Fight Fight Fight!

Referrals Mismanagement

a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://2.bp.blogspot.com/_srKLQ9PUso4/SfdRB3lNi0I/AAAAAAAAAh4/0rxhiFKLxFQ/s1600-h/Incompetence.jpg”img style=”display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 320px;” src=”http://2.bp.blogspot.com/_srKLQ9PUso4/SfdRB3lNi0I/AAAAAAAAAh4/0rxhiFKLxFQ/s400/Incompetence.jpg” border=”0″ alt=”"id=”BLOGGER_PHOTO_ID_5329817776558017346″ //abr /br /Well Fuck Me. The Fucking fuckwits who manage the NHS have managed to fuck it up again!br /br /This time it’s on a href=”http://www.pulsetoday.co.uk/story.asp?sectioncode=23amp;storycode=4122441amp;c=2″referrals/a. Referrals are a basic necessity in any healthcare system such as the NHS as one doctor passes on a patient to another.br /br /Now the idiots who run the NHS think that GPs refer on:-br /ulliTo save themselves a job/liliTo bankrupt their PCT/liliWith no a href=”http://www.hsj.co.uk/news/primary-care/care-quality-commission-to-regulate-primary-care/2007623.article%20″regard for guidelines/a/lilia href=”http://www.pulsetoday.co.uk/story.asp?storycode=4120990″Needlessly/a/liliFor things which could be managed closer to home, within primary care/liliFor things which a href=”http://www.pulsetoday.co.uk/story.asp?storycode=4121958″don’t need referring at all./a/liliToo a href=”http://www.pulsetoday.co.uk/story.asp?sectioncode=23amp;storycode=4122020″often/a/liliand of course GPs refer a href=”http://www.drrant.net/2008/05/please-dont-admit-anyone-hospitals.html”far too many /apatients./li/ulbr /And these fuckwits with fuck all knowledge of medicine, and rather less of people and patients take it on themselves to adjudicate on “best practice” and set up useless extra layers of bureaucracy such as “Referrala href=”http://www.bmj.com/cgi/content/full/332/7545/844″ management /acentres” to second guess doctors who actually know some medicine and something about their patients and their needs. They fool themselves into thinking that they know what the appropriate rate of referrals is for populations by some misapplied basic maths. The result is of course a false measure, and another league table.br /br /Let’s get real on referrals. GPs refer to specialists for several very good reasons. These are for specialist knowledge, specialist diagnosis, specialised treatment, more detailed review of a patient’s symptoms than can be achieved in a GP’s surgery.br /GPs ask specialists to see their patients as they believe that the specialist’s knowledge will help the patient. span style=”font-weight: bold;”GPs refer to help the patients/span.br /br /Now there are as yet no criteria which reliably distinguish a good from a bad referral. Indeed no one even knows what the criteria to make such a judgement would be. We can make general statements such as “a good referral gets the right patient to right specialist for the right reason” but the devil here comes in defining the “right” not the participants.br /br /GPs have for many years kept a href=”http://www.guardian.co.uk/society/2003/apr/13/medicineandhealth.comment”referral rates in the UK down/a. Indeed GPs are often criticised for failure to refer and failure to diagnose. In the UK GPs historically have underused rather than overused specialist services. This has some good effects- too much high tech hospital intervention is harmful…unless you are ill enough to make the alternative riskier still!br /br /The increasing medico-legal risk that GPs suffer from will erode this under-referring and may lead to extra “defensive” referrals.br /br /Referrals are going to be a battleground between primary care doctors and cost cutting managers. The doctors have to win this one- we know the medicine, we know the patients and we have a duty to care for patients, not figures or finances.br /br /Sorry NHS managers. For many years you have had the NHS on the cheap. (you weren’t around then to squander money by making the doctor’s job harder) The drivers in the GP consulting room (medico-legal fear, GMC guidance, NICE guidance, drug company datasheets etc) and in patient demographics (older, more treatments possible, more needed, patient demand etc) are all towards ever more referrals, more treatments, and a href=”http://www.drrant.net/2008/07/saving-lives-and-saving-money-what.html”less risk sinking/a done by primary care. This may even be an improvement in medicine. It’s going to be expensive, and it’s not clear the NHS can a href=”http://news.bbc.co.uk/1/hi/health/7658539.stm%20″afford it./abr /br /But in current climate of NHS a href=”http://www.keepournhspublic.com/pdf/HCDI_1007.pdf”delay, diminish, deny and blam/ae no doubt the managers will find some false measure with which to taunt the doctors. span style=”font-weight: bold;”No one will actually be looking at what the patients actually need and matching it with what the system can deliver.br //spandiv class=”blogger-post-footer”img width=’1′ height=’1′ src=’//blogger.googleusercontent.com/tracker/28089527-3357049655460716951?l=www.drrant.net’//div

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