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The grim reality of a very grim story

The grim reality of a very grim story – bureaucratic delays in accepting a GP referral being implicated in an adolescent’s suicide – is that this is just the tip of a depressing and dangerous iceberg.

Nowadays, it’s the norm for overstretched teams to set arbitrary hurdles to referral, or develop systems that seem desperate to keep patients at an arm’s length. They’ll call it triage, multidisciplinary working, enhanced information sharing or a smoothing of the patient journey. But GPs trying to steer the patient through this obstacle course know that, in truth, it’s just an overwhelmed system trying to find ways to cope.

Which is why, each day, we GPs face:

  • The horrors of ‘straight to test’, a relatively new phenomenon meaning the nearest my patient with diarrhoea and weight loss gets to a consultant is a masked man with a colonoscope talking to his anus, and the nearest I get to help is a letter saying, ‘No sign of cancer, back to you’
  • Well-meaning missives from noctors who don’t quite provide the specialist opinion I was seeking not least because, frankly, they’re not specialist doctors, and a specialist nurse may well know less than a generalist doctor
  • Coroners’ officers and safeguarding agencies who refuse to talk to us over the phone but instead use minions/messages to direct us to online referral forms, which take ten times longer and then don’t work
  • Mental health crisis teams/early intervention in psychosis teams/whatever the hell they’re calling the team to front the psychiatry service this week refusing to take our referral because the patient does not fit their whimsical, illogical and ever-changing criteria
  • Community paediatricians bouncing back our referral letters because their protocol, which, naturally, hasn’t been shared with us, requires a full school report before they’ll even consider it

And so on. But this self-protectionism of health professionals adversely impacting on us and the patient is not something I’ll get over sanctimonious about.

After all, when I looked in the mirror the other day, I saw, staring back at me, an advanced nurse practitioner and a pharmacist.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield