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


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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?

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Letter sent and reply received....I rang the hospital and asked if the accepted NHS referral and they said yes.

 

Reply from Practice Manager (see below)

 

Dear Sofiaa

 

Thank you for your letter [date]

 

I am sorry you are unhappy with the service received

 

I have checked our records to find out what is happening and can see appoitment has been made at [hospital name] for [date]. I see you don't want to go to this appointment and want to be see at [hospital name]

 

I have checked NHS booking system and the [preferred hospital] does not provide this procedure under the NHS. I have also contacted NHS referral line at [preferred hospital] and they have confirmed this with.

 

They offer this service but on private basis.

 

If you would like to pay for this procedure privately we can write a private referral letter but you will be charged for this.

 

Your mothers appointment is still booked (but as I mentioned in my above posts, its been cancelled by someone) for the date and hospital mentioned above as long as it has not been cancelled by yourself (when somehow its been cancelled as I mentioned in my earlier posts, so they have not even bothered to check their system, if they did it would have shown as cancelled)

 

If you require help, please contact us asap

 

This is basically the reply, I understand you can still be referred to a private hospital, I myself have been referred to the hospital of choice a few years ago under the NHS and did not have to pay, please help

 

 

 

 

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Hi.

 

Are you absolutely sure that the private hospital will carry out the procedure your mum wants on the NHS? It wasn't just that they accept NHS referrals for some operations?

 

Could you remind us why you don't want to use the hospital suggested by the GP's surgery please?

 

HB

Illegitimi non carborundum

 

 

 

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I think it’s potentially a case of the fact that the NHS occasionally uses private healthcare facilities to offer additional capacity when needed. Almost in a queue-busting manner of helping reduce waiting times when NHS Facilities are unable to meet demand. Obviously once the queue has been busted, so to speak, then the private facilities are not used as it makes no financial sense to have unused capacity in NHS facilities and to be paying a premium for private rooms. Choose and book can only apply where the preferred option is an available one. If the facility is not in use by the NHS then it is not an available option.

 

As such should your mother wish to use private healthcare then it should be self-funded as capacity exists to offer the necessary treatment within existing NHS facilities. 

My views are my own and are not representative of any organisation. if you've found my post helpful please click on the star below.

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I spoke to the hospital and asked if they accept NHS referrals and they said yes.

I also asked if they had an the relevant department that dealt with the medical solution and they said yes

 

I've been referred to this hospital myself in the past by my GP for surgery

 

The reply fails to address the issue of no choice being given

 

The preferred hospital is closer to home, less waiting times, better service overall and more convienient. compared to the local NHS hospital which is at bursting point with bad  reviews

 

The fact is NO choice has been given at all - just a referral to a hospital with not very good overall reviews, then somehow that appointment has been cancelled by someone, after I called the surgery to explain the referal was not to the hospital of choice.

 

The Practice Manager reply states that he has checked the NHS booking system and the [preferred hospital] does not provide this procedure under the NHS and also contacted NHS referral line at [preferred hospital] and they have confirmed this with

 

But then the practice manager contradicts himself by saying 'They offer this service but on private basis'

 

BUT as a NHS patient you still have the right to be sent to a private hospital which the GP has refused and even worse not given any choice of where to go for treatment, then that appointment has somehow been cancelled which the practice manager has failed to identify in their response

 

Please help me with a reply back to the practice manager

 

 

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52 minutes ago, sofiaa said:

I spoke to the hospital and asked if they accept NHS referrals and they said yes.

I also asked if they had an the relevant department that dealt with the medical solution and they said yes

Of course, almost every private hospital will accept and indeed will seldom proceed without a referral fom the patient’s GP. The fact that they accept referrals doesn’t mean that the NHS will fund the treatment at their facility.

Quote

 

I've been referred to this hospital myself in the past by my GP for surgery

And as demand and queues change so does the engagement with private sector providers.

Quote

 

The reply fails to address the issue of no choice being given

 

The preferred hospital is closer to home, less waiting times, better service overall and more convienient. compared to the local NHS hospital which is at bursting point with bad  reviews

 

The fact is NO choice has been given at all - just a referral to a hospital with not very good overall reviews, then somehow that appointment has been cancelled by someone, after I called the surgery to explain the referal was not to the hospital of choice.

 

The Practice Manager reply states that he has checked the NHS booking system and the [preferred hospital] does not provide this procedure under the NHS and also contacted NHS referral line at [preferred hospital] and they have confirmed this with

I’d suggest checking the rules about choose and book before responding, specifically they state: 

 

There are some exceptions that may limit your choice – for example, not all hospitals are able to treat every condition, and a hospital must meet NHS conditions on standards and costs.

https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/can-i-choose-where-to-receive-treatment/#when-choice-is-limited

 

 

Quote

 

But then the practice manager contradicts himself by saying 'They offer this service but on private basis'. 

No contradiction here I’m afraid - yes they’ll carry out the treatment if you pay for it - doesn’t mean that the NHS will fund it there.

Quote

 

BUT as a NHS patient you still have the right to be sent to a private hospital which the GP has refused and even worse not given any choice of where to go for treatment,

 

Again, check here: https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/can-i-choose-where-to-receive-treatment/#when-choice-is-limited

Quote

 

then that appointment has somehow been cancelled which the practice manager has failed to identify in their response

 

Please help me with a reply back to the practice manager

 

 

Dear Practice Manager, thanks for your response. Can you please confirm that the booking on Xth of Maytember 20XX is still in place as the booking line seems to suggest that it has been cancelled.

 

Yours, Sofiaa

Edited by think about it
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My views are my own and are not representative of any organisation. if you've found my post helpful please click on the star below.

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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.

 

 

 

 

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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.

 

 

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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.

 

 

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On 01/05/2019 at 10:24, Manxman in exile said:

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.

 

 

 

 

On 01/05/2019 at 10:24, Manxman in exile said:

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.

 

 

 

 

Hi Manxman in exile,


I have tried to summarise what happened in order so it is a more clear to your questions above #33


1. The GP surgery sent a Choose and book Referral letter, basically saying following your GP visit, you have been referred through the choice system. Please find enclosed paperwork with appointment details (all printed on surgery paper). This was not to the hosital which the GP and my mother had agreed on the week before.

The enclosed paperwork shows appointment details and 'changing your appointment' to cancel or change go to
www.nhs.uk/referrals (all this paperwork is dated 19th)

 

I call the GP surgery explain to receptionist wrong hospital on referral, not the hositpal which GP agreed to send my mother to. Receptionist tells me he will speak to the medical secretary on Monday and ring me back on Monday. I could hear receptionist typing away on the keyboard (maube he cancelled the appointment?)

I call the hospital (where my mother agreed with the GP to be sent) and ask if that specific medical department is available at the hospital (as the referral letter to the wrong hospital). Yes its available and yes they accept NHS patients but the GP has to make the referral.

 

2. Letter from the actual hospital dated 19th (same date as the GP letter in point 1 above) received with appointment details.

 

After a few days....

 

3. My mother has appointment at the surgery for something else, I explain to receptionist wrong referral received, not for hospital agreed by GP. Receptionist says 'nothing else is available'. I ask to speak to Practice Manager, get told he is in meeting. I explain NO choice been provided, receptionist rings medical secretary 'patients daughter is here not happy with patient not being given any choice etc'. Receptionist tells me to ring the number on the letter which the surgery sent in point above and get it referral changed (when the GP surgery made the referral themselves, so it should be them to change it). I ask for copy of complaint procedure, receptionist refuses to provide.


4. Hospital send a cancellation letter dated (2oth) for the appointment (it was not cancelled by my mother) so someone else cancelled it and why? Letter says appointment has been cancelled and new appointment will be sent out (still not received 5 weeks on)

 

5. I write the letter to the Practice Manager as you advised and reply received (see #28). This fails to address my my question of not being given any choice at all. The NHS Constitution gives people living in England the right to choose where to receive treatment. This also means you can choose the organisation that provides your NHS care when you're referred for your first appointment with a consultant.  This point not addressed by the practice manager who basically says it not available under the NHS but available in private and they will charge me if I want for a private referral letter (if I want my mother to be treated at hospital of choice) and the treatment is available.


I've been treated at this hospital several times as well as other members of family and all under the NHS because despite the hospital being private they accept NHS patients if a GP referral is made.

 

The pratice manager says appointment still booked (when in fact its been cancelled by someone who I have no idea is and no idea why its been cancelled). If pratice manager when he received my letter had checked their system he would have realised the appointment is cancelled - but he did not do and tells me its still booked! Thats incomptetance!

 

My mother has not been treated for this medical issue before and no choice at all has been given. They are sending my mother to a hospital which has a bad rating and feedback, which is working flat out to get people in/out in minutes and don't really take care of patients as they should - in summary does not have a good rating.
I get the feeling the GP surgery is doing this for financial reasons when in fact it should be working on the side of the patient, but it is putting financial reasons first and totally ignoring patient choice under the NHS.


I need to write a reply back to the practice manager this week manxman in exile can you please help me?

 

You told me to do the following


1. Ring number on original appointment letter from the NHS hospital? and ask them if they have a record of the appointment and who (if anybody) has cancelled it

 

2. appointment with the GP who did the original referral (I have tried with no luck so far) keep getting told to try the next day

 

3. Contact Care Commissioning Group and ask to speak to somebody there about choose and book and why limitations in place for my mothers case. I think it would be better to send a letter - so I have a paper trail.

 

I have tried  https://www.nhs.uk/service-search but the site is down so far
 

 

 

 

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Hi.

 

I expect others will comment, but I'm not sure you can sort this out by writing letters.  I understand about paper trails, but if you have the person's email address you could write to confirm after the conversation.

 

Are you able to get an appointment to see the practice manager to discuss this or the original GP? Why are they telling you to ring back rather than give you an appointment at some time in the future?

 

HB

Illegitimi non carborundum

 

 

 

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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.)

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1 hour ago, Manxman in exile said:

 

(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.)

 

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!

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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.

 

 

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On 01/05/2019 at 10:24, Manxman in exile said:

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. 

 

 

 

 

 

Hi Manxman in Exile, I did what you said above and this is what I found out

 

I rang the hospital number on the original hospital letter and was told the original appointment has been cancelled, the day after the referral was made. It has been cancelled by someone at this GP practice, without even telling us.

 

All we received was the appointment cancellation letter which I has mentioned in earlier posts

 

What should I do now?

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the GP is the budget holder so the buck stops there.

Pracice manager/receptionist/medical secretary may well send out the paperwork/fill in the screen to send the info to wherever but they have no say in what is said and done.

Dont forget that the private hospital you speak so highty of may have refused to see hetr as a patient for this condition for a multitude of reasons- time, budgetary allocation etc

 

you also forget that doctors can see a hundred patients a day and it may have been a slip of the tongue when agreeing to refer her to the private hospital.

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  • 2 weeks later...

she dasnt been denied her legal rights,  by making this statement your letter comes across as being very aggressive when what you really want to ay sis that your mother understood she was being referred to hosplital X and nstead seh has been referred to hospltal y. As it would be her wish to go to x can it please be explained why this is now not the case?

 

also, do you ave power of attorney over your mother's medical matters? if you dont they will correctly tell you they cant deiscuss anything with you at all. This will have neccessitated the signing of a consent form at some point in the past, not just you turning up with your mum and speaking on her behalf

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