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

26/09/2015

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.

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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

17/07/2015

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.

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

Scoundrels.


My next email to Jeremy Hunt on the #gpboundaryscam

02/07/2015

Dear Jeremy Hunt,

I have received a reply from the Department of Health following my email to you on 14/6/15.

To remind you, my email raised the concern that there was no cover in place in London (and other parts of England) for patients taking up the offer to register with GP practices at a distance from where they live. Should they fall sick at home, there is no local primary care cover for them. They have to go to a local walk in centre or to their nearest accident and emergency department. This is for the in hours part of the week. Out of hours, they are covered by whatever service is available where they live.

This policy as a whole is fraught with problems, and I have written to you and others about these. The particular problem of lack of local GP cover for these patients is one I had not anticipated.

The reply from the Department of Health contains an untruth, an error of fact: “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.”

This is, to put it into plain English, crap, 100% crap. In London (and other parts of the country) there are NO arrangements in place to “ensure that those patients are able to access services should they require primary care whilst at home.” There are services in place to cover patients registered locally, but not those not registered locally, which is the case of those registered at a practice at a distance from their home.

The Department of Health official points out that 14,000 people in England have registered with out of area practices and that there have been no complaints. This represents 0.026% of the population which is very small numbers. The problems will arise for patients when they are unwell.

I have tried to complain to the Parliamentary Health Ombudsman; I have been told that it is not legal for them to look into this sort of problem and they have advised I contact NHS England. This I have done several months ago, and they have still not replied. The Ombudsman advised I contact the CQC; various people I have spoken to at the CQC have felt out of their depth and do not want to handle it.

So we have a strange situation: there is a Government policy riddled with problems and in some circumstances unsafe but the system is structured in such a way that someone like myself from the frontline who raises quite basic, objective concerns is fobbed off in a Kafkaesque way. And then you wonder why GPs are emigrating.

 

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.”  Richard Feynman, Physicist


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

02/07/2015

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

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

 


My latest email to Jeremy Hunt on #gpboundaryscam

14/06/2015

Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I have emailed you on a number of occasions regarding the Government’s policy on allowing patients to register with a GP at a distance from their home. My last email pointed out that there are actual serious flaws in the way you have implemented this policy which went live on 5/1/15.

I have received a reply from the Department of Health, which was typical in that it does not address the fundamental issue of safety and avoided mentioning the rather large elephant in the room: that the policy simply does not work, and that for people who are actually too ill to get to their registered GPs it is unsafe. This is something the Health Select Committee should look into.

Incidentally, I complained to the Parliamentary and Health Service Ombudsman about the Department of Health’s wholly inadequate replies to my emails. They replied, politely, saying they are not able to deal with my complaint because, by law, they are prevented from investigating complaints about policy decisions taken by government departments.

In addition, I have an email exchange going with the NHS Choices website who are, understandably, reluctant to publish my comment on their webpage dealing with this policy.

So we have an interesting situation: successive governments have promoted this policy since 2009, apparently unaware of the foolishness of their claims and promises. My GP colleagues and I, as frontline workers who have to deal on a daily basis with the practicalities of delivering general practice services, have tried to warn you but you do not listen. And when you actually implement a policy which is operationally unsafe, I cannot find a way to make a complaint. I have of course emailed NHS England (two separate threads, click here & here) but I have had no reply.

Normally, under these circumstances, one might expect the media to pick up this story: ‘Government pushes through flawed policy by misleading the public’ etc etc. But the mainstream media seem to have singular approach to this issue: they will publish the Department of Health’s fanciful promises, but when it comes to the multiple flaws in the policy they are silent. They behave as though they have been paid off. Or perhaps it is the Emperor’s New Clothes dynamic. Strange.

I will close with a question which I am sure you and the Department of Health will not answer: if a citizen, a frontline worker, discovers a significant flaw or flaws, in a Government policy and the Government and the relevant civil service department (and the Health Select Committee?), pretend it is not happening; and if a complaint cannot legally be investigated; and if the media will not ask some awkward questions–what then is the citizen, the person on the ground, to do next?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.”  Richard Feynman, Physicist


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

25/05/2015

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

 

 

 

 

 

 


My attempts to post a comment on NHS Choices

25/05/2015

NHS Choices have a webpage to support patients who want to choose a GP practice where they do not reside. They do not have a list of practices offering this option (it is voluntary), patients have to research this themselves.

One paragraph reads as follows:

Because of the greater distance to your home, the GP you register with is under no obligation to offer you a home visit. If you are not well enough to go to the practice yourself then other arrangements will be made. NHS England (the body responsible for buying GP services) ensures that there is access to a service either near your home or at home (if required). When you register with a practice away from home you will be given information about what you should do in those circumstances.

However, if you are too ill to attend the practice in person, or the practice is unable to help you over the phone, call NHS 111. The NHS 111 service will be able to tell you about access to local services or, where necessary, arrange a home visit.

However, at the end of January 2015 I rang 3 different London NHS 111 centres (covering east London, north London, and central London) and none of them were aware of the new policy and none of them had in place a way of dealing, in hours, with patients who were not registered with a local GP. I was told that the patient would be advised to go to a walk in centre or to A+E.

[I rang NHS 111 for central London this morning, to see if things have moved on. I spoke to a first line adviser and then the supervisor. The supervisor thought a person could register with a GP in the home area, and then also register with a practice near their work or wherever else they chose. I told her this was not the case and I read her the text above. She said NHS 111 could not arrange this, and that the patient would be advised to attend a walk in centre or A+E.]

Elsewhere in the NHS Choices webpage is the following sentence:

This means that you are able to register with practices in more convenient locations, such as a practice near your work or closer to your children’s schools.

This idea of registering near your children’s schools has been a constant declared benefit of the policy since it was first broached in September 2009. But such a choice would not actually work, and would create problems for the parents and children. I have made a modest video explaining why.

I wrote a comment for this webpage; it was rejected; and an email exchange is in progress:

The proposed comment:

“I am a GP in Tower Hamlets. I think it is important that people thinking about registering with a GP practice away from where they live check carefully whether they will have in hours GP cover if they are ill at home and unable to travel to their registered practice. The cover throughout England is patchy. In London, there is no cover at all (at the time of writing this, 3/3/15).

I have written to Jeremy Hunt, the Department of Health, and NHS England so hopefully they will put this right.

Another issue: it is not a very good idea to register with a practice near your children’s school, it will actually cause problems, so beware. For details, see my video on YouTube:

http://bit.ly/1tzoP7S

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The subsequent email exchange:

From: NHS Choices [thechoicesteam@nhschoices.nhs.uk]
Sent: 19 March 2015 10:11

To: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: Your review has been rejected

Dear George Farrelly,

Thank you for contributing to the NHS Choices website. We have removed your contribution because we feel it is unsuitable for publication on this page. We do not allow comments which actively seek to dissuade other site users from following the evidence-based health advice provided. Please see the site Terms and Conditions or refer to the Moderation Rules policy. http://www.nhs.uk/Commentspolicy/Pages/Moderationrules.aspx

Please click the button or follow the link below to submit a new review of the service. etc etc….

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From: Farrelly George (NHS TOWER HAMLETS CCG)

Sent: 27 March 2015 07:18

To: NHS Choices Service Desk

Cc: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: RE: Your review has been rejected | 219186RL

Dear NHS Choices,

I do not accept the reasons you have given for rejecting my comment to the page http://www.nhs.uk/nhsengland/aboutnhsservices/doctors/pages/patient-choice-gp-practices.aspx

I will remind you of my comment:

“I am a GP in Tower Hamlets. I think it is important that people thinking about registering with a GP practice away from where they live check carefully whether they will have in hours GP cover if they are ill at home and unable to travel to their registered practice. The cover throughout England is patchy. In London, there is no cover at all (at the time of writing this, 3/3/15).

I have written to Jeremy Hunt, the Department of Health, and NHS England so hopefully they will put this right.

Another issue: it is not a very good idea to register with a practice near your children’s school, it will actually cause problems, so beware. For details, see my video on YouTube:

http://bit.ly/1tzoP7S

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I can see why you would prefer not to include this comment, but I do not accept that your reasons are valid. You say that you do not allow ‘comments which actively seek to dissuade other site users from the following the evidence-based health advice provided’.

In my comment I make 2 main points: 1. there is no cover in London for patients registering with a practice at a distance from where they live should they fall ill and not be able to get to their registered practice; this is a matter of fact, and introduces a safety risk for these patients; you are offering a service which has a very basic flaw and patients should be aware of it.

2. registering with a practice near your child’s school: this simply does not work and offering this as a benefit to patients is misleading and irresponsible. I illustrate why in this video: https://www.youtube.com/watch?v=JMllmAcg9II

Would you please explain in what way this advice to register near your child’s school (or the policy as a whole) is ‘evidence-based’?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

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From: NHS Choices Service Desk
Sent: 02 April 2015 09:17

To: ‘Farrelly George (NHS TOWER HAMLETS CCG)’

Subject: RE: Your review has been rejected | 219186RL

Dear George,

Thank you for contacting the NHS Choices Service Desk.

We have now assigned your query to the Subject Matter Expert (SME) within NHS Choices. A member of our service desk will be in touch as soon as we receive a response.

If you require an update at any time, please feel free to respond to this email quoting the reference 219186RL in the subject line.

Kind Regards,

Rachael

The NHS Choices Service Desk

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From: NHS Choices Service Desk [servicedesk@nhschoices.nhs.uk]
Sent: 10 April 2015 12:21

To: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: RE: Your review has been rejected | 219186RL

Dear George,

Thank you for contacting the NHS Choices Service Desk.

Please see the response below from our user generated content team.

” Dear George,

Without making any judgement on the validity of your arguments I have to tell you that NHS Choices is not the correct forum for your concerns.

Choices’ comments section was set up to offer patients the opportunity to rate and comment on their NHS care and treatment. Our comments policy does not permit campaigning of any sort.

The moderator used the correct rejection category though they should have paid more attention to the wording used in the automatic notification sent when that category is used.

Kind regards “

Please get back to us if you have any other queries.

Kind Regards,

Rachael

The NHS Choices Service Desk

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Dear Rachael or Colleague,

Thank you for your reply.

I have three questions:

1. if a patient, non-‘campaigner’, were to point out on your page that he/she is unable to find ‘at-home’ GP cover in London, would that be acceptable? Or if a patient were to point out that registering with a practice near their child’s school did not actually work, would you accept that comment?

2. If someone like me, with specialist understanding about how a frontline service works, finds a flaw with a ‘choice’ you are promoting, what is the ‘correct forum’ for my concerns?

3. What is the governance for ensuring the ‘choices’ you are offering on the NHS Choices website are safe and workable? If it is pointed out that a ‘choice’ you are offering does not work or is unsafe, do you have any responsibility to look into this or is it ok to simply leave it unchanged?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

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From: NHS Choices Service Desk
Sent: 15 May 2015 09:57

To: Farrelly George (NHS TOWER HAMLETS CCG)

Subject: RE: Your review has been rejected | 219186RL

Dear George,

Thank you for contacting the NHS Choices Service Desk.

Please see the response below from our user generated content team.

” Dear Dr Farrelly,

As I explained to you a while ago when you last tried to post your comment NHS Choices comments policy prohibits all campaigning of any sort.

This is no reflection on the aims of your campaign or any judgement regarding its merit, merely that Choices is not the correct forum for your concerns. We are very strong on not supporting or endorsing any campaigns. Furthermore providing health advice is not permitted.

Choices is meant to be a platform whereby patients can comment and rate their NHS care and treatment.

Choices comments policy is explained here:

http://www.nhs.uk/aboutNHSChoices/aboutnhschoices/termsandconditions/Pages/commentspolicy.aspx

Kind regards “

Please get back to us if you have any other queries.

Kind Regards,

Rachael
The NHS Choices Service Desk

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From: Farrelly George (NHS TOWER HAMLETS CCG)
Sent: 15 May 2015 16:09

To: NHS Choices Service Desk

Subject: RE: Your review has been rejected | 219186RL

Dear Rachael,

They have not answered my questions. They are in plain English; there are three of them.

Please ask them to answer them, one at a time, directly, without evasion or obfuscation.

Many thanks,

George

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[I will add their reply when I receive it]