Who makes referrals to which agencies?

[LemonRedwood]

I'm a senco and am used to making various referrals to various outside agencies, e.g. speech and language, ed psych, support bases, OT etc, but am a little confused by what a GP told one of our parents.

I'll try to give detail but without breaking confidentiality! This parent took her DD to the GP for a physical issue which, if she had approached us first, I probably would have suggested an OT referral. These are usually filled out by me but are signed by the school nurse, so officially come from her. The GP told the parent that they couldn't make a referral to OT and it should be done by the school. This seems a bit odd to me, as it's an NHS referral, so surely the GP is able to make the referral themselves?

The same GP made a similar comment when asked by a parent about counselling for a child last year and said the school had to make the referral. We can and do make referrals to the counselling in schools service but I thought GPs were able to access and refer to mental health services as well.

I'm wondering if those kinds of referrals are always done by schools or if this particular GP averse to paperwork. She seems to bat a lot of things in our direction. What happens in your school?

[SuburbanRhonda]

In my experience, GPs will walk over burning coals before they bother themselves to make a referral that can easily be palmed off onto school.

[LemonRedwood]

I did wonder if that might be the case!

[mrsmilktray]

IME the GP refers the child to a developmental pediatrician who then oversees any referrals to other agencies including O.T.

[LemonRedwood]

Thank you mrsmilktray. This GP appeared to imply that she was a "dead end". Good to see this shouldn't be the case.

[QueenofLouisiana]

I also wonder about the number of EHC referrals recommended by NHS staff- for me to do the paperwork for.

I've had 3 so far this term- 2 from SALT, 1 from psychology. All say an EHC should be applied for- by me!

[Haggisfish]

Actually i think guidelines etc have changed since Tories got in. My gp couldn't refer me for something she used to be able to-diagnostic scanning I think. It's to reduce the number of referrals deemed unnecessary by government. Sigh.

[SuburbanRhonda]

I've worked in my current job for seven years. I've never known a GP to even attend a child protection conference in all that time, and they are always invited.

[IguanaTail]

I was under the impression GPs could refer and that if they did it tended to be speedier.

[ArmchairTraveller]

Our GP practice was fantastic, told us that we could choose, but they'd be faster for an ASD diagnosis, and they were right.
But they are very good all round.
Too much of a lottery it seems.

[ArmchairTraveller]

Sorry, forgot to say that they linked to mental health support and counselling for depression as well as helping us know what was available.

[puglife]

I'm an OT. We take referrals from anyone.. GPs parents and other professionals. The GP should have referred but in my experience a lot of GPs refuse and some don't really understand the role ofOTs so are reluctant. Sounds like he just wanted to pass the buck.

[justabigdisco]

Ok, I'll bite. I'm a GP.

I am not lazy and do not 'palm off' referrals as a previous poster suggested. In fact, I'm a professional and like to do my job properly.

Parents sometimes come to me asking for a referral for eg ASD, because school have suggested it. I may have never met that child - they often don't even bring the child to the appointment.

A lot goes into a referral - it's not just a letter saying 'please see this child'. Contrary to popular opinion, we don't get paid for referring / not referring.

I frequently do decline referrals such as this as schools often don't realise that they are able to make them, and the default is always 'see your GP'. IMO, the person who should make the referral is the person who knows that child best - which is normally the teacher/SENCO - so that they can put the relevant information on the referral about WHY they feel the child needs seeing.

[justabigdisco]

Oh and it definitely isn't quicker if the GP does the referral. In fact it would be slower if we didn't have enough information to refer with - as the organisation would often then contact the school for more information, or decline the referral. If the person with best knowledge of that child does the referral to begin with, that's the quickest way.

[puglife]

Sorry just. I wasn't implying GPs are lazy at all. I think it largely depends on the area and referral criteria really. We accept referrals over the phone and with minimal info. As we then source all the info we need from other people.
Though I'm sure other areas require a lot more in which case you're right, the person that knows the needs of the child would be in the best position to refer.

I often feel for parents though, I find it hard enough getting my head around different services etc. so it must be a nightmare for parents trying to coordinate the best care for their child.

[MumTryingHerBest]

justabigdisco it's not just a letter saying 'please see this child'. Contrary to popular opinion, we don't get paid for referring / not referring.

Are you saying that referrals and associated paper work have to be done outside working hours?

Understandably, if a parent approached a Dr because the school SENCO has instructed them to do so, I would understand them referring them back to the school. However, if the parent approaches the Dr in the first instance should they then be directed to the school for help?

justabigdisco - IMO, the person who should make the referral is the person who knows that child best - which is normally the teacher/SENCO

The SENCO had never met my DC, the suggestion that there could be a problem came from the class teacher. Can class teachers do referrals? To assist the SENCO we created a detailed outline of all possible issues. The same document could just as easily be give to a Dr. In our case we proceeded through the school, however, I do know people who have preferred not to due to not wanting other parents to know.

[justabigdisco]

Well, we don't really have 'normal working hours'. We work until everything is done. What I meant was, we don't get a fee for making / not making certain referral, as the Daily Fail would have you believe.

If a parent approached me about a referral for their child for possible ASD, then yes I would normally bounce that back to the school, regardless of whether the school told the parent to see me. Class teachers can make referrals. I used to do them myself but request a letter from the teacher to back up my referral. Sometimes the letter would not materialise. When it did, I realised that it was just duplicating work. What is the point of me essentially writing a covering letter to a detailed teachers report, when that teacher can just do the referral themselves? Especially when I've never met said child or seem them very briefly? It's not about payment or avoiding work - it just makes sense that the most appropriate person provides that information.

If for example it was a referral to a paediatrician for a physical problem such as investigation of coeliac disease - then of course the GP is best placed to do that.

[justabigdisco]

Of course as puglife says, it all depends on the area. Class teachers can refer where I work, which is good I think.

And I agree that often parents are left 'in the middle' and might feel that their GP is being obstructive - but I like to think that I explain to my patients the reasoning behind what I do. They all seem to be ok with it.

[justabigdisco]

And in response to your point about creating your own list of problems (sorry on phone so can't read thread while posting) - if a GP sent a referral with a parents' list of problems then that's all well and good - but CAMHS would still contact the school for further info.

The reverse is not true - if a teacher did a referral enclosing a list of the parents concerns, then CAMHS would not contact the GP - as they are unlikely to be able to add anything to what's already been said.

I take your point about parents not wanting it to be known about through school though - hadn't thought of it like that.

I guess my point is - we're not doing it to be difficult/avoid work - we are (as in most cases) trying to do the best for our patients while avoiding unnecessary duplication of work. Sometimes perhaps the message gets through differently and people can feel 'fobbed off'

[MumTryingHerBest]

justabigdisco - Well, we don't really have 'normal working hours'. We work until everything is done

The same as teachers then.

If a parent approached me about a referral for their child for possible ASD, then yes I would normally bounce that back to the school, regardless

If the child has just started a new school year the teacher will not be familiar with that child. How would that teacher be in a better position to refer the child than the family Dr?

So if the parents wish to have the referral done outside the school for personal reasons it would be ignored?

it just makes sense that the most appropriate person provides that information.

How do you determine who the most appropriate person is if you simply refer them back to the school, regardless?

It would seem that you are saying that it's not that you can't help, you just don't want to. Of course that is entirely your choice.

[MumTryingHerBest]

justabigdisco- sorry cross posted on some points.

It would perhaps help to consider the situation at my DCs school. They had no SENCO for 6 months due to illness. They had 7 teachers resign at the end of the last school year and are having to fill some gaps with supply. Would you turn a parent from the school away and insit that get a referral from the school, regardless?

[justabigdisco]

Of course not! As I said, I'm trying to do my best for my patients and avoid unnecessary DUPLICATION of work. Not trying to avoid work. It is my opinion that class teachers are better places to make referrals for things like possible ASD / ADHD. as I said before, I may never have met the child in question. Frequently parents come without their child and ask me to refer based on their list of issues. That is fine - but as I said earlier, CAMHS will then contact the school for more info. And I can guarantee that an experienced teacher will gain more insight into whether a child might have ASD/ADHD after one single day in class, compared to me who has often never met them, or seen them for five minutes!

[LemonRedwood]

Appears I started an unintended debate!

Just to clarify the original situation - this parent had approached the gp first, concerned that what she was seeing in her dd was a medical issue, so her dd was there with her at the appointment. Gp bounced it straight to us even though we were not yet aware of the mother's concerns. This one particular gp seems to have form for this. Other GPs in my school's area seem cooperative and lovely, helpful and informative.

Had a meeting with the mother tonight and filled out the referral form along with her and the class teacher. Of course, from an education p.o.v. there wasn't a lot to say and there was a lot of "Mother reports that..." "Advice from GP is that..." types of sentences. Possible that in this instance, the referral may have been more informative coming from the GP.

I will now send the form to the school nurse, who has to sign it never having seen the child.

The whole system can be a bit ridiculous sometimes.