Intended for healthcare professionals


Defending referrals between consultants

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

Tertiary referrals in theNational Health Service (NHS)

Dear BMJ Editor

The article by Michael Goodman in your issue of 11th February, and
the correspondence to which it has subsequently given rise, have recently
been brought to my attention. As a layman patient, I had cause last year
to feel aggrieved after I was referred at the end of 2004 by my renal
consultant to an orthopaedic consultant colleague at another local

I received a letter dated 27th January offering me an appointment on
25th July, which enabled me to avoid this date when booking my summer
holiday. A second letter dated 16th June changed the date to 28th July,
which did not clash with my holiday, the booking of which by this time had
been confirmed, and a deposit paid. Yet another letter dated 23rd June
changed the date again to 14th July, which fell in the middle of my
planned holiday. I immediately rang the appointments office, explained the
problem, but the best they could do was to offer me an alternative
appointment on 29th September!

My irritation became unbearable when on the very morning I expected
at last to see the orthopaedic consultant, I received yet another letter
deferring the appointment until 16th March 2006 as the consultant’s clinic
on 29th September had had to be cancelled at the last minute. In the
circumstances, I felt constrained to write at once to my Member of
Parliament (MP)to vent my profound disappointment at this intolerable
series of deferments. I copied my letter to the consultant with whom I was
expecting an appointment, and he replied saying that his clinic on 29th
September had had to be cancelled in order that he might complete an NHS
target by performing non-urgent operations.

I sent a copy of his letter to my MP, who had referred the matter to
the Chief Executive Officer (CEO) of the NHS Trust concerned. His reply,
which suggested that my last appointment had been cancelled because the
consultant was required to carry out “urgent surgery”, also intimated that
whilst GP to consultants referrals were subject to NHS target dates, in
cases of “a consultant to consultant referral the (NHS) Trust is not
obliged to ensure that the appointment is within Government targets”.

As a result of these exchanges, it was possible to bring forward my
appointment from 16th March 2006 to 12th December 2005. The most
interesting point was that the reason given by the consultant for the 29th
September cancellation at that of the NHS Trust CEO did not correspond.

My MP, I am pleased to say, picked up on the difference in treatment
between a General Practitioner (GP) to consultant referral and a so-called
tertiary referral from one consultant to another, and promptly, on 24th
November, wrote to Patricia Hewitt, the Secretary of State for Health,
saying: “I strongly feel that this method of (tertiary) referral should
fall within Government Targets and would appreciate it if you would inform
me of your views on this matter.”

I received a copy of this letter, as I did of the reply, towards the
end of January, after parliament had resumed after the Christmas recess.
It came from the Minister of State, Lord Warner. He waffled on
unconvincingly about what had been achieved in the NHS under the present
administration, intimating that by 2008 the promised improvements in
patients’ waiting times would be reduced to forecast levels. He failed to
address specifically my assertion that unacceptable discrimination exists
when referral by consultants to consultants are not subject to the waiting
time targets which apply to referrals by GPs.

I said as much to my MP, and I have heard nothing since. I remain
concerned, I am sure like many patients in a similar position, that the
Department of Health is not responding properly to the needs of patients
who need specialist advice or treatment and whose cases are referred from
one consultant to another.

I apologise for the length of this letter, but I felt it important to
tell the full story.

Yours truly

Peter Coates

Competing interests:
None declared

Competing interests: No competing interests

01 March 2006
Peter E D Coates
Retired Independent School Bursar
I no longer work