Monday, 14 March 2011

The NHS and me

I've not blogged before about the the proposed changes to the NHS and look set to be imposed. Partly the complexity intimidates me and partly I find myself swinging here and there with the various arguments.

But every now and then I find some firm footing. Today I read in Pulse (the most read GP weekly), that 'You have to draw a line in the sand at any suggestion GPs should be rewarded at practice level for reducing referrals. It's absolutely unethical'. So says Dr Nigel Watson, chair of the GPC's commissioning and service development sub-committee.

I appreciate that over-referral or rather inappropriate referrals can be made out of laziness or just plain incompetence, so any attempt to improve in that area would be good. But I don't want a financial disincentive to sway me in my day to day practice, when I am trying to  make a reasonable judgement about referring the pateint in front of me. Historically the role of the consultant was to be consulted in cases where the GP needed  clinical advice. Of course sometimes the referral was made, both then and now, under pressure from the patient to 'see a proper doctor'. But with increasing skill and knowledge of the GP this should be less and less of a reason.

Perhaps I'm just an idealist. But improving clinical skill and especially improving consultaion and communication skills are at the heart of what is needed to make an impact on the number of referrals.
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