Urgent: what phrases might MAKE GP upgrade my Referral?

[54isanopendoor]

I have longstanding mobility problems (deformed bones in both feet, nerve entrapment & entanglement, 6 operations between 2010 & 2018)

In 2019 I was due to have both ankles pinned. Then Covid. Then I was made to start from scratch, going through podiatry for inserts, physio for exercises etc.
I need surgery. I've been on a wait list for 32 weeks now (standard referral) I have another 52 weeks to wait for my 1st appointment. I can't walk properly. I'm in pain. GP said 'you have to expect this at your age'. I am 55 !!!
Last appt she said she would upgrade my referral to urgent. Hosp says not ...

She is Head of Practice.
I cant afford private (assume won't cover as it's an exisiting condition ?

sorry to put 'urgent' in the title but I have an appt tomorrow for bloods results tomorrow first thing. I think I need to write a letter& hand it over then?

I am in Scotland.

Maybe emphasise the impacts on your life. eg, psychologically, ability to work etc.

Write to your local MSP. I had waited 2 years for gynae surgery. Two weeks after I wrote the letter to the MSP I was in for surgery.

@Useyourfork thanks, good suggestion. Unfortunately GP knows all this (small village) & just doesnt give a stuff.

@Bakedbeansandtoast I guess I could that's a good idea.

I know there isn't a 'magic formula' & that there are people dying of cancer whilst waiting to be seen (my own Mother was one nearly 2 years ago now)

but I'm so tired of it & it's an established condition which has worsened considerably & my GP just lies to my face (said she would bump my referral)

May have just forgotten, remind her and say it hasn't been upgraded according to the hospital, has it got lost in the system? and could she chase it?

Has she just forgotten to do it? Is it worth ringing and saying 'Last time I saw you, you told me you would mark my referral as urgent but the hospital said it has not been. Please could you do this now?'

@Silverbirchtwo @Justanything86

Good point! (she does have form - she 'forgot' to send my 'Urgent - suspected cancer' referral 18m ago before she went on holiday - fortunately it proved, post biopsy to be negative but it was no thanks to her).

I feel quite stressed about it so I thought a letter would be better (plus paper trail etc) but I guess I could start by saying: 'did you forget'?

I cant afford private (assume won't cover as it's an existing condition ?

Does this mean you have private medical insurance ? If so it's always worth a call to check if your condition is consider a pre-existing condition.

Yes I agree with others, it's always worth another appointment or a letter to push your point about your lack of mobility and the pain. However I have to warn you, this maybe completely out of your GP's hands, even if she does mark your referral as urgent. If there is an 74 week wait, there will be many others whose conditions are also urgent. Would your GP consider referring you to another hospital ?- this may not be possible in Scotland.

Complain to PALS and explain what you have here, that your operation has been delayed since 2019 and that you are facing a new referral and a further 52 week wait and that its not acceptable.

My experience of PALS has been very positive, my daughter was facing lengthy delays for referrals she had already been waiting for 1 year plus for both. PALS arranged her appointments that were within 2 weeks of my complaint!

Not sure your GP can do anything.

I have a standard letter I send back (I'm a foot and ankle surgeon) saying all patients are already prioritised based on the supplied information.

Unless something has significantly changed there's not much you can do via the gp.

I'd be getting on to the hospital secretary for the consultant and / or the service manager to check where the referral is up to in the queue.

It's not your GP you need to chase. All the GP can do is send a letter asking for your referral to be made urgent. It is entirely 100% absolutely in the hands of the hospital to decide whether they agree that the reasons given for urgency meet their criteria to qualify as urgent.
You have literally written 'hosp says not', how on earth is this the GP's fault?!
By all means ask to see the letter the GP has written, and if you think relevant information has been omitted then ask her to provide this to the hospital.
It's worth knowing though that there are specific criteria which the hospital will see as meaning you need an urgent appointment and if you don't have these then the GP can't say you do. For instance, relating to orthopaedics, it might include progressive weakness or numbness, unremitting night pain, inability to work due to the issue.

GP has already said she has upgraded it to urgent, if I have understood your post.

İt is the hospital that is saying no. GPs do not have control over that.

@Girlattheback OP is in Scotland so it is not PALS she needs to contact.

OP here is info about the PALS equivalent in Scotland:

https://www.cas.org.uk/about-us/partnerships-services/cab-service-partners/patient-advice-and-support-service

Exactly as above, your GP has no control over how the hospital orthopaedic team prioritise their referrals, all they can do is send the relevant information. The better thing to do would be contact the Consultant’s secretary, make it clear your be happy for a last minute or cancellation appointment to try and expedite things.

I don't know what to do about the GP, but have you looked at the Momentum brace at all? A small number of people have got them via the NHS.

Its down to the hospital not your GP - the hospital will have completed a harm review/ risk assessment based on the information provided and any test results. Thats how we are prioritising patients.

I'm not sure your GP can do much. I work in the hospital and often upgrade referrals to urgent or downgrade them to routine depending on the symptoms the individual has and what can be done for them. Therefore, to get onto the urgent list you would need to contact the relevant department and ask one of the consultants to review your referral.

Two suggestions

1. Email the consultant who did your previous surgery.
2. I couldn't afford private treatment. I did pay for a single appointment with a orthopaedic consultant who did a great letter to GP recommending a particular course of treatment.

thank you all for the comments & suggestions.

sorry if I wasn't clear - a HCP at the Hosp (an ortho podiatrist) told me to ask GP to upgrade my 'urgency' as he said nothing more he can do for me & I probably needed the Ortho surgeon & the wait list is long. GP said they would. Hosp says GP hasn't made contact. (I understand the Hosp would then make their own decisions). I will ask GP to see the referral letters today at appt & go from there.

I misunderstood them OP, sorry, yes definitely if the GP has agreed to do a letter, they obviously should do it in a timely manner (would expect this type of letter to be sent within 3 weeks at the surgery I work at).

Speak to GP, starting with the assumption they forgot.

You can then later check with the receptionist as they will have a record of whether the letter has been sent.

If the receptionist in a couple of weeks says the letter has not been sent then you can get her to get it typed and signed as long as it is on your records that the GO agreed.

I would also contact the hospital and make clear you will take any cancellation at short notice.

I also have severe mobility difficulties due to an accident which mangled my right foot. You should be aware that not being able to walk and being in pain doesn't necessarily mean that the hospital will consider it urgent- they will prioritise people where the injury/situation is likely to get much worse and be life threatening eg spinal problems.

Speak to your GP about pain relief if you do not already have some.

Asked GP who clarified they have not written to Hospital & asked me 'why I thought they should'. Frustrating as we discussed that at last appt. I explained again that, having been on crutches for over 10 years, with various surgeries which improved things for a while but it's now worsening again that 'some shoe inserts from Boots' (her first suggestion) wouldn't fix it & I need to go back & see the Consultant who suggested surgery in 2019. I pointed out that I am sole Carer for two young people with additional needs. I cried. She said she'd write.

I was also re-prescribed some Pregabalin (originally given by consultant in 2014, with a history of effectiveness. GP very reluctant to prescribe but did in the end)

Good for you for being insistent. It sounds pretty horrible for you coping for so long like this. I would recommend checking with the surgery in 2-3 weeks to check it has actually been sent. Hope the pregabalin gives you some relief.

I just want to send good wishes, OP. Sounds like a complete nightmare. Perhaps once the GP has actually written as she promised you could look into changing GP practices. You shouldn't have to put up with that treatment

you can pay privately for first ortho consult then swap back to nhs for treatment