Yep. Whole thing collapses, gp take on the risk as it happens. And to top it all off, GPs implode under the fiscal hole that the GMS contract and ARSS scheme have left.
Beautiful.
What an absolute blinder the conservatives have played. Hats off to them.
and to be quite honest, the profession deserves it. Absolute invertebrates. The recent sighting of gonads won’t be enough to undo the various blows.
I'm not a GP but this sounds like a bureaucratic mess that will be rife with administrative errors, unnecessary repetition of work and clinical decision errors.
Not sure if I understand correctly. They are decreasing peer-peer collaboration by allowing hospital systems (not doctors, but admin?) the ability to reject patient referrals and give general advice without actually seeing the patient? I reaaaally hope I am misunderstanding. Can someone explain please?
I don't think it mentions admin rejecting or responding to these queries. The hospital consultant would review the advice & guidance, as they do currently, and decide whether to offer advice, see them in clinic etc. Not saying its a good idea but that's what it means.
I know several departments doing this already.
Apparently saves hundreds of thousands of pounds. It’s obviously not described but it’s on departments heads if they don’t.
As a GP I've seen several patients recently come to harm including the delay of metastatic malignancy because of rejected referrals or changing criteria for 2ww referrals that would in time gone by been assessed appropriately. Many of these rejections are not even by clinicians and their name/grade/profession not often even stated on the letter.
This seems basically like how mental health services work - I actually didn't realise that GPs could directly book people into secondary care clinics in other specialties.
Pathway is GP refers -> team reviews referral -> either accept the patient or write back to the GP with advice/signposting to alternative services.
I don't have a problem with this in theory (to be honest, if patients could just pitch up to a psych clinic because a GP had referred them it would be a nightmare) but it needs good communication pathways between GPs and secondary care to work effectively. I've seen teams where the referrals meeting has gradually lost senior medical input so you have a bunch of AHPs screening all referrals. Has led to e.g. referrals for specialist review of valproate being rejected, repeated rejection of referrals without actually answering the question the GP has been asking etc. Patients also often end up stuck in limbo because the GP feels out of their depth but various mental health teams aren't accepting responsibility for them.
Edit: it has also meant that every psych team has its own separate referral form which infuriates me, never mind the GPs
Having AHPs do it without any doctor input, especially over the phone, can result in some some horrendous examples of referral rejection
Eg.
1. The person with acute mania. Called by AHP in response to GP referral-> asked how they are feeling, they say "fantastic", asked if they want support, they say "no", asked if they think they are a risk to themselves, they say "no". Referral rejected.
‘These services can improve collaboration and communication between clinicians. They can support better patient self-management and ensure that patients are seen more quickly by the right professional and in the right setting.’
Most of the time its too late for 'self-management' that's why a GP with a minimum of 10 years of medical education and training makes that call. All that's going to happen is legitimate referrals, which will appear to be arbitrarily knocked back, will loop round and round as part of 'improved collaboration' and the patient will eventually be seen by secondary care anyway. The only differences are, there will be a metric which says x number of patients were knocked back (sorry given advice) and patients/GPs get pissed with a referral system which is putting up barriers to access.
All our referrals are triaged but
- the trust gets money for each new slot so we're told not to bounce any
- you're taking on legal risk providing advice and refusing to review the patient that you've never met. Ballsy
- risks clogging the poor GP further
Yes 20-30% referrals are nonsense buuut there isn't really an alternative. Maybe If patients start paying for consults they won't want to see a cardiologist with their 15second twingy post tennis pectoralis pain and will take the gp advice
I know the GPs don't like this route but have seen the other side where a patient is seen after a 6 month wait only to find that they are booked into the wrong specialty and so have to linger on a different waiting list for another 6+months, whereas at least this way they get told up front if it might be the wrong specialty.
Is that not an issue with the secondary care triage process though? I find it hard to believe that it wasn't until a patient appeared in clinic that it was felt the specialty was wrong.
My understanding is that it used to be that the GP sends a referral requesting a specific clinic and the patient would go on that list, with specific criteria for certain clinics but not for others and that's why I would see patients with a cardiac problem in resp clinic, or possible rheumatoid arthritis in general neurology.
Now all referrals are triaged up front with A&R and it still happens ("I can't tell what's going on here so I just need to see the patient") but probably less so
What you describe sounds like a simple fix where the inevitable screening should occur earlier on. The new process referred to in this link seems more radical, albeit, I don’t really understand what they are trying to accomplish.
I don’t know how it works the GP end but when we outcome the guidance we can click options which include referral of necessary or referral and then we can even book the appointment. But it’s sketchy and needs proper implementation to work.
Eyes here: we have always triaged every letter from gp or optometrist. But the numbers have gone wild so that it can easily be a whole session per consultant to triage (if you do it properly). We used to take urgent referrals by phone but again numbers went wild so the eye cas person could spend their entire morning taking calls. So now we have emails for urgent and referrals for the rest,but electronic. And with the daft system for requesting advice bolted on the side. Getting rid of one of those systems would make things easier so I don’t see the scandal here.
If, on the other hand, we try and delegate triage to less skilled people it will end up an unholy mess.
This comes accross to me as secondary care protecting itself from any primary care mess (non-doctors/out of depth doctors making lots of referrals) and asking it to sort itself out.
The funny thing is that primary care might actually get better feedback on non doctors but at the cost of increasing workload for collapsing system.
We do this already. It’s called RAS and we can triage the referral accordingly. Cuts out a lot of rubbish referrals and also allows us to go back to GP’s and tell them to do x, y, z.
And so General Practice is further entrenched as the risk sink and scapegoat for a failing system.
I think that's the plan
Yep. Whole thing collapses, gp take on the risk as it happens. And to top it all off, GPs implode under the fiscal hole that the GMS contract and ARSS scheme have left. Beautiful. What an absolute blinder the conservatives have played. Hats off to them. and to be quite honest, the profession deserves it. Absolute invertebrates. The recent sighting of gonads won’t be enough to undo the various blows.
I'm not a GP but this sounds like a bureaucratic mess that will be rife with administrative errors, unnecessary repetition of work and clinical decision errors.
Not sure if I understand correctly. They are decreasing peer-peer collaboration by allowing hospital systems (not doctors, but admin?) the ability to reject patient referrals and give general advice without actually seeing the patient? I reaaaally hope I am misunderstanding. Can someone explain please?
I don't think it mentions admin rejecting or responding to these queries. The hospital consultant would review the advice & guidance, as they do currently, and decide whether to offer advice, see them in clinic etc. Not saying its a good idea but that's what it means.
A lot of places it's not even a consultant looking at these A&Q queries, it gets delegated to the registrars.
Not admin. Triage by doctors. Lots of places doing this already
Where does it exclusively say triage by doctors? It’ll be the PA in the hospital giving the PA in the surgery the advice before long…
Ah the classic blind leading the blind.
I know several departments doing this already. Apparently saves hundreds of thousands of pounds. It’s obviously not described but it’s on departments heads if they don’t.
As if we needed longer for urgent cancel referrals? Seriously wtf is this?
Deck chairs on the titanic springs to mind
As a GP I've seen several patients recently come to harm including the delay of metastatic malignancy because of rejected referrals or changing criteria for 2ww referrals that would in time gone by been assessed appropriately. Many of these rejections are not even by clinicians and their name/grade/profession not often even stated on the letter.
Oh for fucks sake. Here we go. You bet PAs will be answering and bouncing these before long.
This seems basically like how mental health services work - I actually didn't realise that GPs could directly book people into secondary care clinics in other specialties. Pathway is GP refers -> team reviews referral -> either accept the patient or write back to the GP with advice/signposting to alternative services. I don't have a problem with this in theory (to be honest, if patients could just pitch up to a psych clinic because a GP had referred them it would be a nightmare) but it needs good communication pathways between GPs and secondary care to work effectively. I've seen teams where the referrals meeting has gradually lost senior medical input so you have a bunch of AHPs screening all referrals. Has led to e.g. referrals for specialist review of valproate being rejected, repeated rejection of referrals without actually answering the question the GP has been asking etc. Patients also often end up stuck in limbo because the GP feels out of their depth but various mental health teams aren't accepting responsibility for them. Edit: it has also meant that every psych team has its own separate referral form which infuriates me, never mind the GPs
Having AHPs do it without any doctor input, especially over the phone, can result in some some horrendous examples of referral rejection Eg. 1. The person with acute mania. Called by AHP in response to GP referral-> asked how they are feeling, they say "fantastic", asked if they want support, they say "no", asked if they think they are a risk to themselves, they say "no". Referral rejected.
‘These services can improve collaboration and communication between clinicians. They can support better patient self-management and ensure that patients are seen more quickly by the right professional and in the right setting.’ Most of the time its too late for 'self-management' that's why a GP with a minimum of 10 years of medical education and training makes that call. All that's going to happen is legitimate referrals, which will appear to be arbitrarily knocked back, will loop round and round as part of 'improved collaboration' and the patient will eventually be seen by secondary care anyway. The only differences are, there will be a metric which says x number of patients were knocked back (sorry given advice) and patients/GPs get pissed with a referral system which is putting up barriers to access.
All our referrals are triaged but - the trust gets money for each new slot so we're told not to bounce any - you're taking on legal risk providing advice and refusing to review the patient that you've never met. Ballsy - risks clogging the poor GP further Yes 20-30% referrals are nonsense buuut there isn't really an alternative. Maybe If patients start paying for consults they won't want to see a cardiologist with their 15second twingy post tennis pectoralis pain and will take the gp advice
that is a wild idea. (referral rejected. patient dies. great!)
At this point, just use chat gpt, it will be better than non clinical staff, abd there is the word gp in it, surely can fool some ignorant public
I know the GPs don't like this route but have seen the other side where a patient is seen after a 6 month wait only to find that they are booked into the wrong specialty and so have to linger on a different waiting list for another 6+months, whereas at least this way they get told up front if it might be the wrong specialty.
Is that not an issue with the secondary care triage process though? I find it hard to believe that it wasn't until a patient appeared in clinic that it was felt the specialty was wrong.
My understanding is that it used to be that the GP sends a referral requesting a specific clinic and the patient would go on that list, with specific criteria for certain clinics but not for others and that's why I would see patients with a cardiac problem in resp clinic, or possible rheumatoid arthritis in general neurology. Now all referrals are triaged up front with A&R and it still happens ("I can't tell what's going on here so I just need to see the patient") but probably less so
What you describe sounds like a simple fix where the inevitable screening should occur earlier on. The new process referred to in this link seems more radical, albeit, I don’t really understand what they are trying to accomplish.
This already happens where I work. Prevents needless referrals when all is needed is advice
So just send an advice & guidance request?
I don’t know how it works the GP end but when we outcome the guidance we can click options which include referral of necessary or referral and then we can even book the appointment. But it’s sketchy and needs proper implementation to work.
This is needed tbh. I am seeing increasing referrals from non-GPs that are wasting everyone’s time and reducing the ability to see those we need to.
Would a solution not be that non gps cannot refer rather than changing a system that has been in place for seventy years
Lmao love how the answer to so many medical system conundrums also coincide with “Why are non-GPs pretending to be GPs and why is it allowed?”.
Eyes here: we have always triaged every letter from gp or optometrist. But the numbers have gone wild so that it can easily be a whole session per consultant to triage (if you do it properly). We used to take urgent referrals by phone but again numbers went wild so the eye cas person could spend their entire morning taking calls. So now we have emails for urgent and referrals for the rest,but electronic. And with the daft system for requesting advice bolted on the side. Getting rid of one of those systems would make things easier so I don’t see the scandal here. If, on the other hand, we try and delegate triage to less skilled people it will end up an unholy mess.
Good care costs money. That's the bit they don't like.
This comes accross to me as secondary care protecting itself from any primary care mess (non-doctors/out of depth doctors making lots of referrals) and asking it to sort itself out. The funny thing is that primary care might actually get better feedback on non doctors but at the cost of increasing workload for collapsing system.
We do this already. It’s called RAS and we can triage the referral accordingly. Cuts out a lot of rubbish referrals and also allows us to go back to GP’s and tell them to do x, y, z.