Why Is Another Layer Of Bureaucracy The Answer?

The NHS is rolling out a scheme that requires all family doctors in England to seek approval from a medical panel for all non-urgent hospital referrals, including hip and knee surgery, cataract removals, X-rays and scans. The “peer review” scheme is being expanded nationwide from next week following a pilot in two regions in the north-east.

Great! That’ll help! It’s not like people already wait far too long as it is…

Is this a good or bad thing? Should we rethink the gatekeeper role of GPs? Will this scheme make it harder than ever to get to see a specialist? Or will it help to streamline the referral process so you get to the right service in a shorter time?

Going on previous NHS track records, what do you think?

Most healthcare in the UK is delivered in primary care. Everyone wanting to access secondary care (usually hospital-based consultant teams) has to go via a GP. Most private health insurance companies require a GP referral too. The only way to bypass GPs is to pay a specialist yourself, and even then most will ask for details from the GP. People who come from countries where primary care isn’t well developed, and where the rich are used to accessing specialists as they would buy any other service, often find this GP gatekeeper idea frustrating and unnecessary.

Yes, they think we’re barmy. And maybe they are right?

The best sort of GP referrals will be asking the specialist a specific question that the generalist can’t answer or requesting access to investigations and treatments that aren’t available in primary care. GPs are usually also good at understanding what’s available locally and signposting you to the appropriate specialist service.

So if GPs are so good at making and directing referrals, why not trust us to send our referrals directly? Why introduce another tier that scrutinises the referrals? Doesn’t that just waste money and cause further delay in an already sluggish system?

All very good questions. Probably the ones anyone reading this article is asking themselves right now.

The conscientious GP will do their utmost to follow guidelines and supply all the necessary information with the initial referral. And if it gets bounced back with a request for more information, will supply it promptly. But GPs vary in quality and efficiency and some referrals that get bounced back languish in in-trays while the patient waits for an appointment, unaware that it is yet to be processed.

Then, identify these GPs and tackle them. Don’t go in for the usual bureaucratic collective punishment!

7 comments for “Why Is Another Layer Of Bureaucracy The Answer?

  1. September 8, 2017 at 12:06 pm

    And in my current situation, there’s no communication between the GP and the hospital. I personally have to phone results of tests between the two. Why is there no central record? Oh, my privacy.

  2. JS
    September 8, 2017 at 1:46 pm

    Privacy isn’t even the excuse in my case. I went for specialist treatment at a hospital just over the border in another health region because there were no appointments available in the foreseeable future nearer to me.
    Every communication from the hospital to the GP have been sent by post. Fortunately they copied me so that when the GP didn’t receive (or claimed they hadn’t) their letter I could give them my copy.
    Apparently inter-area communication has barely progressed beyond the mail coach. I look forward to them discovering the fax.

    • Ted Treen
      September 8, 2017 at 10:58 pm

      I look forward to them discovering the fax.

      And in future years, they just might stumble across the wonders of email.

  3. JS
    September 8, 2017 at 2:22 pm

    I can’t help feeling that a lot of time could be saved, for both specialists and patients by the use of “new” technology. E,g, using Skype or similar, either during normal GP consultations or via special local GP “video consultations” (perhaps with a nurse practitioner at the patient’s end).

    Even if the initial video consultation wasn’t with the specialist who would ultimately be treating the patient if they do subsequently need a specialist (a small number of specialists across the nation could be “on call” for this purpose at any one time), it would deal quickly with a lot of cases where there isn’t the further need for a face-to-face specialist appointment and the specialist could advise the GP on the correct treatment to begin immediately or refer them directly to the correct department for the next step e.g. X-rays or blood tests.
    It would also be a more efficient use of a specialist’s time.
    Most would only be seeing face-to-face patients who really needed it and only after receiving the results of initial tests and treatments.
    Even the video appointments might be shorter than the average normal specialist appointment.

    As it stands, patients often wait months for a first appointment – even if there aren’t postponements, which they often are, they have to travel miles, take time off from work and live with whatever discomfort or disability they have for a lot longer then necessary, even assuming it doesn’t get worse. Follow-ups can take as long, even if it is obvious that the treatment isn’t working.
    There would also be cost savings in treating conditions sooner, before they get worse and harder to treat.

  4. Mudplugger
    September 8, 2017 at 2:42 pm

    Oh dear, some of us seem to be labouring under the misapprehension that the last word in the initials NHS suggests ‘service to customers’ – wrong.

    The NHS is a self-perpetuating bureaucracy, deliberately configured to emasculate any potential benefits from new technology, unless it’s big shiny machines which the suppliers are ever-so-anxious to sell that they’ll help you to make your purchasing decision however you need that help.

    From the GPs, through the BMA, the nursing unions and the bloated administrators, it’s all about preserving their roles, power, pensions and golf-days, nothing about delivering for their pay-masters.

    Patients are a nuisance, they clutter up the system and some even have the effrontery to expect some degree of customer service in return for their mandatory taxes. It’s time they knew their place.

    • Ted Treen
      September 8, 2017 at 11:05 pm

      The NHS is the epitome of examples of Pournelle’s Iron Law of Bureaucracy:-

      In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control and those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely.

  5. Mona
    September 8, 2017 at 5:47 pm

    If you want to help the NHS and yourself is to stay away from it if possible. Go to your GP tell him anything and he will give you a prescription, when all you need is a diet sheet, over ten years ago after tests I was told I needed stents and I was given a prescription for five different drugs to take daily for the rest of my life, my closest friend begged me not to, just go on a diet lose weight and exercise he said I did, cancelled the op at St Thomas’s, I saved the NHS thousands over the years Big Pharma lost the same, never had a flu jab never will. The key to health is on the Internet, and yes crappy teeth will give you heart disease.

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