GP Receptonist and GP Medical Secretary refusing to give choice at the point of referral for elderly family member

[Manxman in exile]

Receptionists and medical secretaries don't have the power to determine where patients are referred to - only  the GP.

 

As ericsbrother has suggested there may be many good reasons why a referral has not been made to the private hospital.  One may be that it is not appropriate to refer your relative there because they don't have the facilities/expertise.  (Private hospitals can be surprisingly limited in what they can offer outside of relatively routine treatments.  There may(?) also be funding issues - I'm not sure how NHS referrals to private hospitals work within patient choice).

 

The only way to resolve this is for your relative to discuss it with the (or a) GP in question.  The relative will need to do this themself unless they've given you written authorisation to discuss it on their behalf (I don't think a power of attorney is necessary but I may be mistaken).

 

Can they get a 'phone consultation?  Nothing to prevent you being present for that or for a face to face consultation.

 

PS - if your relative has a FtF consultation but you can't be present, get them to ask the doctor to write down what the problem is - assuming there is a problem.

[Manxman in exile]

Where your relative gets referred to has got nothing to do with the receptionist.  Is it possible you have misunderstood what they have said and that it is the GP who has NOT referred to the private hospital?

 

Ask to speak to the Practice Manager and ask him/her for an explanation.  If that gets you nowhere you'll have to go back to the GP for an explanation.

[Manxman in exile]

On ‎13‎/‎04‎/‎2019 at 17:54, sofiaa said:

The GP did say she would make the referral to the hospital of choice but the medical secretary did not offer any choice at all when she sent the appointment letter, then she told me to go ring the number on the letter to change the place of appointment when it was the surgery themselves that did the referral

 

Sorry - I'm confused.  What do you mean by "...did not offer any choice at all when she sent the appointment letter..."?  The GP decides where to refer the patient to, and the secretarial staff follow the GP's instructions and arrange the paperwork for the referral.  Do you mean that the practice wrote to the patient confirming the referral (to the wrong hospital)?  It's just that whenever I've been referred to secondary services I've only received an appointment letter from the hospital and nothing from my GP (or their staff).

 

Also, I find it strange that you were advised to ring (the wrong hospital!) yourself to change the appointment to the hospital you wanted - this makes no sense at all.

 

Are you sure this is what has happened?  Because if it is, you need to contact the practice manager PDQ because there is something very seriously amiss here.  God knows what else this secretary/receptionist is doing and telling other patients.

 

When speaking to the practice manager I would not be approaching this as a "complaint".  Just recount the facts as you've stated them here.  I would also act a little "bemused" as to why your relative has not been referred to the hospital of their choice, which you understand to be their right under patient choice.  Approach it as if you think a simple mistake has been made and you just want it rectified.  You could also "innocently" ask why the secretary doesn't seem to have followed what was agreed with the GP.  Depending what response you get you may want to take it further.

[Manxman in exile]

As honeybee has said, at this stage you are NOT making a complaint.

 

Just ask to speak to the Practice Manager and seek an explanation as to why your relative has not been referred to the hospital of their choice.

 

By acting "bemused" I mean saying something like "GP so and so agreed to refer my relative to such and such a hospital, but when the referral letter came through we were puzzled to see that it was for another hospital not the one my relative wanted.  I'm sure it's just some easily explained clerical error or mistake and I'm sure it will be very easy for you to put right for us.  Can you do that please?"

 

That's it.  There is absolutely no point whatsoever in making a written complaint before you've tried to resolve it informally.

 

EDIT: I fully agree with honeybee's last post

 

Edited April 14, 2019 by Manxman in exile

[Manxman in exile]

I agree with "think about it".  If you can't get through on the 'phone (which could be said to be a problem in itself) just send a simple and straightforward letter as you have explained here.  I think the wording I suggested earlier for a face to face conversation will do as well in a letter as in a conversation.  If you have written authorisation from your relative to act on their behalf include a copy, otherwise get written confirmation now and include that.

 

There's no special formula or wording you need to use, just explain your concerns in a non-confrontational way as honeybee suggested.

 

If English is not your first language(?) say so in the letter and apologise if your wording comes across as abrupt - say it's not intentional and you are just looking for an amicable resolution.

 

OK?

[Manxman in exile]

I think that's fine.  As think about it says, get it sent off and the sooner you'll get an answer.  Let us know what sort of reply you get.

 

Out of interest, how did you get to speak to the preferred hospital to find out they would accept your relative as a referral?

[Manxman in exile]

If I recall correctly, think about it has experience of practice management so I'd be inclined to follow their advice.  I also worked as an NHS manager for over 25 years (so am well aware of what can go wrong!) but don't have any experience of choose and book.

 

I suspect that what think about it says regarding limitations/exclusions on your freedom through choose and book is correct and that it may not be available at the moment at the hospital of your choice.  Or it may be that you are not asking the right questions of the right people.

 

If I were in your shoes I would consider the following if I wanted to try to get to the bottom of this:

 

1.  on the original appointment letter from the NHS hospital you don't want (I'm assuming you have such a letter - that is how it would work here) there ought to be a 'phone number for the medical secretary (or appointments secretary) of the specialist your relative has (or had) an appointment with.  Ring them and ask them if they have a record of the appointment and who (if anybody) has cancelled it.

 

2.  I'd try to get an appointment with the GP who did the original referral and ask them to explain what is happening and why choose and book is not available  (I appreciate that may be difficult to do in terms of timelines etc. so it may be worthwhile just trying to see any GP at the practice).

 

3.  You could also try contacting your local Care Commissioning Group and ask to speak to somebody there about choose and book and ask them if they are aware of any limitations that would apply in your relative's case.  You ought to be able to get details off the internet or there may be a link or contact details on the practice website.  Again don't say anything about making a complaint, simply explain that you don't understand why choose and book does not appear to be an option in this case.

 

4.  Follow think about it's advice in their last paragraph.

 

Before doing any of the above I would wait to see if think about it has any advice on my suggestions above.  They may think I am giving the wrong advice.

 

For what it's worth, I've never understood how choose and book was meant to work within a national health service.  I've always seen it as a political gimmick.  I worked in the NHS for over 25 years and I would not necessarily know how to decide where the best place to go is, or who the best person to see is.  My local NHS acute hospital is in special measures and I've had to use their services a lot over the past few years (I spent a week as an in-patient in February) and I've never had any complaints about the service they provide.  Sometimes a bad reputation is just bad luck.

 

Out of interest, is your relative waiting for an outpatient appointment or what exactly?  Appreciate if you don't want to reveal this information.

 

 

 

 

[Manxman in exile]

OK - I've just searched for my own CCG and it's not as easy as I thought!

 

Looking at patient choice you do not appear to be eligible if:

"Are these legal rights?

Yes but there are circumstances in which you may not choose. These are set out below.

When am I not able to make a choice?

You do not have legal rights to choose if you are already receiving care and treatment for the condition for which you are being referred..."

 

This refers to outpatient appointments and can be found in the NHS Choice Framework here  https://www.gov.uk/government/publications/the-nhs-choice-framework/the-nhs-choice-framework-what-choices-are-available-to-me-in-the-nhs#section-3

 

Could this apply to your relative?

 

Also might be worth searching for health condition and postcode to see if your preferred hospital works with the NHS.

 

https://www.nhs.uk/service-search

 

Hope I've not made this more complicated and apologies if you've already done all of this.

 

See what think about it says.

 

 

[Manxman in exile]

1 hour ago, Manxman in exile said:

OK - I've just searched for my own CCG and it's not as easy as I thought!

 

Looking at patient choice you do not appear to be eligible if:

"Are these legal rights?

Yes but there are circumstances in which you may not choose. These are set out below.

When am I not able to make a choice?

You do not have legal rights to choose if you are already receiving care and treatment for the condition for which you are being referred..."

 

This refers to outpatient appointments and can be found in the NHS Choice Framework here  https://www.gov.uk/government/publications/the-nhs-choice-framework/the-nhs-choice-framework-what-choices-are-available-to-me-in-the-nhs#section-3

 

Could this apply to your relative?

 

Also might be worth searching for health condition and postcode to see if your preferred hospital works with the NHS.

 

https://www.nhs.uk/service-search

 

Hope I've not made this more complicated and apologies if you've already done all of this.

 

See what think about it says.

 

 

 

Apologies for quoting my own post but I seem to be too late to edit it.

 

The bit highlighted in red:  this refers to a first OP appointment so not very clear to me what "...already receiving care and treatment..." actually means.  It can't mean from a previous OP appointment because it only applies to first OP appointment (or can it mean a previous OP appointment?).  So does it refer to "care and treatment" from your GP?  If "Yes" then the patient will almost never be entitled to choose OP services because they will already have received "treatment" (in its broadest meaning) from the referring GP.

 

Also, I've tried the "service-search" link for my area and it's not clear to me whether it is up to date and accurate.

 

The whole thing seems a bit of a mess to me but it presumably works for most people trying it.  Maybe I'm overthinking it.

 

Sophiaa - apologies if I've only muddied the waters further!  See what think about it says.

 

 

[Manxman in exile]

Hi sophiaa

 

Don't think I can add much to my advice in #33.

 

First, I think you need to get a GP appointment to discuss this, preferably with the original referring GP.  Try to get that sorted now even if it's a couple of weeks away.  Try to impress on the reception staff that for you and your relative it's important to you although not (necessarily) a medical emergency.  (I'm assuming it isn't).  As honeybee advised in an earlier post, keep any conversations calm and non-confrontational.  I appreciate that timing may be an issue for you, so try to arrange an appointment ASAP.  Alternatively, try again to get an appointment with the practice manager.

 

Second, I'm not familiar with how secondary referrals (ie to a hospital specialist) work in your area.  In mine, I'd expect either to get a 'phone call from the hospital to arrange an appointment, or get a letter from them with an appointment together with instructions on how to change the appointment.  This would be to contact an appointments secretary/clerk.  I would try contacting this person or the medical secretary of the specialist whom the appointment is with and try asking them about the appointment and why/who cancelled it.  If this information is not immediately obvious, I'd ring the hospital's main switchboard number and ask to speak to whomever deals with appointments for whatever specialty it is.

 

Third, find out who your local Care Commissioning Group is, 'phone them and ask to speak to somebody about how choose and book/patient choice works in their area, and explain to them what the problem is (or what the problem appears to be).  Again keep it calm and non-confrontational and emphasise your confusion/puzzlement.  I'd also make it clear that you aren't making a complaint at this stage - just seeking information and advice about why the system doesn't seem to be working as you understand it should be.  You need to try all avenues available to you before making any kind of complaint.  You can complain later if necessary.

 

I don't think it matters what order you do the second and third steps in.  In fact I'd do all three together unless you can get a really quick GP appointment.

 

Like honeybee, I appreciate that you'd like to keep a paper trail, but I agree with him/her that it would be better to speak to someone on the 'phone initially (you should get it sorted quicker in my experience) and then follow it up with a confirmatory email exchange.

 

That's all I can suggest I'm afraid.  I also understand that it's easy for me to post the above (my NHS role involved a lot of sorting out problems when things had gone wrong and trying to improve systems) but that it may be confusing and stressful for you to do.

 

Good luck!

 

(PS - I think contacting your CCG may get you an answer to your issue quicker than anything else.  If you can't find their contact details on the web, I'm sure someone here could identify them for you if you are happy to tell us where you live - of course you may not want to do so.)

[Manxman in exile]

1 hour ago, BazzaS said:

 

Way back on 4/4/19 I said:

 

“if you wish to get a quicker resolution: go to the GP’s.

if you are wedded to not going to the GP’s : go to the CCG.

 

if you are adamant you want to go to the GMC : do as you wish. It’ll be the least speedy (and likely least successful) approach.”

 

and here we are ....... a month later.

at least the respondent suggesting “go in guns blazing, demanding GMC numbers” has ceased firing from the hip!

 

Yeah - I'd forgotten your post mentioning the CCG.  I agree that going to the GPs again should be the quickest way of dealing with this, but it would seem that sopiaa's relative is on the list of a somewhat difficult and intransigent practice, but without being physically able to witness the exchanges between them I can't say for sure.

 

I agree with you about the other poster's "advice"!!!  A quick way of getting nowhere and/or getting kicked off the list!

 

There is no point in making anything resembling a complaint until you've gathered enough information to identify the substance of the complaint or, indeed, to identify whether there are grounds for a complaint at all.  I think sophiaa is still at the information gathering stage.

 

sophiaa - when you contact the CCG be prepared to have to explain the problem to more than one person.  It's not unreasonable for the first (or second or third...) person you speak to not to be in a position to give a definite answer, but somebody must be able to do so.

 

Also, if English not your first language (apologies if this assumption is wrong!) then I think you can legitimately use this to reinforce your confusion and puzzlement over why patient choice is not working how you think it should.  Play it as you not understanding the system and being grateful for somebody to explain it to you.

 

 

[Manxman in exile]

As above.

 

GP appointment for explanation and ring CCG.