To be annoyed with my friends GP? (and can anyone help - Named referral)

[ASorcererIsAWizardSquared]

My best friend is ill, but the GP are doing so little to help her.

Her symptoms are indicative of her having Crohnes disease, mouth full of ulcers, sudden weight loss, nausea, unable to eat...etc.

My brothers DP has crohnes and spoke to her Consultant about my friend, and the Consultant said my BF should have been seen by a consultant ages ago, that the rapid weightloss and mouth ulcers alone should be screaming REFER TO GASTRO at them, and told brothers DP to tell my BF to go to her GP and tell them to refer her straight to her.

She said as its a named referral, bf's GP legally had to make the referral.

BF been to her GP today, and they have refused to refer her, stating they want to do more investigations and get her in counselling for her anxiety before they will refer her to a gastro consultant.

Quite frankly, by then my friend will be dead, she can barely eat, her weight has dropped from her being a size 12/14 to a size 6 in the space of 4 months, she is wasting away in front of us and her GPs are being assholes and there will be nothing of her left for them to refer by the time NHS counselling materialises!

What can we do? I'm lost and i cant bear to see my friend so ill and being messed around like this, the GPs can't do anything, she needs to see a proper Gastro Consultant!!

Election, I'm really not having a pop at GPs. I trained in and then worked in the NHS for 12 years so I know the pressures and I think the NHS generally does a sterling job - I was taught that functional disorders required a psychiatric consultation in the NHS context, I've only moved recently, and was surprised to read that a GP would diagnose this.

Tell your friend to ask to speak to the Practice manager at her GP's.

Do you have an emergency out of hours surgery where you live?

We do and it's not connected to our usual Dr's surgery.
If you do have one you could get your friend to get the number and ring them when her normal surgery is closed.

Please don't let her leave it I have Ulcerative Colitis and I have 2 friends (one a very close friend)that have Crohns,one is about to have major surgery to have her bowel removed because of the same symptoms you'd described your friend has.

Myself and both of my friends have all nearly lost our life's in the past because of our conditions.

You are far too over invested in the idea/ wish that your friend has crohns disease. If her main problem is mouth ulcers seeing her dentist and discussing a referral to an oral surgeon might be sensible. A lot of diseases can cause bad mouth ulcers and oral surgeons who get most of their referrals from dentists are experts in this area and can do a biopsy if necessary

^Do you have an emergency out of hours surgery where you live?
We do and it's not connected to our usual Dr's surgery.
If you do have one you could get your friend to get the number and ring them when her normal surgery is closed.^

Please don't do that unless you want to waste your friend's time. They will ascertain that it's an ongoing issue and tell her to contact the GP on the next working day.

I was taught that functional disorders required a psychiatric consultation in the NHS context

You haven't worked in the NHS for a while then, do you have any idea how overstretched NHS psychiatry is? We have hundreds of patients with somatisation issues, the idea that the mental health team would see them all is, I'm afraid, laughable. I can't get my young girls with serious eating disorders seen without a several month wait.

Elphaba, again. Thank you for the informative post.

If she's waiting for a colonoscopy I can see why the gP isn't referring her at the minute!

The first thing the consultant will say is let's have a look at the result of your colonoscopy.........oh you've not had one yet? Well go away and have one and come back when you have.

So at the minute it would be a waste of an appt. it's the colonoscopy waiting time which is the problem surely?

If she is waiting significant time for a colonoscopy the gp needs to look at whether there is a shorter waiting list elsewhere. She should also be ensuring she can see a consultant quickly.

At the risk of stating the obvious a diagnosis of depression/ anxiety does not exclude chrohns/ colitis/ bowel cancer/ hiv or whatever. Most of us would be pretty anxious if all of a sudden we couldn't control our bowel. People with depression get other things wrong. So really its irrelevant until all else has been ruled out.

When a relative of mine developed colitis he was anxious and depressed. He felt he couldn't leave the house. His weight plummetted from 11 to 8 stone. Part of this was psychosematic in so far as in his head the less he ate the less shit there would be . By the time he had his bowel removed he was so weak and malnourished that after the op he ended up in intensive care for 6 weeks and nearly died.

Oh and he had investigations quicker than the op because he could afford to go private.

So gp defend all you like but this lady sounds seriously ill to me.

She should also be ensuring she can see a consultant quickly.

By waving a magic wand and beaming down a few more consultants to the local hospital I assume?

If she has a combination of symptoms that suggest a malignancy, she can be seen under the two week rule. If not, waiting times are entirely outside of the GPs control. This women may get benefit from asking her MP to intervene if waiting lists are long.

No waiting times are not outside the control of GPs. Different hospitals have different waiting times, GPs can select where to refer to based on this.

The fact is that there is a sick woman at the centre of this thread.

tobysmum77 where I work all our local hospitals have very similar waiting times. I can do nothing to influence this. It is rare to find that hospital A will see people in 2 weeks and hospital B will take 2 months.

If the patient is genuinely this sick and with severe weight loss, I'd have expected her to be referred on a two week wait form, which makes me wonder if there is more to the story than the OP knows.

To see gastro where I am would be similar wait time in all the local hospitals. Mostly because the gastro' work them all.
Even with choose and book I am unable to see the surgeon until July 29th and I have a huge mass. And crohns.

"You haven't worked in the NHS for a while then, do you have any idea how overstretched NHS psychiatry is? We have hundreds of patients with somatisation issues, the idea that the mental health team would see them all is, I'm afraid, laughable. I can't get my young girls with serious eating disorders seen without a several month wait."

I really don't understand the logic that because a service is overstretched it makes it laughable to even ask a question . I was working and living in the UK until last Summer and referred into psychiatric services, and was myself in receipt of psychiatric services in that time. Of course it is overstretched, but a functional disorder is a real illness too, being psychiatric doesn't make it less important to treat seriously. It certainly doesn't make it laughable to ask a QUESTION about what best practice would be.

And it seems that answer is here, in part:
www.rcpsych.ac.uk/pdf/C%20Feinmann%20Slides.pdf
So GP management for low risk cases and stepped care approach as someone becomes progressively unwell.

I have had 12 years of banging my head against the brick wall of trying to get psych services to take my functional patients. They're not suicidal? They're not psychotic? they're not interested. The presentation you've linked is an ideal world scenario. There may be the odd team here and there that have the miracle of joined up physical and mental health teams to help these people, but they are very much an exception and not a rule.

It's just interesting, because as a presentation it's often related to OCD, which most of my psych referrals would be (and my own diagnosis, for which I had quite a LOT of NHS support with a moderate-severe diagnosis). I never seemed to have had much trouble having any of my cases seen by psych teams, certainly at the level of CMHT and CAMHS. I wouldn't be expecting these patients to be accessing inpatient levels of support, but in terms of impact and disability, if you're at a level you are unable to work or function in society (and if you have a significant functional disorder where you are not eating/losing lots of weight etc that's likely to be the case), how does this differ from moderate-severe OCD or depression? I'm not sure what the barrier is?

duplodon fair point, maybe not the best choice of language but I can assure you that where I work (deprived area of London) psychiatry does not have the capacity to see even a small percentage of our patients with somatisation and functional conditions.

"(and my DH often doesn't bother to invoice PP's who are seeing him because their GP is tooling around and there is something seriously wrong)"

OldFarticus your husband is a very special man. for him.

I'm not disputing that they're not being seen, just wondering why it is differentiated from other disorders of similar severity. Do your OCD and moderate depression clients get a service or is there none in your area at that level of care?

Not much, no. NHS mental health services are hugely stretched, our eating disorders service has an 18 week wait.