Should you require evidence of the utter contempt in which senior NHS officials hold the public, look no further than a ‘peer review’ scheme being rolled out next week.
The new plans require GPs to seek approval from a panel, made up of other doctors, before being able to refer patients for all non-urgent hospital appointments.
This means that referrals for things such as X-rays, hip and knee surgery, and cataracts may be rejected by a group of people who have never seen the patient. They also will not review the patients’ medical notes, but instead base the decision on the referral letter.
Should you require evidence of the utter contempt in which senior NHS officials hold the public, look no further than a ‘peer review’ scheme being rolled out next week
The patient’s GP will retain responsibility and make final decisions, but this is still a kick in the teeth for GPs and shows the thinly-veiled loathing NHS bosses have for clinicians these days.
They are an irritation, what with all their referring patients on to other doctors, and NHS bosses will do anything they can to neuter them because they have the best interests of patients — rather than a balance sheet — at heart.
This comes as it was announced this week that the NHS will pay £100 million to agencies to recruit 3,000 GPs from overseas amid a growing recruitment crisis hitting the profession.
Is it any wonder our home-grown doctors don’t want to be GPs when they apparently can’t even be trusted to know when a patient needs to see a specialist?
By and large, the GPs I know are dedicated and hard-working.
They do their absolute best despite some pretty testing circumstances and they care deeply about their patients. They also know them better than any panel does: after all, it’s their job to assess patients and decide the best course of action.
The peer review scheme flies in the face of this. And it’s yet more red tape.
The new plans require GPs to seek approval from a panel, made up of other doctors, before being able to refer patients for all non-urgent hospital appointments. This means that referrals for things such as X-rays, hip and knee surgery, and cataracts may be rejected by a group of people who have never seen the patient. (File photo)
The last thing GPs need is yet another layer of bureaucracy. It defies belief that when doctors on the front line are having to contend with so much, they are given yet another set of hoops to jump through. This is only going to cause frustration and anger.
So why bother doing it? If you listen to the official line, the purpose is to ‘support’ GPs and ensure that patients don’t make unnecessary trips to hospital.
Please! Who are they trying to kid? It is clear that this is going to delay patients getting treatment, increase the risk of things deteriorating or something serious happening and result in misery and yet more headaches as doctors and patients negotiate yet more paperwork and box-ticking.
And to add salt to the wound, because the NHS is devolved, it will happen only in England.
So what are we saying here is that English GPs can’t be trusted to make clinically appropriate referrals, but those in Wales, Scotland and Northern Ireland can. Is that really the case?
Let’s be honest, we all know what’s really going on here. This isn’t about ensuring evidence-based medicine or that patients get the best possible care. This is about one thing: money. The real purpose of these panels is to reduce the number of hospital referrals, isn’t it?
Of course. But rather than insulting our intelligence by trying to give it to us as something else, something for our benefit, why can’t the NHS officials and the Government just be honest and straight with us about the real motivation behind this.
Why can’t they just stand up and say that there isn’t enough money, that we are reaching a crisis point in the NHS, and it has now got to the stage where they are trying to find ways to prevent people getting treatment for non-urgent problems?
We actually need them to say this. We need them to clarify the problems the NHS is facing so that we can have a serious debate about the future of our healthcare.
This debate will never happen while we’re not told the real reasons behind schemes like this.
With the 20th anniversary of Princess Diana’s death this week, there’s been much discussion about her legacy. As a doctor, there is no doubt in my mind what this is for me.
For the younger generation, it’s hard to imagine quite the fear that HIV/Aids generated.
I remember at primary school being told that under no circumstances should we share drinks containers in case we caught it from them, and there being much discussion about whether it was safe to use the same toilet seat. It was truly petrifying.
With the 20th anniversary of Princess Diana’s death this week, there’s been much discussion about her legacy. As a doctor, there is no doubt in my mind what this is for me. For the younger generation, it’s hard to imagine quite the fear that HIV/Aids generated
Yet in April 1987, Princess Diana was photographed touching an HIV positive man on a visit to a hospital. It was reported around the world.
In one single gesture, she showed that this was a condition that needed our compassion and understanding, not fear and ignorance. Medical sociologists now credit her taking up the plight of those with HIV with a shift in public opinion around the disease.
In this way she did more than any other individual or charity in tackling the stigma in those dark, scary times.
Midlife crisis? No, just part of living
We all know the scenario: a man in middle age suddenly divorces his loyal, long-suffering wife, starts dating a woman half his age, buys a Porsche or motorbike and gets a hair transplant.
Diagnosis? Midlife crisis.
This week, economists claimed to have definitive proof it is a real, bona fide phenomenon. They undertook an analysis of data, and found a dip in happiness in middle age.
But I’m not convinced this is really evidence of a midlife crisis and not the result of other factors, such as changes to working patterns, relationships or health at this age.
While it is has caught on in the public imagination, psychologists actually question the existence of the midlife crisis, and I share this scepticism.
The research supporting it is very weak. The term ‘midlife crisis’ was coined in 1965 by Elliot Jaques, a Canadian psychoanalyst, to describe challenges during the normal period of transition and self‑reflection that many adults experience from ages 40 to 60.
There’s no doubt middle-aged people question their lives. As their children become more independent, and with years of marriage behind them, they might look at their career and realise it’s stagnating.
Or maybe they have drifted away from their partner. Or they realise time is running out to do the things they really wanted to. They look around and ask what it’s all for, and revaluate the choices they have made that resulted in where they find themselves.
But the idea that this only happens to people in middle age is, I think, a myth. People of all ages find themselves, at different points in their life and for different reasons, asking big, philosophical questions about what the point of it all is and what they want to do with their lives.
Working with adolescents, I often met youngsters asking these exact questions faced with which A-levels to do and whether to go to university. Many were overwhelmed and felt at a crisis point. It’s perfectly normal.
Similarly, when I worked in geriatrics, older people would often be very contemplative, questioning their lives, appraising the choices they made and figuring out what to do with their remaining time.
The truth is we go through our lives having periods of introspection and reflection, evaluating what we’ve done and what we want to do.
It’s a normal, everyday part of life, and it’s no more likely to happen in midlife than at another time.
A second opinion that can save lives
Recently, I went to a talk by the charity Brainstrust about brain tumours and the difficulties patients face in getting accurate diagnoses.
I was astonished and horrified to hear that in 80 per cent of cases, the diagnosis changes after a second opinion is sought. This means that either the type of tumour was wrong, or how advanced it is was incorrect.
Brain tumours are the biggest cancer killer of children and adults under 40. More than 11,000 people are diagnosed with a primary brain tumour every year in the UK.
A change in diagnosis like this can have a profound and fundamental impact on the type of treatment that should be offered for the best chance of survival.
Brain tumours are the biggest cancer killer of children and adults under 40. More than 11,000 people are diagnosed with a primary brain tumour every year in the UK
The reason such a large number of diagnoses were initially incorrect is that diagnosing, staging and grading brain tumours is incredibly complex.
Thanks to advances in scanning and biopsy techniques, we now understand that there are more than 120 different types of brain tumour and have developed specific treatments for many of them.
But because of the vast number of types of tumour, doctors may have seen a particular type only a handful of times.
It is, therefore, essential that those with a diagnosis of brain tumour have their scans and medical notes reviewed by more than one team, and preferably by people who are experts in that particular type of tumour.
But how do you do this if you’re somewhere rural? Or elderly, or infirm and can’t readily travel to a large teaching hospital?
While I’m often sceptical of claims that technology is the answer to medicine’s problems — think of the complete waste of money that Labour’s abandoned £12 billion NHS IT programme turned out to be — a new social enterprise backed by Brainstrust called Trustedoctor is trying to address the problem. I think they may be on to something.
Patients are able to upload their medical records and scans. Expert neurosurgeons, neurologists and pathologists whom the patient can choose are then able to review the notes and talk to the patient over the internet and provide a second opinion, meaning the patient doesn’t even have to leave their front room.
Clinicians are free to charge for their time if they wish, but so far about half are working pro bono. Trustedoctor hope to expand the service to other types of cancer in the next year.
What a brilliant idea, that will have a real impact on patients’ lives.