One GP's Protest

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.