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Straight to detest



I hate a lot of things, but what I currently hate most is ‘Straight To Test’. Or, if you must, ‘STT’. Assuming this initiative isn’t just another punishment inflicted on Essex for being Essex, then you’re suffering it, too. If not, you soon will.

STT does what it says on the tin. You refer patients on the two-week pathway and, instead of having a consultation, relevant tests and a follow up letter/appointment, they receive a phone-call (from a nurse specialist, obviously), the relevant tests and then, unless there’s a barn-door abnormality, they’re bounced straight back to the GP.

Typically, this ‘efficient and seamless pathway to optimise the patient journey’ (not an actual quote, I made it up, but it’s what they’d say, isn’t it?) was imposed without any consultation with grassroots GPs. Had they asked me, I’d have been able to tell them, prospectively rather than retrospectively, that it’s a horrible idea. And here’s why:

1. It means that, when I tell a patient I’m referring them to a specialist, I don’t really know if I am or not. They might encounter a real specialist. Or they might just meet the pointy end of a colonoscope.

2. It’s psychologically traumatic for patients to be referred under the two-week rule, not least because we’re obliged to tell them it’s a check for cancer, it’s an urgent appointment and it’s important to attend. In writing. If the system was humane, it would incorporate at least some face-to-face contact with the specialist team. It isn’t, so it doesn’t.

3. This is simply another way of the hospital keeping patients at arm’s length, diluting their responsibility while increasing the GP’s.

4. Most importantly, STT significantly expands the GP role. I don’t refer patients just to rule out cancer, I refer to rule in other significant and treatable disease. If my patient’s unexplained diarrhoea isn’t the Big C, then what is it?

Not everything that isn’t colon cancer is IBS. So am I confident that I can exclude (from the STT results +/- anything else I can arrange myself), say, colitis, malabsorption, coeliac, intolerance, mesenteric ischaemia, etc etc?

Suddenly, I’m doing the job of secondary care gastroenterology – and if not, then I’m making a second, routine, referral, entailing more work for me, more expense for the NHS and more hassle and anxiety for the patient.

On paper it probably looked like a good idea. But for me, it’s Straight To Detest.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield