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?

I think I'll speak to the consultants and request that they follow up letters with a phonecall where actioning is required. good luck with that. They don't even check the typed letter for mistakes prior to posting so doubt they'd ever call a GP after a routine appointment.

I’m a nurse in a GP practice . When correspondence is received from a hospital department etc , it is left for review in the GPs in tray . If any action is required , the patient is sent a letter or text asking them to make an appointment to see the dr or nurse . If the letter from the hospital is simply an information update eg: New diagnosis /treatment then this information is typed into the patients electronic file so that it can be seen at an immediate glance .
A change of prescription drugs would be acted upon in a similar manner .
All correspondence is then scanned into the patients file and dated so it can be easily accessed .
It sounds as though this isn’t happening in your Gps . Is it possible that correspondence is being scanned into your file by the clerical staff without being seen by the medical staff ? If so that’s unacceptable.

My DF's GP will refer him to a Consultant for his condition. The Consultant changes the prescription. A letter is sent to the GP. The GP doesn't change the prescription. DF goes back to GP about his condition. The GP refers him a Consultant. Repeat.

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There is normally a member of the reception staff whose job it is to take the letters from the electronic system in which they are received and put them to the Gp to be actioned. The Gp was probably annoyed as to why it wasn’t passed over to be actioned by the member of staff at the surgery

GP surgery admin here. We try hard to ensure that downloaded letters are scanned onto the patient record and forwarded to a prescribing nurse or GP to action medication changes. However, it would really help if the clinic letters are typed up and sent over in a timely fashion and the hospital consultation requesting a a med change actually prescribed it themselves. At least a month's supply, or enough to last until the patient's review appointment, where any further adjustment might be made.

Hospital doctors SHOULD refer onward to their colleagues in secondary care rather than tell a patient to go back to the GP and initiate a new referral. GPs at the practice I work at often write them letters reminding them of this - ditto when the hospital doctor tells a patient to acquire a hospital issue only drug from their GP.

Unfortunately it does pay to be on the ball with ones own med changes etc and we welcome patients bringing in their copy of a letter, which they've often received before we're get it!

In most other countries I've lived in, patients are expected to cart round a folder of their own notes, book, pay for and collect blood and scan results and present them to doctors for review. The NHS isn't perfectly joined up I know, but there is communication!

In my practice they are really good, luckily, and we are called about any changes or other information. I did find out that a blood test result was not communicated, but apparently I had been told to call within a week, which I'd probably forgotten.

Medical Practices do not have the time to do this, nor are they there to action things prescribed by a hospital consultant (although that may be better for patients) they have far to much to do already.

It is one reason why our NHS is not as equal and inclusive as it pretends sets out to be.

Anyone who is bright, articulate and/or proactive gets a better service from the NHS, (with extra benefits for being all three) especially if they have some medical knowledge.

My GP is on the ball- she recently wrote to me because one of my consultants hadnt been in touch (they'd told me at clinic they would be).

In saying that, I take responsibility for my own health because I have to. I know not everyone can/is capable of doing so, but wherever possible individuals need to keep on top of their own care. I'm between roughly 6 consultants and specialties - I keep up with what's going on because things get very complicated, very quickly.

If you see a doctor in clinic you can sometimes ask for a letter/prescription
change there and then to hand in to your GP - that can make it easier to keep up with than letters flying about.

I'm a GP Receptionist and the GP's in our practice read the letters before they are scanned. Usually requests by Consultants are not actioned but that's another story.

There is an option for the letters to be scanned when received and work flowed to the GP. IIRC this method is a bit of a faff as it could be work flowed to a GP not in work, hence a delay in actioning the request.

My consultant changes my meds, gives me a hospital Px for 4 weeks supply and a copy to give to my gp.
All the info is put in the clinic letter and sent to my gp, cc to me and my other consultants.
So I have 4 wks to make sure my gp repeat Px list is updated.
I still end up with errors and have to sort it out, but at least I have the documentary evidence!

My dd had very serious health problems and was under the care of GOSH and I always had to phone the gp surgery to ask them to read the letters sent by the consultants to action medication changed etc. I guess it depends on the surgery and how busy they are, but I found they never bothered to read them unless asked

I think you have just as much responsibility for your health and medication as the doctor. I value my health and if I had been copied into letters, but heard nothing from the doctors within a few days I would be calling the. GOs are under enormous stress so I wouldn’t have a problem doing this and not leaving everything to them, then moaning on Mumsnet because something hadn’t been done!

I also ask my consultant to give me a print out of my blood results because I can't have my meds without them.
There is always a delay of weeks before the gp sees the results.
The gp won't give me a print out unless I pay for it.
I need to keep an eye on this myself because I am on some pretty toxic meds.

That sounds so hard OP. I know you have comments saying patients have to take responsibility for their own health, but you have already said you are not capable of this.
I sympathise. I remember when I was very ill having a Dr explain that I needed to go to the hospital for some tests. I was too ill to take anything in and was surprised later to find out that the tests were for cancer, Apparently I had been told that, but when you are really ill it can be hard enough to remember your own name and address, never mind know what your GP should be prescribing you.

Hospital doctors SHOULD refer onward to their colleagues in secondary care rather than tell a patient to go back to the GP and initiate a new referral. if you work in a GP practice you should know this (mostly) isn’t possible because payment for secondary care comes from primary care/the CCG. The reason hospital consultants refer back to GPs to action is so that the hospital gets paid.
As a hospital consultant, I usually assume the GP might not see/action the letter. If it’s important I give a copy to the patient and underline the important bits for the patient to take to the GP.

While I appreciate that you all are saying that it's actually my responsibility - with all due respect - it's not. I am not a medical professional. I am a patient.
I'm not always well enough to remember what has been said, to bring all the letters to the GP, or even to get to the GP.
So they really need to up their game with me.
I'll ring and ask to speak to the practice manager tomorrow. Because my health is really suffering.

@thisisacrazyidea
Might explain why the hospital has rang me every day.

The hospital was bringing me to A&E initially, then decided to refer me back to the GP (3rd). Except the GP never read the blooming letter!

Just checked my phone. Do you know how many times it took me to get through to the GP today?

Fifty four times. Yes 54 calls. FIFTY FOUR TIMES to just get through.

I'd quite happily screenshot that to you but there are other numbers on there.

The thing that's most annoying me is that another consultant wrote to the GP, let me find the letter

A lot of drugs can’t be prescribed by GPs . They’re “hospital consultant only” drugs. GPs are not allowed to prescribe them. Hospital consultants know this, but sometimes still chance it anyway, so the drug cost comes off the GP budget and not the hospitals.

Also, as a GP, if I see that a letter has been copied to patient, I assume they will read it and act on it". For example, if the letter said “I would like Mrs X to have a blood test in a month”, I wouldn’t be writing to Mrs X about this unless I knew she had dementia or SEN. I would expect her to take some responsibility.

My surgery is average size. There are 2000 patients per GP. We get about 1500 hospital letters per month, between 5 of us. We read them all, but we can’t be expected to chase everyone up on the offchance they haven’t bothered to do it themselves.

I’m eating my tea now, having worked for 14 hours without a break, as a GP. This is normal for me. I’m not sure that it is possible for GPs to “up their game” OP. The game is as upped as it can be.
If you are so ill that you can’t read a letter (you clearly aren’t illiterate) then perhaps you need a carer to look after you. That is something you sort out with social services.

I went for a review with my psychiatrist, 3 months after I last seen her. 5 minutes into the conversation we realised we were taking about different things. She wanted to see me after changing my bipolar meds 3 months previously. However the letter went to my GP and nothing was done, so I hadn’t been taking the new meds, as I was not aware, and my GP had been prescribing my ‘old’ meds monthly. Shambles! Waste of 3 months and waste of a psychiatrist appointment!

It can depend OP- I agee that if I have asked a GP to prescribe something, then I would expect it to be acted upon within a reasonable time frame. Mistakes do happen and it is important for patients to be proactive too. If it’s happening regularly then it suggests a problem with practice administration and is probably worth addressing with the practice.

However, consultants and specialist registrars/trainees do get it wrong sometimes too e.g. not realising something they have suggested interacts with other medications being taken (especially if outside their area of expertise) and GP has to contact them to discuss it (and done of us can be hard for GP’s to get hold of directly via telephone, so has to be done via email/letter unless an emergency). I am also aware sometimes specialists want GP’s something the GP’s have been asked not to prescribe (e.g. a particular brand instead of generic) and if they do it’s the GP who gets asked questions/knuckles rapped for prescribing “off formulary” (which is different to off license).

I also agree with a previous poster in that there is some conflict between hospital consultants and GP’s regarding boundaries of “shared care” and the requests for tests/referrals the consultants send to the GP or whether they should arrange them. I see both sides. I’m a specialist and my good friend is a GP. I know she gets really hacked off when some consultants treat the GP like one of their juniors by requesting things they can and should do themselves, or make incorrect assumptions about what is realistic/deliverable in a the timescale specified, or within a community setting/resources. One example is: patient referred to orthopaedics re joint pain but ortho think needs to be seen by another specialty to rule out something before they go any further- they could easily refer directly by way of copying the clinic letter to both GP and the specialist they want them to see (with a “Dear x, please accept this letter by way of referral for assessment or investigation of y condition”). This prevents extra work for the GP and reduces delay for the patient (GP has to receive letter, dictate/write referral and then 2nd specialty has to make appointment).