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Just who is the NHS working for?

In the potpourri of patients in my surgery yesterday, one was a retired GP.

He was most apologetic when asking me to write a private referral to a cardiologist, but that’s what his insurance company required.

He and his wife, a retired nurse, ‘wouldn’t be without it’. ‘Well’, I thought, ‘he should know’.

Then there was our lunchtime meeting, where one of the only allergy specialists in our region gave a talk. As her team looks after patients in Kent, Surrey, Sussex and Berkshire (for context, this represents half of the ancient Kingdom of Wessex, and there were only two kingdoms), it’s no wonder that a referral placed now wouldn’t be seen until June 2020.

This is nothing to be proud of, especially when set against her statistic that the UK features in the top three countries in the world for allergy incidences.

Add to that our inability to get hold of any adrenaline auto-injectors except Epipens (and that isn’t even enough adrenaline for the adult anaphylaxis protocol), all we could do was sit there and raise an eyebrow, or in the case of my colleague, joke about how Grazax to treat hayfever was ‘eye-wateringly expensive’. (Geddit?)

With this done and dusted, I strolled back to my room ready to tackle a referral for adult ADHD that had been sitting in my inbox for three weeks.

In a world of ‘computer says no’, writing makes no difference

It was rejected the first time round because there wasn’t enough information – my detailed referral letter was deemed inadequate. What I hadn’t done was tick enough boxes or complete enough questionnaires.

Listening carefully to the patient and judging that he was most likely somewhere on the spectrum and that getting a diagnosis seemed very important for him and his daughter wasn’t enough.

So an extra hour of admin was required, and I had to send the patient two self-reported questionnaires and then score them (but it can’t be too easy, just in case the doctor or patient are trying to play the system, meaning that questions 1, 3, 5, 9 and 10 are scored differently to the others).

Then I had to fill out some boxes about his functioning, considering I’ve only met him once, until finally, when all meaningful information had been reduced to a protocol, it was ready to go.

But that was followed by an additional phone call from a patient who had been booked into see a male colorectal surgeon, which ignored what I’d specified. She had phoned the hospital, but they had no record of the request. I’d written it, of course, but in a world of ‘computer says no’, it had made no difference.

To round off the day, I did a bit of social media surfing, and came across Dr Tony Goldstone, the BMA’s pay and pensions advisor, explaining at a Royal College of Physicians conference that only a tiny proportion of people truly understand the pension tax problem.

Not for the first time that day, I had to ask myself ‘just who is the NHS working for?’

Dr Charlotte Alexander is a GP in Surrey