The NHS, at least in England, is currently afflicted by managerial interference in the referral of patients from one consultant to another and also in the scheduling of follow-up appointments in consultants' clinics.

Each inpatient and outpatient in NHS hospitals (with a few exceptions) is under the care of a medically or dentally qualified consultant, who needs access to a number of facilities so as to provide treatment and give advice. These facilities include investigations, operating theatres, and the services of other professionals such as physiotherapists. Consultants also need to be able to get opinions and interventions from other consultants—from colleagues in their own hospital and sometimes by referring to a consultant in another hospital. Access to this facility is as fundamental as access to the others.

In the NHS, capacity for prompt referral from one consultant to another is often lacking. Patients needing such referrals often have to join waiting lists for clinics to which general practitioners …