Particularly interested in people within the medical profession to answer this one?

[asdou]

AIBU to think that when consultants send letters to your GP, that they should review them and action them (as in maybe call you in for an appointment or something?)

As it is with my practice, there are 3 doctors. My GP is down as the senior doctor, though the GP I see the most is probably the female GP.

Anyway, today, it turns out, that though I've been cc'd on 2 letters from consultants re changes recommended to my meds etc., they are never read, or certainly never actioned.

Today I went because yet another consultant has referred me back to the GP as I need some general stuff done before they can do the specialist stuff. The GP seemed totally baffled and then annoyed/anxious. Whether she was annoyed at them firing me back at her, or annoyed at herself for not having read the letters or what, I don't know, but she seemed just annoyed is the only word I can think of. She then said she wasn't going to prescribe me anything until she spoke to the medical/clinical registrar (she used different terms). Why was she annoyed? Because it was outside her speciality of general practitioner?

But, AIBU to think that when a consultant sends a letter to your GP that they should at least read and action it? Not just file it onto your file?

This seems like an issue with the administration of the practice not the GPs themselves. I would speak to the practice manager.

Or when I receive the letters recommending a medication change, is it up to me to call the GP and bring the letter with me - bear in mind, I'm only copied on the letters.

Do you know what I’m not actually sure sorry. I would definitely raise with the practice manager though and find out what the usual procedure is.

Should be actioned by the GP - you’re cc’d FYI only

Letters are generally sent electronically and filed automatically into the GP system and marked for the attention of your formal GP (not the one you generally see). They would generally review these clinical letters along with results of any pathology and radiology tests ordered for their patients, along with hospital discharge forms. There are lots to review and things can be missed.

Whilst it's reasonable to expect doctors to be proactive, as a patient make sure the required changes happen by making an appointment and raising the issues with any GP in your practice you feel comfortable with.

The amount the GPs are trying to deal with are huge and the system doesn't make it as easy to identify drug changes etc. as it should be. Plans are underway but it will take a while before all organisations will be ready to move to improved electronic communications

Depends what they asked the GP to do.

This is an issue as old as time. GPs are not the hospital's dogsbody but a lot of hospital letters airily treat them as if they are. Neither do they have the skills of the hospital consultant to interpret some of the tests or the budget to order them.

Yes, you can ask GPs in your letter to kindly do x or y, or reduce the dose of drug in 6 weeks or something, but there is a line where you really should be doing it yourself.

This argument between GPs and hospitals has been going on since the foundation of the NHS and probably long before that.

This practice seems to be entirely electronic, except they don't read the consultants' letters! They just seem to be scanned or submitted electronically into their system. So when I say, oh such and such a consultant recommended a change to my meds 2 months ago, they look through the computer files and THEN action it.

I think they should be actioning things that require actioning, not just filing the letters and depending on the patient to make an appointment and bring it up.

I'm probably not a proactive patient, nor am I a patient who would be deemed entirely capable of managing my own health. So I think it's unacceptable that they've had letters from consultants for months in some cases, and they're just not reading or actioning them! They have access to them when I go in and mention whatever letters I can recall, but surely it shouldn't be the patient's responsibility to administer or request changes to their meds?

Letters requesting medication changes should be automatically emailed to your GP, reviewed and actioned in time for you to request the next prescription.

However it is always worth checking they have the letter well in advance of you needing the meds - bitter experience of us thinking we had done this for DH's meds then finding out not only they hadn't received the letter, then the letter didn't contain the actual details of the meds, by this time of course he has one tablet left the day before the bank holiday weekend

I think I'll speak to the consultants and request that they follow up letters with a phonecall where actioning is required. I can't be relied upon to know what needs action and what doesn't!

I think it’s highly reasonable for your gp to seek clarification before auctioning a med change they are not comfortable with. Doctors are legally responsible for any prescription they write.

Regarding letters, some surgeries process letters as they receive them, others are more responsive. Also, some letters get automatically downloaded into patient’s notes, others are physically scanned on (and then auctioned). It doesn’t take much for a back log to develop. Also, some consultants can take a while to get letters dictated and then sent out, so the doctors can receive them weeks after the event.

The letter was sent surely a month ago requesting my GP to change my meds from one med to another. Nothing happened. Haven't been to GP until today, about the other issue, mentioned that, and she was in such a flitter about the other issue that she totally didn't add the new med to my prescription! I'm getting a little annoyed with them now to be honest.

Basically, I have to tell them what to fucking do!

I'll ring them tomorrow and remind her that she didn't change my meds.

And why are they referring back to GP if GP needs to consult with a registrar?

It's like the GP was thinking, this is WAY beyond my scope of specialism. Why are they asking ME to sort you out!

I'll see if there's a practice manager and ask to speak to them tomorrow. I can't be trying to interpret medical letters!

It's exactly the same at my GP surgery OP (a small and well-reviewed practice in a small commuter town).

I have an autoimmune condition for which I'm now under a hospital consultant. Lost count of the amount of hours I've had to take off work because the GP hasn't read or actioned anything in the clinic letter. I've also wasted months being on the wrong medication before I started being proactive about it all.

The way it works now is- I get my copy in the post, I wait a few days and go down to the practice (they don't accept anything to do with prescriptions over the phone). The receptionist will bring my letter up on screen and stare at it blankly for a while. I get involved, the secretary gets involved, a passing nurse gets involved. Eventually they agree it looks like I need a different prescription and put in a request for this. Several days later I may or may not receive the prescription.

If I didn't get involved nothing would happen. It makes me sad for elderly or less confident patients.

Wow, OP. I don't even get most of my consultant letters. If the GP didn't action them, nothing would happen. (I know this because the GP read me some. I don't know why I don't get copies - am I meant to?)

I've showed up at the pharmacy and been handed meds I had no idea what to do with, and had to call the GP to ask about. It seems like there can be diametrically opposed behaviours... is there some kind of policy on this?

There could also be an issue with Consultant wanting X drug but GP surgery preferring to prescribe Y which is similar but much cheaper to fit in their medicines budget.

@bluedoor4 Sounds like my bloody practice! Except I can't be chasing them up on things when I'm not a medical professional myself!

Going to try to speak to the practice manager tomorrow (assuming there is one).

Yes, I can imagine older patients just dying because nothing is being read or actioned. It's not acceptable!

My GP is the same.

I don't have the spare energy/resources to coordinate medical professionals for them. I feel like a ping pong ball.

Nobody talks to each other. Nobody takes responsibility for anything. It's always somebody else's fault or somebody else's problem, and meanwhile I get stuck in the middle suffering while they stand around pointing their fingers at each other.

I don't care about individual "blame", I just want professional people to take some bloody professional responsibility for their own actions and role in the system of providing care.

My clinic letters are pointless. It's half arsed and dangerous.

The GPs have a huge workload. Theres a massive recruitment and retention problem with general practice because it is so over stretched. It is not unreasonable your GP wishes to speak with the registrar as once the GP prescribes something, they are responsible for it and any consequences of it. By prescribing some medications they are also agreeing to do the follow up monitoring (bloods or regular ECGs if reuqired). And yes, they aren't the specialists so it's not expected they ought to know everything about every medication without taking advice or looking them up in the BNF.

In your specific case, it's difficult to say who's being unreasonable. There may be a problem with letter actually being read by GPs (an admin person uploads to your record but it's never put under the nose of a dr). The hospital doctors may be using the GP as a dogs body by suggested something prescribed and adding "do blood every 3 months" for example. Also your hospital doctor is perfectly capable or writing a prescription themselves during your appointment, any doctor can complete and FP10 (green prescription) apart from those in their 1sy year if practice. They rarely do and tend to fob it off to the GP and expect them to deal with it rather than spend 3 minutes doing it themselves while you're in the appointment.

I would still raise the issue with the practice manager, not because I think the GP did anything wrong by wishing to discuss it with the hospital doctor, that's just being responsible. But they may need to review their process for having letters read and actioned before uploading to the system.

My GP seemingly never reads the letters my consultants send to him. He has ignored requests for him to change my medication and take other actions. I know if I want anything doing I have to go into the surgery and make a fuss. As such I've been marked out as 'that patient'. I just take the view that he is massively overworked and as the only permanent Dr in the surgery he just doesn't have the time to review all his letters. It's hard to find time when you work to get into the surgery every time there is a new letter that has been ignored but I don't see what other option there is apart from to change surgery (which I'm doing in a few weeks due to a house move, but doubt the new place will be any better)

Hi, can I ask how many hours does the female GP actually work? In my practice, 3 GP's too, all letters are scanned and sent to the GP's partners. If the other GP's don't know about it they will mark it for the female GP's attention. She's only in 2 days a week, so you can see why there is a delay. We probably have 100 letters and results per day. I'm sure your letter will have been passed on, but it's probably still sitting waiting to be actioned. How long have you had these letters? In fairness to her, of course she might be annoyed. Primary Care is not just a dumping ground for extra work the hospital don't want to do. Why didn't they prescribe it in the first place or do the work-up or referral? It's called passing the buck. At least they copied you into the letters, I'm all for patients taking responsibility for their health. I get why you're annoyed, if anything you could put in a complaint and let the practice highlight this problem AGAIN to the hospital (I'll guarantee this isn't the first time). It's totally unfair of them to expect someone to prescribe /request something they're unfamiliar with and to make that decision in 10 minutes!

Yes letters should be read and actioned. Most individual GPs will get 40 + letters a day so some things might dip through the net. However hospitals doctors are supposed to organise tests and can prescribe themselves rather than fobbing stuff back to GP.