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?

[TequilaMockingbirdy]

A lot of symptoms that can be referred to specialists are signs of underlying conditions though, and put altogether by a GP can diagnose something? And yes, people would self refer for ridiculous reasons. We have people coming to A&E for splinters for god's sake

Like longtime said we need a sort of 'gate keeper' who can direct people to the area they really need.

If this isn't sufficient, people can go private

[CoteDAzur]

As I said before, if your problem isn't clear (tingling fingers, persistent headache, etc) you would still go to your GP who would send you to the appropriate specialist. You don't have to lose your GP's number if tomorrow you were allowed to go directly to a specialist.

But if you have a very clearly gynaecological problem, for example, like a smelly/itchy fanjo with ample discharge & strange new lesions/warts, you should be able to go straight to a gynaecologist.

Current system treats you a bit like idiots who can't ever know what you need. The system of self-referral works in France. Why shouldn't it work in the UK?

[Booboostoo]

I'm in France as well and the system is no way collapsing. The public health care system here is extremely well funded, you can self-refer and there are no queues.

I have experience of the Greek health care system as well, that one relies mainly on private health care and again self-referring with no queues and no problems like the ones people worry about on this thread.

[TequilaMockingbirdy]

People wouldn't though. Like has been said up thread, people can't even grasp the concept of A&E never mind all different areas.

I had a bit of a to do with someone on facebook because her and her friend's were insisting her child's eczema is a medical emergency and A&E worthy. These are the types of people healthcare professionals deal with day in day out.

The current system treats people like idiots because to be honest, quite a percentage of the general public are when it comes to health. That might sound nasty, but you only need to speak to a doctor, or a nurse and they'll be able to reel off stories about stupidity.

[TequilaMockingbirdy]

I'm not sure why it works in france, how long has it been going on for? People more educated in it perhaps.. I dunno.

The NHS is on the brink of collapsing and this would be the final hit I think if it was to come in.

[CoteDAzur]

Tequila - Are you saying that the British are nowhere near as smart as the French?

[TequilaMockingbirdy]

No I'm not saying that, because I've only been to france once and can't speak from experience :)

But when it comes to healthcare, I have found that a lot of British people abuse it

I'm saying when was it implemented, did it work in the beginning, has it always worked or did it progressively get better?

The fact we already have to have adverts helping people chose where to go in the event of a health scare is very telling - just think what it'll be like if we had this?

[DinoSnores]

"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."

A lot of those sorts of problems are exactly the sort of things that GPs can manage!

[turgiday]

It would have saved money with me. I have a chronic condition. I knew I needed to go back to the consultant. I had to see my GP, then was referred to and assessed by a specialist nurse, and then referred to th consultant.

But look at the tiny things peopel go to GPs with. Some would be insisting they see a consultant over minor stuff

[CoteDAzur]

Well, I've been here for 14 years and can tell you from experience that there is no discernible difference in intelligence between the French and the English.

... which brings me to: If self-referra works here, and works very well, there is no reason why it shouldn't work in the UK.

Your worries about people queuing at neurologists' doors for a headache etc just doesn't happen in practice. You call a doctor's office and his receptionist asks why you want to see him. You simply don't get an appointment if you don't have a valid reason to see a particular specialist.

[turgiday]

France spends a lot more money in its health system than we do. f we want to spend that amount, we can have a similar system.

[TequilaMockingbirdy]

Okay, well you have experience I don't so obviously you know more about it than I do. But is healthcare free in France like here? I've just read for most people it isn't but not sure if this is right. This would have a major impact on the results

[redskyatnight]

Depends what you are referring through. I don't think you can say (unless recurring illness/ persistant condition) that your bad ear needs referrring as opposed to managing via some other means.

I needed to be referred to a specialist department for scanning to see if I had a genetically inherited disease. In this case I had a letter from my relative's consultant advising that all family members needed to be screened and what they needed to be screened for. But the only way I could get referred was to make a GP appointment, wave the letter at my GP, wait for him to read it and say "I need to refer you". A waste of my time and his.

(and the referral then got lost, so I had to waste more doctors time chasing it up - I would have much preferred just to be able to manage the whole thing myself).

[CoteDAzur]

Why would I want a GP to "manage" my knee injury when I can get an MRI and an x-ray and get treatment from a specialist who knows so much more about knee problems?

Similarly, here in France, babies are checked out of the hospital by a paediatrician who then sees the baby every month for a year, then once every year. If ever your child has a problem, you go straight to that paediatrician. When DC break out in a viral infection which may or may not be something serious, why on earth would I want to waste time passing by a GP who would just about "manage" (or maybe not)?

[eurochick]

Dino but in other countries those specialists expect to see you for those kinds of ailments. Their time isn't seen as sacrosanct so that it needs to be guarded by a GP. It's normal to see someone specialising in that part of the body as the first port of call. E.g in Belgium when I had a bladder infection that I just couldn't shift, I went to a urologist. That's just how it works there. The appointment I had was much more thorough than the one I would have had with a GP in the UK.

I've lived in France and Belguim and experienced the systems there. They are so much better. No waiting - you can usually see someone on the same day if you need to. No need for two appointments to get what you need.

I think the issue here is with the attitude to medical services - they are "free" and so can be used at will. That attitude doesn't exist in France and Belgium (possibly because you can see how much everything costs and often have to pay a small %, so you learn the value of the service you are getting and don't abuse it).

[TequilaMockingbirdy]

After reading this www.civitas.org.uk/nhs/download/france.pdf it would seem France's healthcare situation is completely different to ours with most out patients being private, and 90% of the population having private health plans. This makes a massive difference. People are much less likely to abuse and take advantage.

I went to my GP with a knee injury once. He decided what it was straight away, treated me for it and it was fine. No need for expensive MRI's and X-Rays, no need for a specialist. If there would have been need he would have refered me.

[TequilaMockingbirdy]

I think the issue here is with the attitude to medical services - they are "free" and so can be used at will. That attitude doesn't exist in France and Belgium (possibly because you can see how much everything costs and often have to pay a small %, so you learn the value of the service you are getting and don't abuse it)

That's exactly it.

[CoteDAzur]

"France spends a lot more money in its health system than we do"

What are the figures you are referring to?

It would be interesting to see the comparison.

[canutesauntie]

I think there is some misunderstanding of the role of GPs. They are not just gatekeepers to the rest of the system, they do 90% of NHS consultations for about 8% of the budget. Yes they can be cautious in a diagnosis, that's the way doctors are taught, eliminating possibilities before referring on, it's called evidence based practice and it works.
If you have a complex condition they can be your guide & champion through the system too- my practice certainly are and help me navigate the advice from the various consultants that I have to see. It's all very we'll to say I have an earache I need an audiologist / neurologist etc but much illness is not that clear cut.

One last thing, many practices have excellent booking systems including online etc. Before the last election there was a lot of work going on around improving access but the funding for that was pulled, so not entirely the GPs fault if you have to wait for an appointment.

[turgiday]

Or you simply can't afford to use the service. For someone like me with a chronic illness, all those little payments would be so many, they would be unmanageable.

[TequilaMockingbirdy]

Britain: At the heart of the matter is UK spending on health, which at around £57billion a year falls well below the European average.
Latest OECD figures show in 1998 Britain spent just 6.8 per cent of its gross domestic product on health, compared to the European average of 7.9 per cent.
Public sector spending on health here is 5.7 per cent of the GDP, with private sector expenditure making up the remaining 1.1 per cent.
Britain spends an average of £1,510 per head of population on health - some £300 below the average for the rest of Europe.
The way the NHS is funded in Britain, through general taxation, differs from the state service in France and Germany.




France: Spends 9.3 per cent of its GDP on health and its system is funded by ring-fencing taxes for health, so-called 'social insurance' contributions.
This means that workers pay around 13 per cent of their income in tax specifically to pay for their health services, but many have 'top-up' private medical insurance.
The public sector spending on health in France accounts for 7.1 per cent of GDP with the private sector adding 2.2 per cent.
France spends an average of £2,034 per person per year on health, some 25 per cent more than the UK

copy and pasted

[turgiday]

Cote - I read in the WHO documents that were comparing different public health systems. Yes Frances outcomes are very very good. And they spend more money than we do on public health.

[CoteDAzur]

"I went to my GP with a knee injury once. He decided what it was straight away, treated me for it and it was fine. No need for expensive MRI's and X-Rays"

You were lucky. There are many different functional parts in a knee and if your pain is "inside", it is not possible to reliably diagnose just by looking at & touching it.

[TequilaMockingbirdy]

Actually France has increased to 11% now

[turgiday]

I agree that if you don't know what is wrong with you, referring yourself to a consultant is more luck than judgement. So if someone is breathless a lot, who do they refer themselves to? A respiratory consultant, a cardiac consultant, maybe the issue is a chronic lack of iron and they need blood tests? A GP can check out who is the most appropriate consultant for you to see.