It’s back to the future for the NHS.
The Government have suggested that patients facing long waiting lists could be referred to an area where there is less of a problem.
Until the NHS changes in the 1990s, as a GP I could refer a patient to any NHS hospital in the country.
Very few wanted to leave Torbay. The hassle of traveling and follow up was often too much but there were occasions when it was helpful.
One elderly lady lived on her own in Torquay. All her family were in Birmingham.
When she needed a routine operation and it was much easier for her to have operation in Birmingham and stay with family than try to recuperate in Torquay relying on friends.
Sometimes waiting lists were shorter elsewhere although the published lists were not always accurate.
One paper published a national list showing that there was no wait for orthopaedics in Torbay including hip replacements. The hospital was inundated with referrals from all over the country.
What the paper did not mention was the reason for no waiting list.
At the time Torbay did not carry out any orthopaedic surgery. All the orthopaedic operations were carried out in Exeter which had long waiting lists.
In the 1990s the NHS 'internal market' was created. GP representatives negotiated contracts with hospital trusts.
The idea was to create a marketplace with hospitals in competition with each other but it also meant that I could no longer refer to a hospital which did not have a contract with Torbay Primary Care Group, which was every hospital except Torbay.
It was possible to make an 'out of area' referral but it was very bureaucratic and might not be approved.
The 'new' idea of allowing GPs to refer anywhere in the NHS seems a great idea provided it does not mean another mountain of paperwork.
Another suggestion is to reduce outpatient appointments by cutting routine hospital follow ups.
This sounds sensible except that in a way it is already happening.
Many routine follow ups are now carried out on the phone rather than outpatient clinics which is easier for patients and doctors.
When training new GPs I noticed that some found themselves inundated and appointments booked up. Were they just very popular?
When I looked at these appointments I often found that the problem was self-inflicted.
If a new GP lacks confidence they ask the patient to return without asking themselves why.
Having seen a patient and decided that the problem is not serious it takes courage not to arrange a follow up.
What is important is to make it clear to the patient that the door is open if there are any problems and explain what to look for. We used to call this 'safety netting'.
This old idea has a new name 'patient-initiated follow up'.
The new proposals are not for GPs but hospital follow ups.
I have some concerns. First of all, General Practice is on a knife edge. GPs and their teams are struggling to cope.
As a result it may be difficult to get through to the GP surgery.
My hope is that patient-initiated follow up means that the patient has access to the hospital team.
Any problem which would normally be sorted out in a hospital clinic must not be met with 'see your GP'.
My other concern is that this system might work well for younger people if it is explained what to look for but will an elderly person see any warning signs?
Might they 'not want to bother anyone'?
The NHS app which is used for Covid certificates and booking GP appointments could be widened to allow patients to contact clinical staff.
Again it might be helpful but I worry about older people who may not cope with a smartphone.
With 5.8 million on the NHS waiting list there is a crisis and new ideas are welcome, even if the new ideas are not new at all.
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