.
The GP in question called the switchboard of the hospital. As this took place a few days before the Christmas holidays, she thought it needed to be sorted as a priority and asked to be put through to the on-call haematology consultant or someone else in their team. The switchboard operator said that as there had been ‘too many GPs calling’, NHS management had advised them not to put any GPs through to a consultant or any member of their team; instead, they should be redirected to the Consultant Connect App. This is what our GP did, but she was advised by a consultant that it is for general advice only and they have no admitting powers for patients.
Back to the drawing board, and eventually – by means of a very tortuous route, and by using all the guile of our secretarial team contacting the haematology secretaries – a referral to the haematology team was made for the patient to have a blood transfusion.
The saga did not end there, though. The patient’s bloods were done before the transfusion this week and the Hb was now 8.0, and yes, you guessed it, haematology do not transfuse patients with a Hb over 8.0. Having said that, they did helpfully suggest that the patient would benefit from an iron infusion, and yes, you guessed it right again, the GP would need to refer the patient back to them for this procedure.
I do not have the energy to make any suggestions for improvements here, we are past that. But if the NHS were a dog, we would call in the vet to organise a ‘nice long sleep’ and buy a new puppy.
Oh, by the way, Happy New Year!
Dr David Turner is a GP in Hertfordshire. Read more of his blogs here
READERS' COMMENTS [6]
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That is an atrocious waste of GP time.
Sorry, only GPs are allowed to do euthanasia, and you will need to refer to the correct department for a pet replacement : however, since there are two many dogs in the country already, we suggest you refer to the feline supply department, ensuring that you have first checked on the availability of local accomodation, and issued a prescription for food supplements and kitty-litter, as secondary care can not take on responsibility for supplying these.
I’m a GP working in a different part of the country but a similar situation has happened to me. I was told that all blood transfusions and iron infusions are now shared care with GPs which means that the GP organises them. Unfortunately, the woman in my case who went on to have the transfusion in hospital had an adverse reaction. The hospital phoned me working in a practice several miles away to ask me what I was going to do about it. Frankly, it is unsafe for GPs to be responsible for organising procedures done in hospital other than blood tests and x-rays. Since when could shared care agreements be set up without the agreement of the other party involved? General practice needs to stand up to the increasing tide of work being sent its way. How do we do this instead of just complaining about it?
Apologies for flagging accidentally the first two comments on this feedback – it is not clear how I post to reply, and I’ve never done so before!
Another service pathway ‘redesigned’ (unilaterally, without notice or consultation with GP) rendering it practically impossible to access; making it less safe; jettisoning any proper clinical responsibility or senior oversight from the provider; involving significant and inappropriate attendant transactional workload all dumped in the GP’s lap; and usually the ultimate outcome is a denial of care or a rejection (and a massive headache). I am sure we have all pointed out numerous similar examples to the commissioners and providers…
We all know whose fault this is don’t we? So I’m about to break MY New Year’s resolution as the emotional tension caused by keeping it inside is putting my blood pressure up. So… FUCK THE TORIES, and do it so hard that they never get up again.