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LETTERS: Tim E P Davies Referrals between consultants: Consultant referrals are funded BMJ 2006; 332: 490-b [Full text]

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Tertiary referrals: thin end of the wedge?

Andrew N Bamji   (27 February 2006)

Tertiary referrals: thin end of the wedge? 27 February 2006
Andrew N Bamji, Consultant (rheumatology/rehabilitation) Queen Mary's Hospital, Sidcup, Kent DA14 6LT Send response to journal: Re: Tertiary referrals: thin end of the wedge?	The response to Michael Goodman's Personal View from Tim Davies illustrates how far medicine is drifting from common sense and professional integrity. While it may be sensible for primary care trusts to understand how and why consultants refer to each other so that they can assess the costs it is nonsense to place barriers in the way of this process. But that is what has happened. I have had letters from colleagues stating that they are forced to prioritise GP referrals before consultant ones; and in one case it appears that a pile of consultant referrals were deliberately hidden. Last year I wrote to the Secretary of State indicating my concern at the current exclusion of tertiary referrals from waiting time targets, using among others the argument that one specialist dealing with a specialist problem might have a better understanding of priority, need and urgency than a GP. It also seemed unfair that if a patient had already waited to see one specialist it was inappropriate for there then to be an indefinite delay to see the next, simply because they had been referred by the wrong doctor. I asked that consultant-to-consultant referrals be included in the targets. I received a dusty and negative reply. So in fact the only way that a patient can, according to the system, be guaranteed an appointment within the due 13 week interval is if specialists write back to a patient's GP and ask the GP to make the new referral. What a waste of time! And is any GP going to be so foolish as to refuse? The medicolegal consequences are frightening. So why not let common sense prevail? Perhaps Tim Davies should first analyse the appropriateness and professionalism of referrals from GPs before casting aspersions at specialists. Competing interests: I amke frequent consultant-to-consultant referrals