Are GPs under some sort of supervision to ensure they aren’t over referring unnnecessarily?

[Tumtr]

I am just curious as you often read on here about people having difficult convincing their GPs to refer on to hospital. And people ending up having to go private to get a diagnosis. And I don’t really understand why the GP wouldn’t refer if the patient is worried.

There are a lot of worried, anxious people about. It doesn’t mean they need a referral.

Referrals don't work like that. They're based on clinical need so if a GP doesn't believe there is a need it won't happen.

I believe GPs are told not to make too many referrals. My advice to anyone who is genuinely concerned would be to insist and be persistent. Everyone has to advocate for their own health and no-one (including GPs) knows your body like you. Far too many instances of people being misdiagnosed due to lack of investigation or diagnostic testing. Often these instances lead to premature/unnecessary suffering and death.

GPs make referrals based on clinical need. If the guidance says you need to be symptomatic for 8 weeks and have trialled 18 medications and have had 25 blood tests before referral, this needs to be done.

I think it might have recently changed but when you had the commissioning groups there were definitely GPs who were trying to save money by not referring for MRIs etc. My mum needed an MRI and before she could have one she had to wait to see someone else to decide if she needed one or not. They said she did, but then she had to wait again - it must have taken months and the extra stage just cost more money in the end. Some GPs were priding themselves on how little money they could spend from the local commissioning group budget.

I was told that all stopped 20 years ago on a thread a year or so ago, but it didn't, the system only changed in 2022.

I am sure it depends on the GP and the practice. Some GPs put their patients first, others put the bottom line first. Most were somewhere inbetween.

Of course GPs also tread a fine line as people have said. They don't want to be referring the worried well and wasting resources.

In UK most healthcare is managed by GPs. For referral to specialists there are formal pathways now for many different conditions.

So if GP suspects X condition often they firstly have to do specific blood tests and try certain treatments like medication, physiotherapy. If they haven't done this then referral won't be accepted.

If GPs aren't running any tests then it's likely the symptoms and clinical examination are not pointing to any particular condition and are not concerning to the GP.. That's why it's important to go back if symptoms don't improve or get worse as the picture may then become clearer

There are steps that need to be taken before a referral. Unnecessary referrals are just going to be rejected so it's a waste of everyone's time to make them.

Looking in from outside it's crazy the way the British accept such rationing and limited access to what is routine medical care in the rest of Europe. Of course no one wants over or unnecessary referrals or tests to maximise profit as is the case on occasion in the USA, but there is something available between the two extremes!
The U.K. has some of the lowest survival rates in the western world for many diseases and cancers. I believe this is due to the absence of regular health checks, late diagnosis and a reluctance to refer on, not to mention huge time delays. In Germany for example, you identify a problem, see your physician same or next day and specialist almost immediately. Besides that your regular health checks pick up on issues early.

If GPs referred every worried (well) person, waiting lists would be even longer. Referrals are based on need.

ive never had this issue. I'm not anxious in the slightest, but my children and I have lots of random health issues and conditions that we constantly need referrals for. I go in prepared, with a list if need be. I explain the issue, and ask for the referral if I know the situation warrants that. We have always been referred. And it's always been required.

I know someone who constantly thinks she has cancer or similar. She is in asking for referrals all the time. They are rarely made as there is no clinical need.

I may just be blessed with a good GP but this has been the case even when I changed surgery's.

In fact I often wish the surgery could do more investigations themselves without the referrals but that's the set up!

I've not had any problems with getting referrals, they do always tell me there's a log waiting list and going private would be faster but they're usually wrong, never waited longer than a few weeks.

A previous GP of mine said that some of the referrals they sent in were being refused, so I guess that means hospitals are/were only accepting the absolute worst cases.

We have always had pressure not to refer for financial reasons. I tend to ignore it! All the evidence is that those GPs who develop an interest in a particular area refer more, not less, as you are more aware of the possibilities.

Having said that, I do decline unnecessary referrals all the time. People don't have a great understanding of what is appropriate to manage in primary care.

cannot even see a GP at mine, I have had a UTI for over a YEAR, have had to go private to get the treatment I need

This.

We don't have a lot of worried well people. We have a lot of people who suffer early deaths, pain and disability due to late diagnosis, reactive rather than preventative care and being dismissed by GPs.

You’re not a fan of the NHS are you?

How much does the German system cost users?

I hadn't encountered this until we came across my in laws GP. He was the sole GP at his surgery. When MIL went to him with problems breathing he told her she had allergies and prescribed piriton. When she had problems breathing he said it was asthma and gave her inhalers. She got worse and worse and he wouldn't refer. Eventually FIL took her to a private specialist and she was operated on for severe lung problems. She died a few weeks after. He lived a couple more year but stuck with this GP. When he had a huge growth on his head he saw the GP, who told him it wasn't skin cancer, but cosmetic and wouldn't refer. A month later FIL saw a private specialist who took a biopsy. By this time it was so huge that he had to have a very big skin graft. He died shortly after the operation.

It would cost the UK £73billion more per year than we already pay if we wanted to fund at the same level as Germany.

https://www.health.org.uk/news-and-comment/charts-and-infographics/how-does-uk-health-spending-compare-across-europe-over-the-past-decade

I’m a doctor. The nhs is terrible because people keep voting in a right wing party who has no interest in maintaining or improving it.

If it’s over a year wait for a routine neurology review then if they refer in Susan who is worried unnecessarily and the GP is confident is fine (after 10+ years of training) then people like Liz who actually has undiagnosed will have to wait even longer. So we can’t just refer everyone who wants to be referred.

I work in secondary care so I see patients in clinics referred by GPs.

We have both lots of worried well people AND people who have conditions missed.

But a 'patient being worried' does not and should not = referral, because then those who do meet the criteria for referral would have to wait even longer.

There were threads on here during lockdown about people whose family members died after being fobbed of multiple times over the phone. There are two that really shocked me, both young men, one who had stomach cancer and another who had renal failure. It is really not acceptable. But nobody wants to pay the tax. I would willingly pay a bit more for a better service, but there is no guarantee that the money would be used sensibly.

@PosterBoy well I can find 15bil straight away in unclaimed benefits https://www.entitledto.co.uk/blog/2023/may/billions-of-means-tested-benefits-remain-unclaimed-each-year/. This has been going on for a number of years (decades) so it’s arguable there’s been plenty to in invest in a service that will most likely directly benefit those who those benefits are targeted at given established links with poverty and health.

It may not boost us up to German levels, but with sympathetic and strict management it would make a huge difference in the short term and provide maintenance longer term.

I use a private GP service (Babylon) and I always get referred when I ask for a referral. Obviously there is a clinical assessment but I’ve never had a GP push back (more often than not she will suggest seeing a specialist even when I haven’t asked for a referral).