wyvernhealth

I need reminding why we want to restrict GP choice and put everything through one referral centre. The only reason I can think of is that some GPs think that other GPs are making unnecessary or inappropriate referrals and so we can save money by letting a cheaper physio do it instead.
If GPs are making bad referrals the solution is education of the GPS. This would be enhanced by increasing GP/consultant contact. The consultants may know which GPs refer too much. Why don't we ask them who they are and invest in education?
The present idea simply distances GPs from consultants and in the long term unhelpful.

What do others think?

thank you richard for using the forum. hopefully it will pcik up.

the interface service has evolved to
1) try and speed the patients journey ie address the 18 week target
2 ) save money for Primary care t use differently.

both these drivers are imposed from on high.

i agree we need to engage more with the consultants and education is a crucial component in the design of any new pathway.

Wyvernhealth are going to start a dialogue with secondary and primary care GPs to understand the respective perspectives and hopefully reach a mutually satisfying pathway.

if any GP wants to help us look at the orthopaedic pathways , please contact me.

the letter sent out has confused people and we are seeking clarification from the PCT.

as i understand it , a letter sent to a specific consultant will NOT go to the interface clinic. general departmental referrals will got to a local interface service.


matthew dolman

The following is the text of an e-mail that I sent on 9 November.

"Dear Paul & David,

We were perplexed to receive David’s letter of 25 October (e-mailed to our practice manager but passed on to us doctors)

The letter did not read like a letter from an organisation that was set up to represent its constituent practices and indeed with the support of our funding. It read more like a letter from an authoritative health authority seeking to hit a government target. We do not remember any consultation with PBC leads about this move nor do we remember it being one of the priorities that were agreed upon.

Whilst we have no problem with the musculoskeletal interface clinic being an option for referral, or even promoting it as the default option we feel strongly about the removal of other referral options. In particular we object to the statement that “When GPs do refer directly to consultant Orthopaedic Surgeons these will be redirected to the joint Musculoskeletal Interface service”. This is a huge restriction on clinical freedom and the patient, apparently, has no choice about where the point of choice is!

The LMCs’ view (as stated in their November newsletter) is that the policy of the musculoskeletal service being the first port of call is reasonable “provided that a GP referral made to a specific consultant for a particular reason is allowed to pass straight through the system”.

It seems bizarre that we are expected to pay lip service to patient choice by using a cumbersome and confusing IT system and asking patients to fill out surveys. However the patient’s long-standing and trusted GP is no longer in a position to discuss with them how or where they would like their orthopaedic problem managed or to have any input regarding to whom he is passing on the care of his patient.

We are sure that we are not alone in our concerns.

Yours sincerely

James Hickman & Nick Chapman
North Curry Health Centre

CC Taunton Deane Area Senior Partners"

I have yet to receive a reply from Wyvern Health. A few GPs have made sotto voce approving comments to me but no-one apart from Richard seems to feel strongly enough to raise the topic. Am I a dinosaur in wanting to maintain clinical freedom and the importance of the relationship between GP and patient with their joint decision making?

The MSIC are often very uesful as a resource for management of patients with orthopaedic problems. But, like Richard, I can't understand how putting another step in the process will save time or money where a patient clearly needs (or wants) to see an orthopaedic surgeon.

Despite Matthew's assertion, David's original letter of 35 October clearly said "When GPs do refer directly to consultant Orthopaedic Surgeons, these will be redirected to the joint Musculoskeletal Interface Service...Patients will be offered choice of secondary care clinician should onward referral be necessary. "

thanks james

i have been tasked to try and help unravel the musculoskeletal services for WHc. Any input is really useful.

Since the first communication i have been talking to the parties involved.

1. taking T&S alone we have been told that the orthopaedic consultants have directed the RMC to try and move patients through the MSIS.They have enough confidence in the MSIS team to assess the need for orthopaedic clinic (consultant ) review and even allow them to direct book for surgery. This is driven by the desire to reduce the wait for orthopaedic intervention. There is an arguement that the MSIS should be be seen as a Primary Care service , which feeds the arguement that " choice " will begin at the MSIS level. Reduced waits for definative surgery should be supported ? More detail is needed about the "choice" question.

2. I have also spoken to the RMC . They have explained how they have been told by the PCT /Trust to ask patients to consider the MSIS as an option because the Consultants have placed it their pathway anbd won't see patients unless they have been seen in the MSIS first. They did say that if a patient is adamant they want to see a specific consultant , this would be honoured.We need futher info from the RMC in writing to clarify their handling of referrals and I am pursuing this.

the situation for other Providers and the EASE service is more unclear and discussionis are ongoing.

WyvernHealth have decided to consider support for the development of a Commissioning plan for a musculoskeletal paln across the whole County. There is variation in the serivce provison and confusion about the pathways taken.

We will canvas for support for this proposal over the next week.

Please contact me directly if you have more thoughts.

regards

matthew