GPs should be given more autonomy to test and prescribe

[Newbutoldfather]

This thread was prompted by recently spending several hundred pounds to get my son tested and treated for a fairly common chronic complaint. Luckily I can comfortably afford it, but I am very aware most don’t have this option.

I knew what he needed from some basic googling, I am sure any GP would have known but, according to NHS guidelines, only a specialist could test and prescribe the correct medication.

The wait for an NHS referral was 5 months (!).

My brother lives abroad in a close European country and can normally get specialist appointments and scans within a week (including MRIs). They are not considered scarce rationed resources as they are here.

If specialists are so hard to see here, then we need to give GPs a lot more autonomy! The idea that waiting months is somehow better than taking the (slightly) higher risk of giving GPs more autonomy seems crazy and wrongheaded to me.

If specialists are so hard to see here, then we need to give GPs a lot more autonomy! The idea that waiting months is somehow better than taking the (slightly) higher risk of giving GPs more autonomy seems crazy and wrongheaded to me.

But we have no idea what the risk is.

GPs are not trained specialists in every area of medicine. In any case they don't seem to have the time to do the GP work they are meant to do, let alone have capacity for doing consultant's work too.

It’s all indicative of a bigger problem, GP’s (at least ours) are allocated 10 minute slots per patient, that just simply isn’t enough time to actually “do” anything meaningful really. It’s enough time to send a referral to someone who has more information, and more time to look into it.

That's so short. Our GP is 15 mins but they often spend longer than that.

I agree though op. If a GP thinks a woman needs an ultrasound for uterine issues, it is better if she can send that woman to an US booking system - this takes letters and appointments out of the process and the woman can book at a time that's convenient for her, like we already do with blood tests. Absolutely bonkers having to wait to be contacted then to and fro over appt dates and times.

It's so obvious sometimes what is needed but then in the NHS you have to wait for giant cogs to turn.

Obviously, this wouldn’t be for every condition! Some clearly require specialist input.

But, for instance, certain medicines can only be prescribed to a child by a specialist or a paediatrician, even though research shows that they are fundamentally safe. You will often hear a GP say: ‘you need X but I am not allowed to prescribe it’.

Of course, if you could get a timely referral, like in most of the rest of the developed world, that would be ideal. But you can’t. So you have to balance the tiny extra risk of a GP prescribing with the risk of allowing chronic conditions to persist (and maybe worsen) as you wait months for a referral.

It is really short, the BMA recommends that GP slots be 15 minutes but most practices do still just allocate 10 as standard because of demand, even then there is the mad rush for appointments though. The stats on the wall at our GP when I was there a few weeks ago said that the typical appointment there lasts 6-8 minutes which- to me- feels like no time at all!

GPs have a scope of practice for a reason. There’s no point them referring patients for specialist investigations and tests they don’t understand or know how to interpret, that’s why they refer to consultants (the specialists) for their opinion.

We tried letting GPs go “direct to test” for some of our more basic diagnostic tests, and it was a disaster, many requested the wrong test, couldn’t interpret the results, didn’t know how to manage the patients and ended up referring them to a consultant anyway.

@OneQuirkyPanda ,

But autonomy means allowing them to decide on their own competence, as professionals.

Some have previous specialties and expertises and some things are just too tightly regulated.

I also think you are considering just one side of the equation. Referrals that take months are not risk free. Leaving people in chronic pain is also not acceptable when a fix is readily available.

@Newbutoldfather autonomy doesn’t negate scope of practice, all healthcare professionals have to work within their scope of practice. They are autonomous within their scope.

I consider both sides, but the answer to long waiting lists isn’t to let people without adequate knowledge, skills and training “have a go” to speed things up.

We live in the EU. When I've been at the GP and they think I've needed a scan reasonably urgently, they've rung up there and then and I've left with a post it note detailing when and where my appt is.

That's amazing. I'm lucky that I have private cover so I can arrange it at a time that's convenient for me.

I had to have an asthma referral earlier this year and there don't seem to be asthma appointments privately and the faff, it was cancelled twice and then I had to have the morning off work for it. Ridiculous.

I see I am going to lose this one.

But I do think many are coming from the perspective of either using the private sector or having privileged access (work within the system).

I think people in the U.K. are like boiled frogs when it comes to the NHS and don’t realise the huge risks waiting months for essential scans and treatments carries.

If you know people in mainland Europe and how easily they get access to MRIs and other diagnostic tests (and subsequent treatment), it shows how awful the NHS is and why we need to consider radical measures.

So what do you suggest OP. Mass protests outside gp surgeries, a riot or 2?

Maybe you should just stick to going private. Free up resources for those who can't.

@gamerchick ,

I do go private, especially for my children. I am not having them suffering for months.

And I have made a suggestion on this thread.

We have a very top-down system in the NHS, many other systems are bottom-up (there was a lot written about the German system vs the NHS during COVID).

As for protests, that may be a good idea, but not outside GP surgeries. It’s not their fault that the NHS is so messed up. They are leaving in droves anyway.

Op I agree with you. Kids can wait for years to get an adhd diagnosis and then years for medication. I go private for my dds meds and it costs thousands and the titration is managed by a nurse. I’m sure she’s very well trained but why can’t GPs be trained? We’re hoping to move the prescription over - although as dd is about to reach 18 the process may change again. Likewise with melatonin for autism. I had to pay hundreds of pounds for an assessment with a paedetrician so that we could have a prescription for dd2. People who can’t afford it buy unregulated melatonin gummies off the internet.

I thought I'd heard something a while back that there was a proposal to allow GPs to refer directly for a wider range of tests/scans rather than the current system of reference to hospital consultant (with long waiting times) who then refers you for a test/scan that the GP could (under the new system) get the test/scan done directly and only refer to consultant if results are problematic. The idea being to speed up the system and cut down on unnecessary referrals to consultant waiting lists. I think this would be a great idea - especially as I'm currently on a waiting list to see a Consultant who I'm pretty sure will see me for all of 2 minutes and refer me for an MRI scan. I know this because DH went down the same route for something similar and the protocol is to refer for MRI if you meet certain criteria (which i do as already proven by other tests).

What do you want us, the users of the NHS to do?

You can shout how things should be but that doesn't change the way things are.