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We’re so enthused by peer reviews, we’ve started already

No doubt you have been made aware of the latest NHS England back-of-a-postcard missive about peer review? No? Check your junk mail box then.

New guidance has been issued, seemingly without recourse to a sat nav – but that is to be expected from the masters of suck it and see, let’s give it a whirl, despite the lack of evidence.

‘Good practice would be for GPs to review each other’s referrals at least once a week to ensure that all options have been considered blah blah blah…’

The new directive was revealed by our ferreting journalists at Pulse.  

We were so enthused by the potential, as yet unseen, benefits of this process that we threw caution to the wind and instigated it in our practice without even waiting for the ‘significant additional funding’ to arrive.

My wife was slightly alarmed when, on the back of this, I bought up half a million Virgin shares, but I reassured her, the cheque is in the post and Stephen Hawking is never wrong.

Conversations with GP colleagues from the CCG have been interesting since we embarked on the initiative.

‘Bob – I see you referred Mr First Fit for a neurology opinion. Any particular reason for this? Did you consider other options? There is a sale on at Sports Direct and we might be able to tide him over with a new cycling helmet and mouthguard?’

‘Nah – tried that but couldn’t get the blue one and the CCG only have a contract for mouthguards if you are over 55 and have a cat named Trump.’

‘Ok – what about Mrs Loud TV, you’ve referred her to audiology. What’s that all about?

‘Well – she can’t hear.’

‘Are you sure?’


‘Don’t be stupid Bob – this is a serious exercise with benefits to patients and GPs, AND it could reduce referrals by up to 30%! How do you know she can’t hear – where’s the evidence?

‘Oh, you want evidence now. Is that a new thing that NHS England has recently discovered?’

‘OK – what about Ms Knobbly Knees? You’ve referred her again to the orthopaedic team? What’s the problem?’

‘Well I’ve referred her twice before. The first time they said they hadn’t received the letter, and the second time they sent her an appointment letter the day after her appointment. Obviously we have already spent a week of office time chasing this up so it’s great that we have this opportunity to wallow in self pity each week over the state of our secondary care system.’

‘Don’t start getting gnarly Bob.’

‘OK – got to dash anyway, patients to see and all that. Same time next week? By the way, if NHS England were serious about helping GPs and patients can I make a suggestion? Try peer reviewing all hospital discharges and outpatient appointments. Simple things like did a letter arrive within a year of the event, has the patient got their medication, do they know what the follow up arrangements are, are the community services aware, did they bounce straight back in to hospital etc etc.

‘This would free up GP time, and make patient care smoother and safer – there’s probably even some evidence for it if you look hard enough.’

Dr Richard Cook is a GP partner in Hurstpierpoint, West Sussex. You can follow him on Twitter @drmoderate