GP sent my referral to service without consent

[Spalding6]

I had a consultation with my GP for weight loss options in February. I've been accessing support privately (similar to Tier 3 weight loss support on the NHS) but they don't cover for weight loss surgery (Tier 4, which is provided in the next county over), only non surgical interventions. My GP said they would ask the surgical team to see me.

I've not heard back so I called them - they haven't received a referral for me. I spoke with my GP who confirmed that I wouldn't be eligible for Tier 4 support if I hadn't accessed Tier 3, so they had instead sent my referral to the Tier 3 service, without discussing with me.

Tier 3 is delivered by the local Trust, which is also my workplace. I have colleagues and friends who work in Tier 3, so would never have consented to a referral to them. I would have asked to be referred to the Tier 3 in the next county, which is possible, but we're now 8 months on which is a big delay.

I've called the Tier 3 service who say they never received my referral, but my GP have forwarded me the email they sent to them.

AIBU to be upset? And where do I go from here... I have a call with the practice manager on Friday and I'm just so angry about it.

Why would you be upset that someone you know knows you are acccessing support to loose weight?

They would figure it out very very quickly anyway. It's glaringly obvious when people are accessing tier 3 or tier 4 - were you planning to lie by omission? Or just lie?

If the service is available in your area then I don't think it's fair to take a space on a waiting list in another area just because you would prefer people not to know. Your issue shouldn't be allowed to impact others.

Plus as soon as you start losing they'll know!

AIBU to be upset?

I think so. How was the GP supposed to know you wanted to skip a stage and go to the tier 4?

Also you requested a referral for tier 4, and that requires a referral for tier 3 - so obviously that was going to happen.

As an obese person myself I think you're being a complete choosing beggar. You've been referred and are on the list - you're lucky! If you want to be picky pay for your treatment AND surgery.

I'd be a tad miffed if the referral sent by the GP is not recorded with the Tier 3 office.

That said, I'm sure the Practice Manager will be able to resolve the issue after your call on Friday.

GP probably thought, in the absence of any request to the contrary, they were acting in your best interests referring to Tier 3 within your own area to allow you access to Tier 4 in the neighbouring county.

I don't believe it's normal practice for GPs to consult with patients as to where and where not they will accept a referral?

The GP said they would make a referral to Tier 4 when I described the care I had been receiving privately. There was no real discussion about other services - i told them i had done slimming world, weight watchers, have a personal trainer and dietician and have completed CBT and psychoeducation.

I didn't approach the GP asking for only a referral to the surgical team, as stated in my OP I asked about what options were available to me.

The GP suggested surgery in the consultation on the basis i had tried a lot else already. I said I wasn't sure about whether surgery was something i would consider but would welcome a consultation with the surgical team - I hadn't suggested "skipping the queue"

I mean... tbf I'm not actually on the list, the service don't have my referral.

Tbf, most services offer treatment in a neighbouring health board if you work for your local health board. It's because your colleagues would, by accessing your records for the referring issue, be able to access your entire medical history, or at least part of it. I wouldn't want my colleagues knowing about past private medical matters just because I needed to access medical treatment for one particular issue.

YABU to be angry. This could obviously have been handled better but sounds like a mix up in communication for which you’re also responsible, in that you knew your GP was referring you onwards to hospital for review and at that point you should have spoken up and said you didn’t want to be referred to the local Trust for evaluation.

The GP can’t possibly have known your social situation, and did nothing wrong if they reviewed the referral algorithm and had to refer to Tier 3 first.

I can understand not wanting to receive treatment from a friend, so it’s annoying you’ve lost time if you wish to go elsewhere.

It’s annoying for you, but I don’t think GP has made a mistake.

I also don't think the GP has done anything wrong here. I can understand your upset to an extent, but I its an unfortunate circumstance rather than someone acting inappropriately.

My Trust has agreed that those working in it can receive care from other Trusts.

Like, I mean I don't mind telling colleagues socially that I'm undergoing treatment for my weight but theyve also been sent my full medical record by the GP as part of the referral. I don't think that's unreasonable and I think you'd be hard pressed to find someone that would be happy for their employer to have this

Is that in your notes?
Was the GP supposed to guess?

Yeah it's in my notes. I discussed in the consultation that I'm a nurse in the local Trust. I never had reason to suggest that I didn't want my info shared with my Trust because during the consultation there was never any mention of a potential referral to Tier 3, if there had been I would have said no thank you, can you refer me to the other county for this care.

I didn't realise I would have to go into this much detail but it's not the GP who saw me who made the decision to send the referral to Tier 3, it was the secretarial team.

I've had bariatric surgery via the nhs. You have to go via t3 first to access t4. You mention private tier 3. What is this? I'm just wondering if actually they've referred you to t3 to be able to access tier 4?

Also do your colleagues work specifically in the service you were referred to? As people aren't allowed to randomly look at medical records.

If it's in your notes and it's clear that you didnt want to go there then by all means make a complaint.
If your notes do not say you're not to be referred to that trust then the GP.has done nothing wrong.
It's black and white to me.

My colleagues work in the referrals team. They look at all referrals that come in and triage them. They wouldn't access my notes but the email from my GP contains a copy of the referral and my full medical history.

But you know that as a professional you are bound to confidentiality and if one of your colleagues came across your referral they wouldn't be able to access it because they know you.

I work for the nhs and I wouldn’t really want my colleagues knowing about health care I am receiving. For this reason, I would ask for any referrals to be made to a hospital or nhs trust that I do not work in. Obviously this may be context specific. If I needed elective surgery on my knee for example , I’d probably tell my colleagues anyway. But if it was something of a sensitive nature, I believe I have as much right to confidentiality as any one else does. Which I wouldn’t be getting if my colleagues had access to my personal information through their work. Did you say to your gp that you didn’t want the trust you work for involved in your care? If you didn’t , I doubt there is much you can
do. But I do understand why you feel this way.

I think you have a right to be annoyed. You asked specifically for a tier 4 referral. Gp agreed but didn't do it. He instead did a different referral that he hadn't discussed which you did not want. I would complain