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?

[CoteDAzur]

"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..."

1998 was 16 years ago

NHS England has a budget of £95.6 billion for 2013/2014.

[BeyondRepair]

COTE I think that system sounds fantastic.

I have had and my family and friends too many experiences where a GP has not done enough or got something wrong...and wasted time where getting to the knub of the issue with a scan or whatever, gets the heart of the problem straight away.

You therefore solve the problem and get rid of that patient as it were almost immedialty instead of much to and froing trying to rule things out.

[TequilaMockingbirdy]

Sorry completely missed that date

I shall find more

[BeyondRepair]

cote do you pay for your healthcare there? I was under the impression across Europe it was all free?

[CoteDAzur]

"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."

That's not what 'evidence-based practice" means

EBP is about making all practical decisions 1) based on research studies that are 2) selected and interpreted according to specific norms characteristic for EBP.

That is, EBP is about a doctor being scientific rather than woo. Not about a GP eliminating stuff and then referring the patient to someone else.

[firstchoice]

I agree entirely with Struggling100!

The system as it stands now doesn't work, does it?

I have a longstanding mobility issue (pain on mobilising, limited capacity).
I saw a Consultant 3 years ago, who, on the basis of an MRI, told me to self refer back if it didn't improve. A year later it hadn't (complicated by a pregnancy during this time). My GP refused to re-refer and passed me to physio. I dotted on, asking for referrals from both physio and GP who both said: 'well, we've seen you walk your children to school'. I explained that I HAD to and also had to lie flat for an hour after etc but they clearly 'didn't believe me'.
I eventually found the Consultant also worked privately, saved for 6m for the appointment. He was shocked at deterioration, and lack of appropriate drugs from GP. He wrote to GP asking him to refer me directly back to him on NHS as he suspected I needed surgery (on both legs and both feet). GP refused. After much argy bargy, I got referred back, MRI is now done and surgery should take place this autumn (just as I will be forced onto JSA, despite receiving DLA at highest level 'for life').

If I had been able to self refer back to that specialist I could have been saved nearly 3 years of pain and being stuck on benefits.

[BeyondRepair]

Struggling, that is utterly staggering a General Practitioner even refusing after consultant?

Can you report treatment like that..

[CoteDAzur]

Beyond - Free or not depends on your level of income. If you are low-income, all healthcare is free for you because doctors can't charge you more than minimum set by the state and social security pays for all of that.

For the rest of us, social security pays 80% of the minimum set by the state and you pay 20%, except if you have private insurance picking up the rest.

If you always go to the state hospital (which is nice and well-equipped), you get charged the minimum agreed by the state, so you may not need to have private insurance.

Disclaimer: I live in a part of France with slightly different rules about this stuff so I'm not sure if the numbers apply exactly to the entire country.

[CoteDAzur]

firstchoice - That is awful

Could you not have changed your GP when he refused to refer you to a specialist?

[BeyondRepair]

you get charged the minimum agreed by the state, so you may not need to have private insurance Ok we had to use hospital once in France and were charged 30 euros.

anyway, after my experiences it certainly makes sense to me.

I love my GP but only after seeing bad ones, his main philosophy seems to be...a patient generally knows their own body better than anyone else!

[BeyondRepair]

Sorry meant first choice.

[turgiday]

Because of hereditary health problems, I have to pay really high fees for travel insurance. I doubt I would get private health insurance. That kind of system would cripple me financially.

[eurochick]

firstchoice that's shocking.

Beyond healthcare is certainly not free across Europe. Even in our close neighbours Ireland and parts of the UK (Channel Islands) you have to pay.

Cote that sounds similar to the system in use when I lived there. I would have to pay a small proportion of the cost of an appointment. The rest was picked up the mutuelle. Even as a very poor student I could scrape together the money if I needed to see a dr. I didn't have the private top up.

[turgiday]

You know many people in the Uk already struggle to pay their prescription charges?

And students are not the poorest demographic.

I have to see a GP, consultant, or other specialist on average once a week. On a top up system, I would be paying a fortune every month.

[CoteDAzur]

So are prescriptions not covered by the NHS?

They are covered in the French system.

[turgiday]

These kind of proposals always really frighten me. I work part time, the most I can manage with my ill health. Under some of the proposals I have seen for charging for health care, I would be better off not working and getting it for free. I won't be the only person in this situation.

[firstchoice]

Beyond and Cote

I tried. We are rural and there is nowhere else we can go. There are 3 GP's in the practice, but he is Head of Practice and if you see another one they just fall in with his line anyway. I discovered this when I saw the paperwork the Tribunal sent to me contained a report by another GP I had seen in the practice.
I had gone to ask for advice managing pain flare ups. I had been previously been told to 'buy some paracetamol at the chemist' but this was not sufficient and the pain was interfering in my daily life (ie was having to crawl up stairs in evenings to put children into bed) and disturbing sleep. The notes the GP made, which I saw in the Tribunal paperwork stated: 'MrsFirstChoice finds it difficult to deal with her children. She claims pain is an issue. I have - again - suggested physio and painkillers but she claims these "do not help"'. There was not a physio at the practice at the time and, no, neurofen didn't help.

[bochead]

Moved house recently & popped along to the new GP to ask for a referral for OT & SALT as per DS's diagnosed and statement needs. I foolishly assumed that the new area would match what he'd got in the old - at least to the point of giving him an initial appointment with the local specialists.

For pre-existing conditions where people relocate I now think it would save a lot of time and energy if patients could just self-refer to the new area's services within the NHS.

It's a long saga but an over zealous gate keeping GP has meant costs have risen substantially for the NHS, education and social care in regards to my DS long term.

[turgiday]

Cote - You have to pay a fixed charge for prescriptions, unless you are very poor, elderly or have certain medical conditions. But those who are just in the bracket of having to pay, are still poor and can often struggle to pay the cost.

Whenever I have lived in very poor areas, the GP always asks me if I have to pay for prescriptions before deciding what to prescribe me.

[Booboostoo]

France is a bit more complicated than that. Some thing are covered at 100% like cancer treatment and pregnancy and some illnesses are covered at 80% and your insurance covers the rest. It also depends on what laws you have governing health insurance, for example here children are generally covered by the parents' contracts and the insurance company cannot refuse to cover someone with a hereditary condition. Since it's cover for 20% at worst the premiums are low.

[BeyondRepair]

It almost sounds personal first choice?

[turgiday]

What if someone doesnt have a hereditary condition? What if you develop something like lung problems because of exposure to asbestosis? A fairly common condition in older people in the UK.

[firstchoice]

Beyond, that's how it feels.
I am going to request my medical notes.

[Normalisavariantofcrazy]

Wow! Wasn't expecting this to take off like this!

Surely you'd expect the clinics to run a triage system - send out a form or ask over the phone for symptoms and accept or decline referral accordingly?

[eurochick]

turgid students might not be the poorest demographic but I was pretty damned poor when I was a student.

I liked the French system. The care was great and the accessibility was even better. I was happy to pay the small contribution that was required to see a dr.

I can see that with chronic conditions where regular appointments are necessary, the contributions could really mount up. I didn't experience this and don't know anyone who did when I was there, so I'm not sure how the system deals with it. Perhaps someone who is there now can help on that.