To think the NHS could/should trust us to make our own referrals in some circumstances

[Normalisavariantofcrazy]

In the same manner that I can phone the school nurse and say 'can you do a hearing test for my dc' and she toddles off to the school and does one, why should I as an adult not be able to do that for myself but instead need to make a GP appointment before seeing a nurse to check my ears to then be referred to audiology?

Same thing for continence services, one PCT I lived in it was a self referral service, this PCT it's a GP referral service. Again with this one why is it not also automatically linked into gynae? So you have your baby, they then put you on a list to get a letter 12-18 months later inviting you to a check up and advice service if you want to take them up you do if not no harm no foul. With that I wonder if a lot of things can be nipped in the bud with early physio intervention and also means again no embarrassing chat with the GP so possibly a higher uptake on the service.

There are other areas where this could be implemented too such as running clinics in the same manner as sexual health clinics - so diabetes, asthma and blood pressure checks could be run as self referral drop in services.

I realise a lot of this is probably finding restricted but you know when you have a thought and you want to mull it over?

AIBU with this?

I can self refer to most specialists here. It speeds things up so much. I do still find it a bit weird when I call the physio dermatologist and make an appointment because I think they'd be the right treatment, without seeing the doc first.

Physio OR dermatologist...

Because those are specialist services that cost a lot of money and most things can be treated/fixed before they need referred.

Having worked in these services 90% of the people who think they need referred Definitely don't!!
And after appropriate treatment from the appropriate person or service they would also agree about 95% of the time.

holidaysarenice, couldn't agree more!!!

Plus, the waiting lists are huge as it is without the services suddenly being flooded with thousands of people self-referring inappropriately (which WOULD happen)

Agree with holiday. The system would collapse under the strain of all the inappropriate self-referrals.

It depends too on how the service is funded
For the service I work in it is more of an issue than it used to be
We need the GP referral to fund the service, GP's hold the budget now

I think if you have a chronic health condition or are under a specialist, you should be able to self refer to some extent- as I have Crohn's I have the number of an IBD nurse at my hospital, if I think I need an appointment (or advice) I contact her. Likewise I know neurology run an MS nurse service. Not sure if other departments run nurse services, but I think they should! Including the diabetes, asthma and blood pressure you mention, these could have a nurse led drop in session. The number of things that can be dealt with via a quick email or chat to my nurse rather than take up an appointment!

However, new referrals should probably continue to be dealt with via a GP, even though it's not a perfect system and sometimes you have to return a few times before you get the referral you need (this happened to me twice and in both cases the consultant confirmed the referral was needed, so GP was wrong not me!).

Well other systems with self-referrals have not collapsed, but then again they tend to rely on insurance/privately funded consultations and do not have the huge NHS waiting lists.

You only need to look at the amount if self referrals to A&E to see the flaw in what you are suggesting.

it depends would hypochondriacs have the same power? i can see it being an advantage with long standing conditions for example if you have skin problems and you're given treatment that works (so signed off) but you're going on holiday and your treatment is photosensitive (sensitive to light so you can't use them in hot countries) you should be able to refer your self

depression- treated once through counselling and you feel you need a backup session

cases like that yes other things maybe not i can see it being abused and real cases not being seen

You only need to look at the amount if self referrals to A&E to see the flaw in what you are suggesting

Exactly.

Agree with holiday.

The services would be abused so so much.

I can self refer through fast track gynae having had chronic conditions. It saves everyone the hassle of writing out new referrals and trying to ensure they refer me to the right doctor/ department (two wards, several outpatient clinics).

Have done it since I was sixteen or so.

The only disadvantage is that if I want differing treatment (e.g. if I want to see another doctor), then to some extent I need to go back to GP, as reception won't always accommodate stuff like that.

It depends on having a bit of an idea of your illness though. I know when to self treat, when to see my GP and when to contact my consultant. I've got a good idea of what each can deal with through experience.

I can see it not working in the sense that other patients won't necessarily have the knowledge to differenirate (just as I wouldn't necessarily with problems that aren't gynae).. So before you know it you've got twenty patients with recurring headaches filling up a clinic that should be reserved for serious or chronic neurological conditions.

I would think most clinics would end up in a similar way.

I don't see a problem at all if nurse led clinics were opened up - but I think a lot of consultant led stuff should be left as is with only specific self referral depending on patients circumstances.

Plus - having to see community based GP is always beneficial as means they can best support their patient if they know what's happening isywim. If the patient continually bypasses them it won't help at all.

It is easy to assume on (relatively) sane forums like Mumsnet that people have a reasonable level of common sense. In reality, that is not the case, hence the need for sometimes convoluted systems. When you write leaflets for the NHS, you are advised to write them as if you are addressing someone with a reading age of 11. Seriously.

HOWEVER - I do think that there is a basic cultural problem with this and it has to do with failures amongst GPs. Don't get me wrong - I am a passionate believer in the health service, and I know GPs work damn hard. But I don't believe that the system is beyond criticism. The issue I can see is this: GPs generally work to a kind of flowchart. It's like 'rule out the obvious things, then refer if you can't treat in the surgery'. Which is obvious common sense. BUT the problem is that in cases where the most obvious thing isn't the problem this requires persistence on the part of the patient - they need to go back and back. And GPs can be very slow to refer out of the system. I know about cases of cervical abnormalities where young women had to go back literally tens and tens of times before they got the referral they needed to a specialist. It's an appalling record. I also heard a programme on Radio 4, where person after person described getting cancer referrals beyond the GP as like tacking a line in rugby.

Many people are too busy, or too trusting in the system to keep up that level of persistance (not least because the NHS labels them the 'worried well' or tells them they are 'normal' and they are made to feel like they are wasting time and resources) - and inevitably, the bolshy middle class are favoured, because they have the confidence to keep trying.

I don't agree with patients referring themselves except maybe in case of ongoing or chronic condition. We laypeople may not guess correctly what is wrong with us. It is for the same reason I hate the phrase worried well, if you are not a doctor, you cannot necessarily tell what is wrong or indeed if anything is wrong.

What I would like to see is the systems changed so that GPs didn't have financial incentives not to refer patients. I think that creates a potential conflict of interests between patient and GP which is unhealthy. I want to see my GP knowing she will do her best for me, but also recognise when she can't help and pass me on to someone who can, without having to go back several times and argue.

That is the real issue with NHS referrals, and I'm always astonished at what seems like an unethical system.

If we used self referral more not only would there be a risk referring themselves when they didn't need it but also someone who does need a specialist inadvertently referring themselves to the wrong specialist thereby delaying their treatment. Just think what the waiting times would end up like when a large number of appointments are taken by people who didn't need one.

Those on MN who are good at understanding their health can't assume that everyone is as switched on or as sensible. You'd wince at some of the demands I've witnessed.

"Because those are specialist services that cost a lot of money and most things can be treated/fixed before they need referred."

True, although the GP service is also a specialist service that costs a lot of money, we just don't think of it that way because we use it all the time and their specialty is... everything.

Don't France have a system a bit like this? Where you self-refer to a specialist?
Although I think they have an up-front co-payment as well. I could be wrong, I have never been ill in France.

Boulevard -yes, I believe they do, and also that it is best system in the world according to WHO.

I live in the ME and it's self pay, but most employers provide insurance. I can see any specialist I like with about 2 days' notice and I was once given a non -urgent scan on the same today. In the UK I waited 1 year for a cancer diagnosis because first the GP and then the hospital failed to investigate properly. I know which system I prefer...

Yes, you go directly to a specialist in France. No need to pass by a GP if you know what is wrong with you - twisted my knee, got an appointment from an orthopedist. Gynecologist does my smear tests, ophthalmologist checks my eyes for prescription or treats an infection. I have seen a GP once in the last 14 years, and that was to get a certificate of health so I could run a race.

Re upfront payment - It depends on where you go for treatment: I just give my social security number and mutuelle card at the state hospital, no payment necessary. Anywhere else, you pay and then get the money back from your insurance.

"not only would there be a risk referring themselves when they didn't need it but also someone who does need a specialist inadvertently referring themselves to the wrong specialist thereby delaying their treatment"

Most people aren't thrilled about losing hours of their lives going to/from a dr's office & waiting while there, if it is not actually necessary.

And it is the whole having to wait for a GP appointment, then for the specialist appointment afterwards that delays your treatment.

I agree with all of the others who say look at A&E to show how flawed this would be.

I have attended A&E many times, I worked in Care and have/am a Carer.

It is frustrating to sit waiting for an ambulance, to then see those that were prioritised sent home for a Chest Infection, or something equally less important.

I am talking about healthy 20-50 year olds, this has happened a few times, my Relatives/Service Users ambulances was diverted to neighbour's up the road, because they exaggerated their symptoms.

I know people who take themselves to A&E, when they could of attended their GP/Walk In much earlier and been treated easily, some over the counter.

People who need the services would wait much longer, because of clogging.

"And it is the whole having to wait for a GP appointment,"

All of the GP's in my area have walk in open clinics, for a late night appointment, you don't wait more than four days.

It sounds as though the GP system needs an overhaul in some regions.

The whole system would collapse within 5 mins if people were allowed to self refer straight to hospital consultants. People with anxiety would be queuing up to see cardiologists, those with headaches would be booking up all the neurologist appointments... etc etc.

The GP role is as much about gate keeping as anything else. I think the only way this could work is if the system is 100% private and therefore cost would keep demand down (but also stop those that really needed care from accessing it).

revoltingpeasant

If GPs didn't have a gatekeeper function who/how would we keep NHS spending under control? The pot isn't infinite ...

"People with anxiety would be queuing up to see cardiologists, those with headaches would be booking up all the neurologist appointments... etc etc."

It just doesn't happen like that here in France.

When you call up a specialist doctor, you describe your symptoms and the reason for your call to the receptionist. If your call isn't relevant to that specific doctor, you would get told to go see a GP.

If you have a gynaecological problem, surely you know the doctor to see about it isn't the GP. Or if you fell and twisted your knee and still can't walk a month later, you know you need an orthopedist. For itchy/hurting eyes you know that you need to see an ophthalmologist. What exactly is the point of seeing a GP first? Your way incurs more cost for NHS because of 2 dr appointments where 1 would suffice and delays treatment.