Intended for healthcare professionals


Defending referrals between consultants

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:371

Potential for error

Dr Goodman is to be congratulated on this article, which draws
attention to a problem which frustrates GPs and Hospital Doctors alike.

It is ludicrous that one professional cannot readily refer to another
within the hospital system.

Much anecdotal evidence exists to suggest that this is a major
problem. Deliberately introducing delay into such a referral system
increases the risk of problems arising in the interim. Perhaps the time
has come for a formal study of the effects of obstructing efficient
clinical referral? If hospital risk managers are not considering this,
then why not?

The rising practice of asking GPs to make a referral to a second
consultant at the request of a first consultant introduces an extra step
into the referral process which increases the potential for error and also
delay. Many GPs are extremely efficient - they have to be - but is it fair
to the GP, or the patient, to erect an unnecessary hurdle to referral
which a Consultant considers necessary? I believe not.

It should be noted by politicians responsible for the NHS as a whole
that giving GPs unnecessary tasks diverts their clinical time from
appropriate clinical activity. A Prime Minister who was embarrassed during
the 2005 General Election Campaign about access to GPs might usefully
consider a serious attempt to remove unwarranted demands on their clinical
time and administrative resources.

Dr Goodman mentions exercise electrocardiography. In the 1990s - when
fundholding existed and there was certainly importance attached to GP
referrals - I had control over my exercise electrocardiography lists as a
lowly SHO, in two teaching hospitals. It was no problem to accept a
referral from a hospital colleague, and providing a prompt service, with
immediate reporting, was a source of professional satisfaction.

Certainly Hospital Doctors should assert their professional status;
it is, after all, in the best interests of patients.

Competing interests:
1)Academic interest in preventing medical error
2)Retired Medical Practitioner

Competing interests: No competing interests

10 February 2006
Peter Gooderham
Cardiff Law School