Chris Lancelot on an NHS at odds with itself

I was angered and saddened by Dr Rebecca Lewis' letter (GP, 31 August).

She describes how a consultant refused to accept a referral from the local orthopaedic assessment service (run by physiotherapists and orthopaedic practitioners) because the letter was not written by a GP.

How often has something similar happened to you? A consultant unit refuses to accept a message relayed by your secretary or nurse because 'it's not from the doctor'. But GP partners are held liable for everything done by their staff.

The situation is made even more ridiculous because of the introduction of specialised nurses. My diabetes nurse knows more about diabetic control than I do because she sees it all the time, while I become deskilled through lack of practice. But apparently, expert staff like this aren't good enough to make a referral.

In other words, GPs are held responsible for everything done on our behalf; we are expected to work co-operatively with allied specialised professionals; yet some of our consultant colleagues still refuse to relate either to those acting directly on our orders, or to competent colleagues who are part of our practice team.

But when the boot is on the other foot, how things change. I want to refer patients to named NHS consultants, only I'm not allowed to: I am obliged instead to refer to an anonymous departmental referral centre. Indeed, at two local hospitals, GPs are not even allowed to refer patients with back problems to the consultant: they are seen by a physiotherapist. Access to the consultant is, in effect, barred.

This whole situation is typical of our disjointed, dysfunctional NHS: the GP is required to do everything but trusted to do nothing.

We will never achieve a joined-up health service while the different arms of the profession are at odds with one another. All consultants and hospital departments must understand that when they communicate with a member of our staff they are in effect talking to us - just as when we, in turn, speak to a junior doctor or a hospital specialist nurse. Consultants are not superior beings but co-professionals who specialise in a different field.

The same rules should apply to both of us: the courtesy that we extend to our consultant colleagues and their staff must be extended by them in equal measure to us and our teams.

Dr Lancelot is a GP from Lancashire. Email him at .

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