Sign of the Times

This letter, from a distinguished NHS surgeon Mr Peter Mahaffey appeared in the Times. It is worth reading:

Sir, Your report (Jan 9) on the inquest into a mother’s death associated with a hospital’s diversion of her GP’s request for a specialist opinion rings loud bells with any consultant who has watched recent governments vandalise established referral patterns.

One of the most valuable roles of the family doctor was always to know who might give his or her patient the best opinion and treatment, but successive governments have made this increasingly futile. In the “new NHS” climate where almost the entire health budget goes to primary care and hospitals get funding strictly according to referrals from the community, patients frequently have to negotiate the equivalent of an assault course.

First, there are exclusion lists for a host of conditions and any exercise of medical discretion is patrolled by expensive panels which vet cases. Next comes the diktat to GPs that they may not name specialists on referral letters. Hence such “generic” referrals become the ownership of the hospital rather than the specialist. At a stroke, the ability of the GP to find the best opinion rather than the shortest appointment time is damaged. Hospitals living in fear of DoH diktats on waiting targets can deal with these referrals as they choose, switching clinics, using nurse specialists, or even “selling on” the case to another provider hospital.

This pernicious process has nothing to do with quality and everything to do with targets. One wonders if the Southampton coroner is fully aware of the extent to which these mechanisms impinge on so many of the cases he is called to deliberate upon.

Peter Mahaffey, FRCS
Langford, Beds