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

Goodness me, Monica. I was just discussing this with my husband the other day.

Not the same scenario but I went to my GP with a suspicious mole. GP decided to refer me. I got an appointment within 3 weeks, went along to the hospital. Mole was looked at by a nurse who then decided that yes, it needed removal.

Do GPs often refer unnecessarily? Surely not.

So I had 2 appointments at a hospital 40 minutes away.

Just as an aside, the GP I saw performs mole removal at this hospital on a weekly basis. So I have no idea why his referral wasn't taken as a given.

It does seem undermining of doctors, especially GPs, but gone are the days when they could just refer direct. They have to follow the appropriate “pathways” now, which are supposed to be make treatment more appropriate and efficient, but IMO they are a lot about restricted resources and money saving.

In my area if you present to GP with a hip or knee problem, which obviously needs orthopaedic referral, the GP must after X-ray, refer to a physio for exercises and further assessment, thus extending the time taken to eventually reach orthopaedic consultant, and eventually join the list for surgery.

it's just part of rationing. limiting use of resources.

What Farzanah said about "appropriate pathways" (i.e. unnecessary bureaucracy). It happened to me, my optician, and my GP.

I fainted in the street (I think the cause was an IBS-type issue caused by too much citric acid over the previous fortnight), got scraped off the pavement and carted to hospital for a thorough checking over. Hospital doc found nothing except an eye issue that my optician had picked up on a few weeks earlier.

Blah blah blah... GP got a bollocking from the optician who felt his professionalism was being questioned. GP phone me with "what on earth! questions and the long and the short of it was I simply cancelled the hospital appointment with an ophthalmologist when I got the letter about it.

This happened in 2018. When I went for my annual eye check this spring the optician brought it up again, clearly still "put out" that he was apparently being over-ruled by some jobsworth hospital doc who hadn't a clue what was wrong with me (I did tell her what my opinion was but what would I, a mere pleb, know about the behaviour of my innards?). I explained that the GP had told me he had to make the referral and that I'd simply cancelled the appointment when I got the letter about it because I knew it wasn't necessary.

One good thing about the whole episode? – joined up medical records so that the optician got the info about the referral. At least, that's what I'm telling myself.

Anyway. So, yes. GPs do sometimes have to make unnecessary referrals.

PS I should say that I cannot complain about the hospital doc's thoroughness. She was doing her youthful, newly qualified best.

I was involved in this kind of triaging, so can give some perspective, whilst recognising that things do vary, and I have been retired for some years. I also can't comment on your situation M0nica.

Different areas now have different 'pathways' and systems. many GPs are locums or similar and whilst they are well qualified in medicine, don't know the local system (which changes every so often anyway!)
In some areas, GPs can refer directly to say, a physiotherapist or speech therapist, or for scans / Xrays. In some they don't have that facility, so they refer to a consultant. The hospital may wish to triage this, saying 'with these symptoms we think that a 6 week course of xxx may be helpful before seeking a consultant's opinion'.
Within paediatrics, I found these referred to a consultant:
Bed wetting and sleep problems, having had no community nurse input.
Speech problems, no assessment by a speech therapist.
Learning difficulties with no information from the school.

It would be a waste of resources to have a consultant look at these until all the proper information is in place. It is not just doing something on the cheap, but part of diagnosis.

Part of my job was to write back to the GP saying 'We propose a specialist nurse assessment and intervention, and will inform you of our findings before a consultant appointment. Please contact me to discuss if this is not satisfactory for you or your patient'. I also made it clear to the family that this was not 'fobbing off' but actually more specialised and suitable input, with the consultant opinion available at any time.

Now, it would make sense to have a much clearer system across the whole NHS but between Commissioning Groups and Hospital Trusts, that isn't going to happen.
I realise this doesn't apply to some of you, but just giving some context.

I've just got myself into a similar situation. I've had shingles since last Oct. and doctors at our health centre say they can do no more for me.
So I've referred myself to a private neurologist at a nearby hodpital , prepared to pay for an initial consultation - £200, and was told by the secretary that I need a referral from my GP.
I've managed to get a phone appt next week with one of the 9 at our group practise, to ask for a referral, but feel uncomfortable about asking as it looks as if I doubt their professionalism.

It’s not rationing. GPs are what they say on the tin, general practitioners. They are referring you for a specialist opinion, and a nurse working in a specialist field will have more knowledge of that field than a GP.

Patients are often referred inappropriately, eg. A GP may think they need a scan, but those with more knowledge of that specialty may think differently.

The GP is sending a referral requesting you be assessed by a specialist. They can’t book you in for a procedure etc because they aren’t qualified enough in that field to know how to treat you.

I recently had a referral rejected because my GP didn’t submit half the information. That’s another issue, rocking up for an appt only to find the GP hasn’t done everything they needed to before referring. Which gets you sent back to the GP for those things to be done before you can then go back to the specialist at the hospital.

Triaging is absolutely the right thing to do to minimise the patient pathway which is usually beneficial in terms of patient experience ie. Most don’t want unnecessary appts, and the positive consequence is that it does also stop appts being wasted.

But surely those triaging should know when to triage by talking to the patient and when they have sufficent information from the GP to make a decision as soon as the application arrives.

I have recently had a bone density scan done by the UK Biobank because I am part of their data base (for more information about UK BioBank www.ukbiobank.ac.uk/ ).

The Biobank scan, that was a whole body scan, showed a fractured vertibrae in my back, my GP wants a bone density scan that focuses on my back because a crushed vertibrae can be sign of osteoporosis. I cannot see any reason why I need to be contacted by the triage team. They have a scan they can look at, and I can add nothing to the information shown on that scan. Why do I need to wait six weeks for a person to person triage appointment.

I went through a similar rigmarole before I had my carpal tunnel operation. Both GP and consultant were as one that my problem was so severe only an operation could treat it, but each had to refer me for other treatments first, that they knew would be ineffectual because it was ordained that all these should take place before an operation would be approved.

The operation takes about 15-20 minutes, is done under sedation and local anaesthetic and you are in and out of hospital in hours.

I suspect that the cost of all the ineffectual extra treatments, given that it was known they would be ineffectual, probably exceeded the cost of the minor op itself.

There needs to be flexibility in systems like these, so that treatments on a pathway can be skipped when there is clear evidence that they will be ineffectual, and if a GP submits evidence that shows quite clearly what treatment is needed, the Triage team can make their own decision in the hospital on the need for treatment instead of having patients waiting weeks to be phoned, especially when they are unlikely to be able to contribute anything useful to the assessment.

My experience so far, is that far from minimising the patient pathway, the blind blanket way these procedures are applied has led only to extra appointments, extra tests and extra treatments, none of which have contributed anything to the final outcome. just cost the NHS money that they might as well have used for lockdown parties, at least someone would have got some benefit from it.

It took several years to get from my GP identifying knee problems to a surgeon. The route was tortuous involving x-rays, subsequent referrals to physio (3), a course in the hospital gym which was a requirement before any onward referral. Finally arriving with the muscular skeletal interface I saw someone who could and did refer for surgery. The surgeon reviewed my x-rays and asked why I hasn’t presented myself four years earlier. Why? The system!

I have never come across this. Each time I have been referred by my GP I have seen a specialist.

Like dragonfly everytime my GP has referred me to see a consultant I have seen the consultant no problem. I live in the north west.

Perhaps it depends where you live what the health authority guide lines are. And how the hospital trusts are run.

When a consultant orders a procedure or test in a hospital after seeing you, it has to be approved by a committee.

"I explained that the GP had told me he had to make the referral and that I'd simply cancelled the appointment when I got the letter about it because I knew it wasn't necessary."

I'm positive that a qualified Optician can refer a patient to a hospital (ENT) Consultant.

Humbertbear

When a consultant orders a procedure or test in a hospital after seeing you, it has to be approved by a committee.

That's not true. I've had 7 hospital appointments over the last couple of weeks with two MRI scans, two biopsies, three ultrasounds and four blood tests. I know I've been mentioned at three multi-disciplinary meetings to decide on my treatment, but the tests themselves have been ordered by doctors and specialist nurses without committee meetings.

I think it is a ploy to drive as many patients as can afford it into the private sector.

I guess each health trust has different rules. I am very happy with ours.

Humbertbear

When a consultant orders a procedure or test in a hospital after seeing you, it has to be approved by a committee.

No that's not the case.
If your case is Referred to a MDT, it's seeking others advice on your condition, is there another way to treat?
I am still a practicing Health Care professional and I frequently ref my patient to MDT, I work with just Pacemakers/Device now.

Does this patient need, eg Like for like Pacemaker when it's due to be replaced , has their condition changed? do we up grade to a more complicated Device. "The team takes the Notes and goes through the History to make the decision.

Also when I'm Clinic, if a request come in from the Ward, we triage the request, if we think it's not necessary, we say No.

Each to their own field in MDT, it's a jigsaw put it together, you get the overall picture, it's always in the patients best interests.

GPs aren't specialists - and yes, they do sometimes refer people unnecessarily. My (then) GP examined my eyes (when I simply mentioned migraine), expressed concern and referred me to the hospital eye clinic.

There, I faced a long wait (outside, as I tell them to text when they want me) a barrage of questions, various tests - followed by a furious doctor saying there's absolutely nothing wrong - and calling the GP all sorts. A complete waste of time for everyone concerned- especially me!

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!

In 2020, DD, came close to death, she was described as 'critically' ill because a doctor would not even talk to her before a scan was done, no matter how severe her symptoms. She had to go through all the proper procedures first.

She only finally got the scan because she rang the hospital almost daily to get it. And when the doctors got the results of a blood test not done until after the scans, the panic set in, when they realised how ill and close to death, she was. She was told by her GP that she could have a fatal heart attack at any moment. But had she died, it would not have been in vain, all the boxes would have been ticked and procedures followed.

Because the information that may have been supplied by the GP may be incomplete and even now there are some surgeries that do not have a direct link with the hospital to send referrals (they usually use a completely different CRM to the hospital.
The consultant obviously wants as much information about your condition as possible.
It also comes down to budgets and as your primary care provider, your GP has to give"permission" for treatment, if needed to be given. Antiquated system for sure but as the GP surgery is owned by the GP partners and not the hospital, that's the way it has to be.
GPs may well have trained for years and worked in a hospital for years but before they choose to become a GP, they may have only worked in some areas for 12 months or so, before deciding on the specialism they want to follow - hence they don't know everything about all areas!

Same with the dentist. “I’m concerned about an area of your gum. I’m referring you to the hospital to have it checked.”
Link from the hospital says, “Your referral is with triage.”

H1954

"I explained that the GP had told me he had to make the referral and that I'd simply cancelled the appointment when I got the letter about it because I knew it wasn't necessary."

I'm positive that a qualified Optician can refer a patient to a hospital (ENT) Consultant.

At one of my annual eye tests (severe myopia) my optician noticed a potential problem, and referred me directly to the eye hospital. I got an appointment within 2 weeks.