Ok, apologies for the delay, it’s going to be a longish post so I wanted to wait until I had some time to write it.
As a few of you have already guessed, this isn’t a singular colleague, but actually repeated behaviours by a group of colleagues.
That group of colleagues are hospitals and secondary care services (services that we as GPs refer our patients into for further care). For succinctness I’m going to use “hospitals” to describe this group from now on, as they make up the majority.
It is doctors (senior and junior, NHS and private), nurses and other therapists.
What started as isolated incidents are now becoming commonplace. Not only is it causing massive problems for us as GPs, it’s causing issues for you as patients. After all if your GP surgery is busy doing the hospitals work for it, then there’s less time and resources to spend on seeing patients, which is our actual contracted job.
Some of the inappropriate things that hospitals are asking us to do are:
- Deal with their abnormal test results.
Apart from the fact that they are paid to deal with their own results, a large part of dealing with abnormal results depends on the context in which they were done, or speaking directly to another specialist to see whether any further action is needed. Both of those are better achieved within the hospital than by dumping them into the GPs lap.
- Providing sick notes for conditions that they’re treating.
Hospitals have been able to do this for decades. Part of the reason that they have is to free up appointments with GPs. Even so it is amazing how many of them refuse to do so, or if they do do them, provide them for a ridiculously short period of time and then when the patient asks for an extension refuse to issue one and fob them off by telling the patient that it’s the GP’s job.
- Make onward referrals for the patient.
Again this is part of the job that they’re contracted to do, it is not part of a GPs job, and it takes a huge amount of our time and effort. Also when a referral is made, ideally it should be to answer a specific question, so it is best coming directly from the clinician who wants the question answered who is also best placed to forward the relevant information. More and more we’re seeing this as a tactic for hospital doctors and their teams to avoid taking clinical responsibility for their patients.
- Follow up their patients appropriately.
Again it’s part of what hospitals are contracted to do, and they’re not doing it, instead telling patients to come to us for follow up. Once again this is not generally part of our job, and actually takes us away from seeing our own patients who are ill.
- Arrange their own tests and investigations
I’m starting to sound like a broken record here, but hospitals are paid to arrange their own tests and investigations, and deal with the results. In most cases GPs are not. However hospitals often don’t, using the excuse of patient convenience as to why not. This is not credible as it’s perfectly possible for most hospitals to use the same test services that we do for our patients, they just choose not to. Tests are better arranged directly by the person who wants them done, so that they can make sure the correct test is ordered (and avoid the Chinese whispers effect) and get the result directly back to them, rather than rely on a chain to pass them on (through the GP) with the associated potential points of failure.
- Looking for spurious reasons to refuse referrals
More and more we’re seeing referrals being rejected for arbitrary and nonsensical reasons. Often to be reversed when we query it. We can only imagine that this an attempt to avoid their contracted workload.
I am going to write a further post with some examples of all these points.
What makes all this even more egregious is that when we politely raise this with our hospital colleagues we are routinely met worth BS excuses, denial and obfuscation.
Interestingly it’s not just me. Two of my good friends who are senior hospital doctors have seen the same trends of their less senior colleagues doing everything they can to avoid taking clinical responsibility for patients and so creating unnecessary workload for their colleagues.
I’ll be honest, there has always been a tendency amongst a proportion of our hospital colleagues to be arrogant, especially to their (perceived as) lowly GP colleagues, but at least in the past we used to have confidence that (mostly) they were competent. Now I’m not so sure.
