If my GP refers me (or anyone) for a specialist consultation, why does the hospital then have to triage it?

Newquay

One of son-in law is a hospital consultant. When DH and I, in our turn(!), had hip problems we had to INSIST (on his advice) going straight to see Ortho surgeon after x-ray bypassing physio. He likened it to planes coming into Heathrow being held in a holding pattern before touching down-when hip clock starts to tick!

No insisting in my area (not so very far from Newquay). You don’t get a hip X-ray unless you have seen the physio, for which there is a waiting list, and done the prescribed exercises with no improvement.

Following X-ray and a referral from the GP, another physio will phone and triage you by reference to the Oxford Hip Score.

All that extra paperwork and admin - plus, you have to hope that the refferal process runs smoothly.

Many a time I struggled (I mean, REALLY struggled) to get my mum to appointments, only to find they were to review scans which she hadn't had yet.

It keeps them in a job?

GPS do make unnecessary and inappropriate referrals sometimes. Specialist hospital Consultant will vet the referrals, prioritise and give appointments if needed.

A while ago my dentist referred me to thehospital butcher dentist to extract what was left after a crown fell out. Got the letter, arranged dh to look after our son (he's disabled so needs someone with him).
It was just to see someone - no idea if he was a dentist or nurse etc who just asked a few questions - mostly about my alcohol consumption. It was just an office so he didn't even look at the offending tooth stump!

Haven't read all the thread, but when I've seen triage it'snot to determine if you get seen by a specialist, it's to assess the urgency so that things that are going to deteriorate rapidly get seen sooner than things in the queue that are just likely to stay at baseline. As with the best will in the world they cant see everyone promptly

Our early cancer diagnosis figures are appalling. I’m sorry if some will disagree but I think this is down to GP’s not being very good at identifying symptoms. I won’t go into detail but I have several personal experiences of relatives who were diagnosed with cancer after emergency admission to hospital after GPs had either dismissed their concerns or failed to spot symptoms. This being the case is bad enough, but to have GP concerns questioned in this way and triaged by staff less qualified is never going to make the situation any better is it ?

I don't disagree with you PammieAs I mentioned on another thread, I eventually got an appointment with my GP last October because I had discomfort in one breast and I could feel something inside. However, the GP was very dismissive, said she couldn't feel a lump and wouldn't refer me. Eventually, I had a routine mammogram and, to cut a long story short, I have one definite and one very probable cancerous lesion and am due for a mastectomy. It's lobular cancer, which doesn't always form lumps and I really feel my GP should have known that and listened to me because I knew something was wrong. Meanwhile, treatment has been delayed by 8 months - nothing to do with Covid.

PS. I didn't need to be triaged after the mammogram and I've been very satisfied with the service I've received from hospital.

That must have been really worrying, "*Growstuff*, I hope they get everything under control.
My DMIL had breast cancer when she was in her thirties and was screened annually until she reached 75 when they said she she didn't need to go back. Four years later she died of cancer which had ripped through her kidneys; I had been to the Dr with her so many times because she had lost a lot of weight and was obviously very ill. I knew there was something very wrong and I was proved right when she collapsed in the night and was taken to hospital where they discovered the cancer. Shocking!

valdali as I have been told the triage will take place sometimes in the next six weeks and that letter arrived over a month after I saw my GP, I am not sure that assessing urgency plays high in their game.

I had a general scan for something else entirely six weeks ago. It showed up something that could be quite serious and the GP wants a more detailed scan of the affected part. I am not sure what there is to triage. If I have got osteoporosis, then the first symptom is likely to be when I break a hip or other bone, which will be rather counterproductive as, if that is my problem, the sooner I am on medication to protect me from bone fractures the better.

I think the issue is that, with a fragmented health service, GPs can't always order hospital tests. If they could, they would maybe order unnecessary tests on somebody else's budget. It depends on the pathways which have been set up by the local commissioning group.

I'm assuming you need a DEXA scan, which I doubt a GP can order directly.

Why not? If I went privately, it would not be a problem.

I am also worried by the message I am getting that GPs are incompetent and do not know what they are doing as all their requests for treatment need to besecond guessed.

What does that say about their clinical judgement in health issues that are left to their discretion?

M0nica

Why not? If I went privately, it would not be a problem.

Yes, if you went privately, it wouldn't be a problem because you would be paying.

As it is, GPs are separate cost centres. Hospitals don't exist to provide services to GPs. If they did, GPs could order unlimited tests, which they wouldn't pay for, but the hospitals would. Some of the tests would be inappropriate and a waste of everybody's time and money.

As I'm sure you're aware, a fractured spine could have other causes other than osteoporosis and the hospital has the people and equipment to identify the cause. It can't do that without a detailed medical history, which it won't have had from the GP, who is almost not an expert in your condition.

PS. My mother had crumbled vertebrae which resulted in the identification of another condition by the hospital, so I have some experience how the system worked for her.

No wonder no one wants to be a GP, the Health system itself doesn't trust you to know what you are doing.

M0nica

No wonder no one wants to be a GP, the Health system itself doesn't trust you to know what you are doing.

By the nature of their training, GPS are generalists, not specialists. The average GP sees patients with a myriad of different clinical presentations and reported symptoms every day. They are fallible, no doctor can recognise every condition. Patients are often not good at describing their symptoms either, they will not mention important issues, exaggerate, or underplay how they feel.

If the limited number of specialists at hospitals didn’t triage, the waste of their time seeing people who don’t have the condition they specialise in, which would prevent them seeing others who do, would be immense. The system is not by any means perfect, but it’s difficult to see a better alternative unless we go down the American route and test and scan everybody for everything possible - in which case the NHS would need much more funding.

It's certainly more complicated than it seems.

I think we have unrealistic expectations of GPs now medicine has become more sophisticated and we can’t expect them to know everything. Medicine is not an exact science They often have to refer for tests and consultant expertise in diagnosing some conditions.

They should be able to spot possible life threatening or likely cancer diagnoses, but often things are not that clear cut and atypical.

We would have to pay a great deal more for the NHS if we want expensive tests readily available for GPs.

Perhaps it’s time for a complete rethink of GP services? I have a chronic condition about which my own GP is sympathetic but understands little, and it can be difficult.

Yes,GPs are generalists, but surely we should trust them to know when someone needs further investigation by a more focussed expert.

As I know from previous experience this current system just leads to extra and unnecessary treaments and appointments at great cost to the NHS. I agree sometimes a triage may save the NHS a costly investigation, but my experience has been that in most cases it actually leads to several more appointments and treatments that it is known in advance will not work, in order to tick boxes.

M0nica

Yes,GPs are generalists, but surely we should trust them to know when someone needs further investigation by a more focussed expert.

As I know from previous experience this current system just leads to extra and unnecessary treaments and appointments at great cost to the NHS. I agree sometimes a triage may save the NHS a costly investigation, but my experience has been that in most cases it actually leads to several more appointments and treatments that it is known in advance will not work, in order to tick boxes.

I think you’d be surprised at the attrition rate Monica, particularly for orthopaedic procedures. A lot of people opt not to go down a surgical route once they have the full facts, and know how much work they will have to do themselves post operatively, it’s particularly the case with knee replacements. I’m not defending the triage system, but it’s very nuanced depending on individual conditions, and it works effectively in a majority of cases given the capacity constraints.

M0nica

Yes,GPs are generalists, but surely we should trust them to know when someone needs further investigation by a more focussed expert.

As I know from previous experience this current system just leads to extra and unnecessary treaments and appointments at great cost to the NHS. I agree sometimes a triage may save the NHS a costly investigation, but my experience has been that in most cases it actually leads to several more appointments and treatments that it is known in advance will not work, in order to tick boxes.

You're being offered an investigation by a more focussed expert! UK Biobank can't diagnose osteoporosis and neither you nor your GP can rule out other reasons for the fracture at this stage. Hospital specialists will look at other possible reasons and also at any underlying reasons for the fracture. Your area possibly has an integrated fracture liaison service, which might or might not be efficient. Personally, I'd rather know that any symptom was being thoroughly investigated. I certainly wouldn't want to go down the American route of ordering each and every investigation separately.

I could barely walk and was in great pain. I was not offered an xray but referred to a private physio firm contracted by NHS. Absolutely useless. Weeks between appointments with no results. Looking back I believe it was obvious that I needed a hip replacement but this "pathway" appeared to prevent me being put on the NHS waiting list. After years of this I eventually on the advice of a chiropractor I was paying privately for made an appointment with an orthopedic surgeon. Xrays were taken and I was diagnosed with bone on bone hip arthritis. The NHS is great for emergencies but for so called elective surgery my experience was not good. I don't clap for the NHS. In the end I had to pay for my hip replacement privately. I was shocked how poor the NHS treatment was and my faith in it is greatly diminished.

You are right about the accepted Pathway for hip and knee replacements Hippie20 and in my experience it just delays the inevitable when after jumping through lots of hoops (ha ha) you are eventually granted an orthopaedic appointment. This can leave many people suffering extreme pain, mobility problems, or may even die before being seen. I’m sure this is about rationing.