A worse example of useless, bureaucratic, paperwork for paperwork's sake I've not seen in a long time.
It used to be, of course, that to refer to a service we would simply write a letter. We'd give the patients details, descriptions of the problem and the background information.
The first commandment is that: 'This form must be completed in full. Incomplete forms will be returned'. That just gets your back up instantly doesn't it? But just under the patient's name and address is a tick box for me to enter the ethnicity. I can't think why.
The department might want to enter detail like that in its outcome statistics, but won't it be able to ask the patient themselves when it sees them?
There has also been an increasing demand that I acknowledge the patients' consent for referral. Does it worry that GPs refer patients without telling them anything about it?
I'm worried, too, that I have to stipulate how many falls the patient has had. Not that I mind asking, but what if the answer is say five and patients need six or more to qualify?
There are some efforts to be helpful though. I especially enjoyed the definition of a fall as 'a sudden unintentional change in position which causes one to land on a lower level'.
The question 'Does the patient need to use their arms to stand up from a chair?' is followed by the helpful instructions 'How assessed? Ask the patient to stand up from a chair ... without using their arms'.
For goodness sake, we have better things to do with our time than give way to needless bureaucracy.
Dr Kenneth Vickers, Collyhurst, Manchester
Karen Moore, NHS Manchester senior communications officer, said: 'The specialist referral form for the Falls Prevention Service in North Manchester is designed to capture basic demographics and clinical information but also to collect data required by PCT.
'The referral form could be completed by a number of professionals including the patient, therefore explanations are also added. All of the questions are universal, evidence-based and researched and also assist the clinicians in prioritising referrals.
'The form was implemented by a number of senior medical professionals who wanted consistent screening for patients. Consent is a legal standard. The referral form needs to reflect that implied consent has been given.
'Incomplete referral forms cause delays in the referral process. We acknowledge that the wording about completion of the form is a little strong and will modify this as a result of Dr Vickers' comments.
'We are always happy to discuss and work with local GPs regarding any of our services. This is the only complaint registered about this referral form to date.'