More than a mortgage agent

Imagine that you are a building society (OK, I know it's a bit of a stretch; start with something easier, maybe a garden shed), and are reliant on customers being referred to you by mortgage advice agents.

How do you think you might treat these agents upon whom you are so dependent?

Apart from allowing them a decent kickback, I expect that you would be courteous, accessible and, most of all, appreciative that they were sending you the clients who were keeping your business alive.

Now substitute the words 'private specialist', and 'GP' for 'building society' and 'mortgage adviser'. OK, I admit (not without considerable regret) we could not ethically accept kickbacks, but there is a further downside to acting as unpaid agents.

Because we do it for nothing, our services are taken for granted and considered of no value, though the private clinics would find it tough without us.

I also don't think we receive sufficient courtesy, accessibility or appreciation. Referring safely and appropriately is one of the core skills of general practice. Every time we do it, we are putting our own judgment on the line.

Private referrals are an even greater responsibility. The patient is not being referred to a hospital department, with all the guarantees that entails.

The patient is reliant on our opinion and our recommendation, and, if the specialist screws up, no matter how supremely, he or she is well removed from the resultant mess, while we will have it right back at our front door, and guess who will get the blame.

Last week I made a private appointment for a patient but, because I am not always perfect, forgot to tell him in sufficient time. I remembered on the day, but it was too late for the patient to attend the appointment, so I asked my secretary to make another one.

The consultant's secretary bristled with outrage, and said that our patient would not only be charged the next appointment, but for the missed appointment as well. When it was pointed out that it was our error and not the patient's fault, she said she'd have to 'talk to the consultant'.

It was as if it was she who was doing us a big favour by accepting the referral, instead of the other way round.

It is also not quite clear to me why secretaries in private clinics think they can talk down to NHS staff. Private medicine has been leeching off the health service for far too long, and it's time we considered payback.

Liam Farrell, a GP from County Armagh. Email him at 

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