Views & Reviews Personal views

Referral management schemes are damaging patients' interests

BMJ 2007; 334 doi: (Published 18 January 2007) Cite this as: BMJ 2007;334:156
  1. Peter Lapsley, chief executive (
  1. 1Skin Care Campaign, Highgate, London

    Some years ago I visited my GP to ask why the beds of most of my fingernails and toenails were thickening and whitening, raising the nails, which were themselves becoming heavily pitted. She admitted that she did not know and referred me to a consultant dermatologist.

    The consultant diagnosed nail psoriasis, explaining that it was difficult to treat, and prescribed a protracted programme of hand and foot PUVA (psoralen and ultraviolet A treatment). Although this did not cure the psoriasis, it improved it considerably and halted the psoriatic arthritis that was beginning to affect the joints of two of my fingers.

    Had that episode occurred this year in one of the many primary care trusts that have introduced a referral management scheme, it is most unlikely that I would have been granted an appointment with …

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