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Lansley promise 2011: “NHS patients will be able to pick consultant”. September 2015: Where are we now?


An article appeared in The Independent in October 2011 which reported that Andrew Lansley was going to make it possible to pick the hospital consultant of your choice. It seemed to me to be a moronic idea at the time and you can see why in a post I wrote at the time. (In fact, I discover that I wrote an earlier post pointing out the absurdity of promises made in the White Paper which then led to the Health and Social Care Act; it is worth looking at both these posts in view of where we are now.)

So where are we now? Let me tell you how it is for me, referring patients to hospitals in London. Yesterday I spent about an hour trying to arrange an appointment for two patients failed by the system, entirely predictably. One concerns Patient X who has chronic back pain who has had an MRI scan of her/his lumbar spine, and the report recommended referral for possible spinal surgery (I asked for advice from our local spinal orthopaedic surgeon, he advised referral); the other concerns a baby under 1, referred to a London centre of excellence.

I referred Patient X six weeks ago through the Choose and Book system (recently rebranded as the NHS e-Referral Service). What choice did Patient X have? Well, there are two avenues for this sort of situation: a spinal orthopaedic surgeon, and a spinal neurosurgeon. I tried the orthopaedic surgeon first. The wait for our local spinal orthopaedic surgeon at the Royal London Hospital was 185 days (that is, over 6 months); there were not many other options, with similar waits. So I tried spinal neurosurgery. Here the choice was even more reduced, but there was one option: an appointment in 41 days at the National Hospital for Neurology and Neurosurgery. I clicked this option, printed the form and gave it to Patient X to book the appointment online.

When Patient X tried to book the appointment, there were no appointments; Patient X was told that she/he would be contacted by the hospital within 2 weeks regarding an appointment. This did not happen. So Patient X rang the NHS e-Referral Service; they could not help her/him, she/he needed to ring the hospital. Patient X rang the hospital and was told the they would contact her GP to confirm that a referral was necessary (a strange step as I had referred Patient X in the first place). In any event, I did not hear from the hospital.

So yesterday I rang the NHS e-Referral Service. They could not help me, it was out of their hands. I did point out a generalised problem, which was illustrated by the individual case of Patient X. In my experience, whenever the patient finds there are no listed appointments and are told they will hear within two weeks, it usually means an appointment will not be forthcoming; & when the patient pursues it with the hospital they will eventually be told there are no appointments and to go back to their GP (!). And then what I do is start again: I raise another referral through the e-Referral Service but warn the patient not to choose an option that does not give them an actual appointment. So yesterday I spoke with a manager at the NHS e-Referral Service and I told her about this problem. Initially she was evasive and defensive, but then softened and agreed that in these cases the system did not work. I suggested she take this back to her organisation and ask that they at least be honest about this issue and warn patients booking with hospitals who do not have appointments listed.

I then rang the Hospital for Neurology and Neurosurgery. I explained the situation; that the patient had been told I would be contacted; that I had not been contacted. On the NHS e-Referrals system, Patient X’s referral is currently categorised as ‘Deferred to Provider’. The staff member at the Hospital for Neurology and Neurosurgery said that this meant me, her GP. I said I did not think so; I thought it clearly referred to the hospital to whom I had referred the patient. I was then advised to fax a copy of my referral letter to the staff member and that she/he would pass it on for vetting.

With respect to the baby, exactly the same thing has happened. No appointment. Parents told to go back to their GP. I have made a new referral, and chosen only providers who actually have appointments. (The hospitals without current appointments will be listed as ‘Unknown’ as the date of next appointment).

This situation is not unusual. With respect to my local hospital, the Royal London Hospital, many specialties have long waits or are ‘Unknown’. My impression is the ‘Unknown’ category is actually a way of avoiding these referrals appearing in the statistics; if the hospital were to give an appointment that is more than so many days, then that is a breach of the targets and there is a financial penalty. So if they do not give an appointment, if they tell the patient to go back to their GP, perhaps they avoid this breach. I think it is likely that this is what is happening. I could of course chase this up further and get to the root of the problem, but I am a GP, not an investigative journalist (not many of them around these days). Our CCG sent us Tower Hamlets GPs a letter recently advising us not to refer to certain departments at Barts Health since they are having considerable problems with capacity. This is all very well, but then we refer to alternatives like the Homerton Hospital; and it does not take a genius to realise that these alternative providers also face the reality of capacity and their waits will lengthen and possibly/probably go beyond the target and then breach and be financially penalised.

So there is quite limited ‘Choice’; what Lansley and the DoH promised was moronic from the start, the current situation was entirely predictable. Is it the hospitals’ fault? No, it is an absurd Herculean task. What we need is people to be honest about this, to fight back and point out the absurdities in the demands being placed on NHS services by Morons in Government.


For a picture of London spinal neurosurgery referral options as of yesterday, Spinal neurosurgery options on 25.9.15.


Department of Health reply to my email to Jeremy Hunt 2/7/15 on the #gpboundaryscam


I received the following from the Department of Health on 15/7/15, in reply to my email to Jeremy Hunter earlier this month:

Our ref: DE00000945045

Dear Dr Farrelly,

Thank you for your further correspondence of 2 July to Jeremy Hunt, Jane Ellison and Alistair Burt about GP services. I have been asked to reply.

I was sorry to read that you are not satisfied with the Department’s response of 29 June to your previous email (our ref: DE00000940960). I note your continuing concerns about patients registering with GPs outside of traditional practice boundaries.

As stated in my colleague’s previous reply, NHS England will continue to review this policy to ensure that it is meets the needs of the patients who are using the service and who may wish to use it. In addition, it will address the operational issues that have arisen since the introduction of the agreement to ensure that the system remains functional for GP practices.

I note that you have not yet received a response to your correspondence to NHS England, but, as it is responsible for primary care in England, I can only suggest that you continue to raise your concerns with it.

I am sorry I cannot be more directly helpful.
Yours sincerely,

[name removed]
Ministerial Correspondence and Public Enquiries
Department of Health


Please do not reply to this email. To contact the Department of Health, please visit the ‘Contact DH’ section on the GOV.UK website.


Of course, this is not a true reply, just another text masquerading as a reply.


The Department of Health’s response to my last email to Jeremy Hunt about #gpboundaryscam


Our ref: DE00000940960

Dear Dr Farrelly,

Thank you for your further correspondence of 14 June to Jeremy Hunt, Jane Ellison and Alistair Burt about GP services. I have been asked to reply.

I appreciate your ongoing concerns. As you know, the GP contract agreement for 2014/15 allows GP practices to register new patients from outside their traditional boundary areas without a duty to provide home visits for such patients, as they previously had to.

This arrangement is designed to make the system more flexible and give patients greater freedom in choosing a suitable GP practice – for example, commuters may wish to register with a practice close to their workplace, as opposed to where they live, and people who move house may wish to continue to attend their existing practice.

The agreement was introduced in January and there are currently over 14,000 patients registered with practices away from their home since. All NHS England regional teams have arrangements in place to ensure that those patients are able to access services should they require primary medical care whilst at home.

Those arrangements vary across the country. Many regions commission the national enhanced service model, while some use the local out-of-hours services, and others commission a range of services. However, all have ensured that, should the patients registered in their area require care, they are able to provide it.

To date, NHS England has received no patient complaints or concerns about this matter through its customer contact centre or operational teams in the regions. However, it is aware of some concerns from GP practices about registration and operational issues that it has worked with them to resolve.

NHS England will continue to review this policy to ensure that it is meets the needs of the patients who are using the service and who may wish to use it. In addition, it will address the operational issues that have arisen since the introduction of the agreement to ensure that the system remains functional for GP practices.

I am sorry I cannot be more directly helpful.

Yours sincerely,

[name removed to protect the innocent]

Ministerial Correspondence and Public Enquiries
Department of Health

Please do not reply to this email


For my next email to Jeremy Hunt and comments on this response


I complained to Parliamentary & Health Service Ombudsman about DoH non-replies to my concerns; they are legally not allowed to investigate


In September 2013 I sent Jeremy Hunt, Secretary of State for Health, an email pointing out the problems inherent in the Coalition Government’s flagship policy to make it possible for patients to register at any practice they wished in England. I received a non-reply from the Department of Health. So I wrote again and received a similar response. So I wrote again and received a reply saying they had nothing to add to the previous emails and that unless I had something new to ask they would not reply to any further emails. For links to the emails and non-replies, click here.

So I sent a complaint to the Parliamentary & Health Service Ombudsman; in its essentials, my complaint was that Jeremy Hunt and the Department of Health had failed to address the issues I raised and respond to each of the issues raised.. I sent ample documentation to demonstrate the problem.

This is the Ombudsman’s reply:

Ombudsman Reply 1 PNG

Ombudsman Reply 2 PNG







A Question for the BBC


A question for the BBC, but journalists in England as well.

On March 20, 2014 a research team at the London School of Hygiene and Tropical Medicine, headed by Professor Nicholas Mays, published their report on the Government pilot on patients registering with GP practices at a distance from where they live.

The afternoon before I was contacted by BBC London 94.9 asking if I would comment on the policy the next morning. Here is the interview:



I said in the interview that as the policy was actually implemented the problems would become evident; I said that it would be ‘a mess’.

The scheme was meant to start in October 2014. At the last minute, NHS England announced that they were going to delay the implementation. Why?

A spokesperson for NHS England, said: ‘This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP. With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.

‘This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in – a decision that has been taken in the best interests of GP practices and patients.’  (my emphasis)

The policy was implemented (very quietly) on 5 January 2015. The only media report or comment I could find was a post on the ConservativeHome blog.

I subsequently found out that ‘robust arrangements’ were not in place across the country, and the worst affected was London where there are NO ARRANGEMENTS in place. For details, see my piece in Pulse, and a subsequent Pulse article.

I wrote to Jeremy Hunt about this, copied to various media outlets, including BBC London 94.9. And yet this story has not been reported in the mainstream press. I also wrote to NHS England and NHS England London, and the CQC, the King’s Fund, the Patients Association, and the Nuffield Trust. I have not heard from Jeremy Hunt, the Department of Health, or NHS England; in fact, I have not heard from anyone.

Since September 2009 when Andy Burnham announced this policy at the King’s Fund, the press has reported only the positive sounding spin coming from the politicians, entrepreneurs, and the Department of Health, and have been universally silent about the numerous problems inherent with this policy. It is as though there is a news blackout…


It is now crystal clear: the Choose your GP Pilot ‘independent evaluation’ in no way evaluates the actual policy


Yesterday the practice manager of a large Tower Hamlets practice (and CCG Board member) and I went to meet with Professor Nicholas Mays and two other authors of the Evaluation of the choice of GP practice, 2012-13 at the London School of Hygiene and Tropical Medicine.

We outlined the reasons why abandoning practice boundaries in Tower Hamlets would not be in the interests of our aim to provide good quality primary care services to our local communities. Quite to the contrary, why it would be harmful and destabilising.

We had an interesting conversation about the pilot, about the various competing aims, about unintended consequences, about politicians, and about pilots.

I believe their report is well written and contains a number of important points, and they have done a serious piece of work. But they were clear that their evaluation only evaluates the pilot, and not the policy. The pilot had small number of patients and in no way ‘tested’ the policy; in fact, the sorts of risks I have highlighted in my Submission to the Health Select Committee are not revealed by the pilot, they are hidden. (I expressed these concerns in an article for Pulse in December 2012.)

It is as though you invited smokers over the age of 70 to meet you at the top of a tall hill, and you asked them if they liked smoking and if it had impacted negatively on their health. It is likely that they would say that they enjoyed smoking, and it caused them no problems (hence their age and ability to get up the hill). You might conclude that smoking was a harmless pleasure.


On recognising and naming MOOspeak from @Dhgovuk & @DeptHealthPress


The Department of Health is a large organisation, with different departments performing different tasks. No doubt, there are some departments carrying out noble and important work, and many of the civil servants working at the DH are, I am sure, dedicated to trying to make a positive difference to the provision of healthcare in the UK (or is it just England now?).

But there are some departments, the ones handling the more politicised policies, that are having to plan, promote, and implement policies that are not actually positive ones, and where there are significant unintended consequences. During the debate surrounding the Health and Social Care Bill many criticisms and misgivings were articulated. The Department of Health was then having to defend these policies and the methodology by which they were being planned, and this was most evident in the statements issued to journalists in response to the critiques.

‘A spokesman for the Department of Health said, ………’; ‘a spokeswoman for the Department of Health resplied…..’. These statements were understandably designed to minimise the damage done by the critique of the moment, but it meant that they were often fatuous and disingenuous. And what was frustrating from the point of view of those of us who work within the health economy was the, for the most part, the journalists just accepted these statements at face value, even if they contained falsehoods.

An example of this was when, in February 2012, 154 senior paediatricians (including 19 professors) wrote a letter to the Lancet to voice their concerns about the damage that would be done by the Bill. This naturally received attention in the press.

The Department of Health’s response, as quoted in this article:

A spokeswoman for the Department of Health said: “We have listened and substantially strengthened the Bill following the listening exercise. It’s not true to say that the Health and Social Care Bill will fragment children’s healthcare. In fact, the Bill will help address the very concerns about fragmentation that the experts raise. It will help the NHS and other public services work together better for children, young people and their families. These 150 individuals represent just over 1% of the total members of the Royal College of Paediatricians and Children’s Health and cannot be taken as an accurate representation of the College, who we continue to work with.”

The template for these responses is seems to be something like this:

a) make a positive-sounding statement (‘we have listened and substantially strengthened the Bill’); b) refute the criticism (without responding to the substance of the criticism); c) make some positive-sounding noises about the policy (the Bill ‘will help the NHS and other public services…’; and, sometimes, d) undermine the credibility of those voicing the concerns (as in this case).

What struck me about this example at the time (and why I kept the links) was that some anonymous spokeswoman at the Department of Health (who almost certainly had no experience working in paediatrics or medicine and was in all likelihood a PR person) was implicitly afforded equal status in this debate. So we had some paediatricians saying one thing, countered by the (unsubstantiated) assertions of a ‘spokeswoman’ without any qualitifications. Paediatricians 1, Department of Health 1.


What we need is a basic analysis of these communications from the Department of Health, a deconstruction. And where the DH statements are dishonest, disingenuous, misleading, and just meaningless spin, they should be named and ‘outed’ in an efficient way.

For the moment, I am going to use the term ‘MOOspeak’, but I would be happy for any suggestions for a better term. Remember, it needs to be short so able to be used on Twitter.

I would suggest that if a journalist feels the the statement they receive qualifies as MOOspeak, that they write something like:

A spokeswoman from the the Department of Health, issued this MOOspeak statement: ‘Blah blah, etc…’

Or: A MOOspokesman for the Department of Health said, ‘Blah blah….’

Or: In a statement from the Department of Health, which sounded awfully like MOOspeak, …..

I think they would issue fewer MOOspeak statements and we would have a more honest discussion.

And then, perhaps, we could move on to politicians and their ‘speak’….


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