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The mad referral merry-go-round



What a merry dance the NHS leads us. Not the Strictly Come Dancing shimmy-in-sequins type, but a brutal, grinding, interpretive number that can only end badly.

I met up with some friends from medical school recently. One of them is now an interventional radiologist – one of the new breed of all-singing, all-dancing radiologists who can fix tricky things with just a very long needle and an expensive scanner. But like the rest of us, he was complaining about the system.

‘So I saw a patient today who has waited eight months.’ Cue much sympathetic nodding. ‘He went to his GP in February with back pain and turned out to have some weird venous malformation pressing on a nerve. The radiologist who reported the scan suggested referring to me. But the GP isn’t allowed to refer into a neighbouring CCG without a local consultant seeing the patient. So the GP referred him to his friendly neighbourhood neurosurgeons, even though he knew they don’t do the type of procedure the patient needed. They then referred the patient to my hospital’s neurosurgeons because they aren’t allowed to refer to another specialty. After seeing the patient, those kind neurosurgeons sent him to me.’

We all shook our heads, imagining the despair the patient must have felt while being passed like a parcel.

But the story was not finished. ‘I did the procedure today. Hopefully he is sorted. But I need to review him in a few weeks and I can’t do that without a new referral from his GP.’

I didn’t go to medical school to do paperwork all day.

This stunned me into silence. The specialist has effectively discharged the patient and written back to the GP asking for a re-referral for follow-up. With himself. Except the GP is not allowed to refer directly to him. The merry-go-around will begin again, and the patient – who has already waited eight months – will probably be spending that time on a cocktail of painkillers, with a sick note.

This is bureaucracy gone mad. It is infuriating enough to have a contract where consultants in the same hospital cannot refer to each other. But now consultants aren’t even trusted to follow up their own patients?

We get ridiculous letters all the time saying: ‘Dear GP, this patient with COPD developed CKD 4 while a respiratory inpatient. They were reviewed by the renal team while an inpatient, and need renal follow-up, but I am not allowed to arrange this. Please refer to the renal team.’ As if GPs have nothing better to do than be secretaries.

It is this type of maddeningly frustrating, disjointed thinking that we face every day. I didn’t go to medical school to do paperwork all day. I don’t get excited by dictating a good letter. With the precious little time I have, I want to be seeing patients and treating actual pathology.

Where did doctors treating patients get forgotten in all this? Will anyone ever remember that’s supposed to be our job?

‘Oh, no,’ goes the refrain from our leaders in Skipton House. ‘Just keep referring!’

 Dr Zoe Norris is a GP in Hull