To think someone at the GP surgery should do my blood test

[JacobReesMogadishu]

I've got an rare chronic condition which I've had for years. It puts me at risk of kidney and liver failure. I live up north but due to it's scarcity I'm under a consultant in London. This consultant sorts my medication and treatment plan out and I travel to London a couple of times a year.

I haven't seen anyone face to face since Dec as my last appt in March was cancelled.

The hospital emailed me yesterday to say they've realised I'm overdue a kidney and liver function test and can I contact my GP asap to sort this. My GP surgery has done this before, in fact they've rung me before to say I need one.

I rang and spoke to a receptionist today who said now due to covid they're no longer doing hospital bloods. That I have to go to the hospital. I pointed out that firstly it's 4 hours to the hospital and that my clinic isn't seeing people face to face due to covid either.

So she told me to go to the local hospital and to get a blood form from the london hospital. London hospital have said they'll send me a blood form but said they doubt my local hospital will accept it as the forms are different and the lab won't be able to bill the London hospital so won't want to do it.

What the heck has happened to joined up treatment and thinking about the patient holistically? A friend works at a GP surgery 5 miles up the road and they're still doing hospital bloods so it's obviously not a county wide decision to stop doing them.

@JacobReesMogadishuI can probably explain this one and have seen both sides of it.

So, Gp practices are under no requirement to do hospital bloods. If a hospital treatment plan is to have x bloods then it is the requirement of the hospital consultant team to arrange for this.

Historically Gp practices often either did this work unfunded, in effect for free for the hospital team. Or they could request labels/forms etc from the hospital and thus the results when to the hospital team to be actioned. In effect just using the treatment room premises for convenience but with a payment for equipment, nurse time etc.

In certain areas, (mainly rural) some agreements where in place for hospitals to have a certain number of spaces/tests within gp practices - different scenario.

With covid and the restrictions on how many patients can come through a practice/extended visits for nurse time and limitations of ppe provided to GPs (heavily restrited) many practices are now not doing this unfunded work.

Secondly hospital teams moving to phone consults etc have dumped much of this 'oh you need your bloods checked' onto Gp practices. Without a) asking if they can facilitate this b) considering that gps are restricted because of covid and c)handing over any of the funding that goes with this.

A major reason for gps refusing this - is RESULTS. If a GP requests that test they remain responsible for the results. This is particularly difficult in someone with a complicated rx plan needing interpretation. Specialist consultants should be interpreting this with their specialist knowledge. Even if they advise the GP on them, the requestor - here the gp remains responsible. Totally understandable why they are not willing to do so.
This can be avoided if the hospital use their own forms etc - but the gp remains under no duress to allow their treatment room, nurse time or supplies to be used for this.

It is as big a frustration for gps, consultants and patients. Your consultant remains responsible for this - and it should be his team and secretary sorting how it is done. I know that we have declined many of these coming from our local hospital (telephone clinic but dump the tests on the gp), however for a four hour trip to London we would oblige but only if they send the forms and bottles i.e remain responsible for the results. They can also have you return the bottles by post to them.

Hope that helps explain the frustration!!

Just say to the GP that you need blood tests done. He requests them. Jobs a guddun.

i actually would suggest putting this back to your consultant on how they want this done. if as a national team/ very specialised unit they will have hit the problem before.

no doubt they will tell you only your gp isnt doing it - dont fall for that its bollocks. sometimes they just find it easier to dump than to work out the logistics of getting the results/getting their local team to see you for it etc.

also although many people think receptionists are just trying to be awkward they arent. believe me when i say most people requesting special circumstances from them are most definitely not in need in the grand scheme. i dont for an instance think this is you but when i listen to what they put up with im in awe of them and can see why they sometimes break! Ring at a non busy time and ask them if they have any solutions or will ask the TR nurse or GP for advice. Usually rthey can come up with a workaround.

This stuff annoys me immensely. It's incredibly inefficient and, absolutely, poor care.
In a nutshell, your GP should be performing your blood tests routinely and sending the results to your consultant. Covid is not an excuse not to perform basic routine care, IMHO. Annoyingly to, it becomes an issue of funding as GP and hospitals have different budgets and, often times, I've found GPs don't want to pay for things they know the hospital will/should.

I strongly urge you to transfer GP practices if you can.

@MissLucyEyelesbarrow

Well that makes sense I guess. See in my mind I couldn't understand why it was ok for a hospital phlebotomist to be at risk but not the GP one.

It's not satisfactory for patients. I think we need additional community clinics running while hospitals are (understandably) seeing fewer patients because of Covid. It's nuts for you to have a 4 hour round trip for a blood test. But, if your practice is anything like mine, it's already bursting at the seems and short on staff, even without any extra work.

Oh @MissLucyEyelesbarrow Can we put you in charge please!! That common sense idea is one we have been floating for months but guess what.....the beaurocrats say No! Not required.

Its ridiculous and its going to get worse. If hospital clinics wont do the bloods for their patients, it sure as hell isnt falling to Gp practices to take it out of their own budget for their patients - who then suffer - to do it!!

@Lifeisabeach09

This stuff annoys me immensely. It's incredibly inefficient and, absolutely, poor care. In a nutshell, your GP should be performing your blood tests routinely and sending the results to your consultant. Covid is not an excuse not to perform basic routine care, IMHO. Annoyingly to, it becomes an issue of funding as GP and hospitals have different budgets and, often times, I've found GPs don't want to pay for things they know the hospital will/should.

I strongly urge you to transfer GP practices if you can.

In a nutshell - NO they shouldnt.

Your hospital consultant who is requesting these tests and looking after your care should be doing these tests and actioning the results.

Nothing to do with your GP if they are not treating this condition.

With have the same issue with dh as his consultant is over an hour away and GP won’t arrange blood tests. As TisTheSeasonToBe explained the problem is to do with results. Our GP doesn’t know enough about his treatment regime or meds so cannot Confidently read the results so doesn’t like to be involved with them.

Therefore, we get blood forms from consultant, usually a few to keep us going, and on them I write the consultants secure NHS email address as they won’t send results to a standard email address. So that when the bloods are done the results are sent straight to consultant and a copy to GP.

Our surgery haven’t been doing bloods for a long time, well before Covid, so we always have to go to our local hospital for them.

My sister has this. Her consultant writes to the GP who complete the request form, she collects it and goes to the local hospital for the test as out GP don’t do any blood tests now

I get what you are saying, Tis. But I don't feel the 'separation' between primary and secondary care is really efficient along with whose paying for what from the various budgets. And I don't see why OP having routine bloods at her GP for both GP practice records and for assessment by her consultant can't be done, even though management would be by the expert. Just saying.

Interestingly enough a friend did a dissertation on barriers to care where people have specialist medical input at a distance. The evidence shows it puts a lot of people off.

I’ve been very close in the past to stopping treatment. Going to London 2 or 3 times a year for the past 8 years has been in a pita. It can be difficult to get time off work, etc. I have a new consultant now who wants to see me 4-5 times a year.

If I end up having to go to London for blood tests as well (they like them the week before a consultation) then that will be the nail in the coffin. Train ticket is well over £100 a time, days off work are difficult at times. Even next week I’ll now have to take a morning off work to go to the local hospital.

Treatment doesn’t particularly seem to be working and I feel like giving up.

Of course GP's don't want to pay for the things that hospitals should.
Less money in their pot means less staff, less overtime, reduced opening hours etc. We can do all the hospital bloods in the world, but the staff won't then be as available for smears, chronic disease management, immunisations etc. Clinics can fill up with bloods very very quickly if left unchecked. Staff don't want extra hours and in fact very many practice nurses are due to retire in the next ten years.