'Is it for your spots?' I asked, looking at him sympathetically. He had a severe case of acne.
He looked quite taken aback, and the old, wise adage, 'think before you speak', came to my mind.
'No, it's about my psoriasis, actually,' he replied and then took off his hoodie.
I scrutinised his arm intently, with and without my glasses, but struggled to make out anything other than an insignificant, rather nondescript psoriatic patch.
'Perhaps I can give you a cream for it - this is quite a mild case of psoriasis,' I said.
'No, my mum told me not to let you fob me off with a cream and to make sure that I see a dermatologist. It is my right to get a second opinion,' he said, determinedly.
But not for much longer, if CCGs do place restrictions on hospital referral rates. I note that some CCGs are considering payments to GP practices if they reduce outpatient referrals.
Like most GPs, I refer patients for an outpatient hospital opinion based on clinical need, or if we have exhausted all avenues within primary care. Occasionally I have referred for a second opinion - suspecting very little pathology but not being 100% sure - when the patient has frequented the surgery on countless occasions.
For example, I have told Betty repeatedly but without success that her abdominal pain is likely due to IBS, but when esteemed gastroenterologist Dr A says the same thing, she accepts it readily.
GPs see more sick and needy patients than ever more. It is inevitable that referrals will go up. Many GP practices already undertake triage or audit their referrals (particularly in overstretched specialties).
In addition, given that it can take up to a year for patients to be seen in many hospital departments, such as neurology or ADHD clinics, we have usually exhausted every primary care avenue open to patients by that point.
CCGs would be better placed to offer support around referrals instead of payments, as well as increasing capacity within community or hospital clinics to absorb the extra referrals.
- Dr Aziz is a GP partner in north-east Bristol