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.
‘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.
And if they don’t respond to this, I send the angry version.
Dr Tony Copperfield is a jobbing GP in Essex