Clawing to top of appointments list with comments from Karol Sikora

CCGs are sticking their noses in to GP’s referral lists

As if being told by your GP you need to go to hospital wasn’t stress enough, Pulse (the GP’s magazine) reports CCGs are planning to scrutinise GP’s referral lists and cut back on referrals to hospital

So patients face another delay whilst referrals are scrutinised.  

Patients in England now face a possible extended wait whilst their local CCG (a.k.a. Cynical Commissioning Group) reviews their case.  This way, NHS England are sneakily hoping to reduce referrals by 30% in UK;  Wales and Scotland already are seeing increased waiting times.

The Royal College of Surgeons found that over the past year an average of 193,406 people a month did not get surgery within 18 weeks of being referred, including patients waiting for operations for broken limbs, traumatic injuries, brain conditions and eye problems. Not very reassuring if you are waiting, and in pain.

Out in the open

For some time patients have had an uneasy feeling that waiting times were getting longer.  Phoning a hospital to find out when one had been booked for a procedure, more and more patients are being told “we haven’t received the referral yet”.  Phoning your GP’s surgery, enquirers were told the referral had gone off probably a month ago.  ‘Not receiving’ referrals meant hospitals could extend waiting times, and patients had no come-back.

Then an article in Pulse, the GP’s magazine, came out, listing plans to scrutinise practices’ referral systems; after a leaked NHS England memo showed they have promised to incentivise peer review schemes in order to reduce referrals by 30%.

Pulse says NHS England wrote to CCGs in May, asking them to ensure that there is ‘clinical peer review of all referrals from general practice by September 2017’, and this should be done on a weekly basis. In other words, yet another hurdle for patients who urgently need operations, and face yet longer waits.

What you can do to shorten the wait

First, here is an action plan from a reader, with very good advice:

If that doesn’t work, Prof. Karola Sikora is a world-renowned cancer specialist who has written a book with hints and tips

He has worked in medicine for 40 years, originally in the NHS,  then in a senior job in the World Health Organisaiton and now privately.  He is often quoted on new initiatives for cancer treatment, and is passionate about better care for patients.

In his book, “The Street-wise Patient’s Guide to Surviving Cancer” he warns patients that, contrary to what they think, the NHS is not there to help individuals, and they cannot simply trust their doctors and medical team to ensure that they get the best available treatment.

In other words it is up to the patient to ensure they get the best treatment possible for THEMSELVES – don’t sit back and expect your Doctor to do this for you.

If you are a patient, you either make a fuss when things don’t go well and you are faced with a longer wait  (what you should do, according to senior Consultants). Or wait.

So here is some of Sikora’s advice to get the best care for you, and ensure that not only might you be seen quicker, but – most importantly – all the appropriate paperwork is available, and you can’t be sent home to wait for this to arrive: (with some comments from me)

  1. Learn as much as possible about YOUR cancer.  Sikora advises browsing American websites to see what they advise. Start-up list on  or see
  2. Request copies of scans and tests.  Then you have them when the NHS IT system doesn’t work.  Bet some patients wished they had them when IT system went down! Warning: the NHS IT system is still down at certain times.
  3. Negotiate for best treatment – this might mean asking to be referred to another hospital.  It’s YOU we are talking about and ‘hospital targets’ often aren’t working for you. Ring round local hospitals and ask what are waiting timesYour GP will want you to go to their preferred hospital, but this may not be the right one for YOU.  Stick you toes in and INSIST – you have the right.
  4. Work out a treatment ‘diary’ – and if appointments fall behind ask your Team to sort this out.  Don’t be afraid to chase up people/depts. And keep on phoning Appointments office to see if they have a cancellation. They DON’T phone YOU.
  5. Learn names of Receptionists and Consultant’s PA – and thank them for their help (not many patients do).  Sikora recommends “give them flowers”, or I found a home-made cake went down very well, or flowers or herbs from my garden.  Then when things go wrong you can go directly to them and it is surprising how helpful they can be, particularly in getting you moved up to the top of the appointments list.
  6. Always try to see same doctor or consultant.  Talking to French doctors (their cancer care is acknowledged as best in world) they were horrified at the thought of ‘their’ patients being seen by someone else.  They say you need continuity.  When NHS Outpatient Receptionists try to shove me in to see another doctor in Clinics, I say politely that I have come to see ‘Dr. X…’ and will wait until they are free.  They soon learn I won’t be fobbed off and it is surprising how much time you save seeing the same doctor, who doesn’t need you to repeat your medical history.

Take note of this comment from Roy Lilley, the admired medical write, writing about proposed savings in NHS budget:

“As is his perfect, democratic right, the Chancellor has determined that he will balance the books and accumulate a £10bn surplus by 2020.  In consequence he is reducing borrowings, realigning taxes and cutting public expenditure.”     
                                                                                                                                                                                  Begging the question, why does the Govt. need to save money on the NHS?   
Whatever the parties’ Manifestos promised for the NHS, there are going to be more cuts.  Just make sure it isn’t your care that suffers.  And be prepared to make a fuss.  Many doctors know the NHS’s faults, and admire patients who stand up for themselves.
 Kris Hallenga, founder of charity CoppaFeel says, “You think there is a clear road map .  No-one tells you how pro-active you have to be”.
As a noted Oncologist told me, “those who take control of their care will have a better outcome”.

Funds to set up this system

Yet, although the NHS cries poverty, Pulse reports the May 2017 guidance ‘Elective Care High Impact Interventions: Clinical Peer Review’ says that there will be ‘significant additional funding’ for commissioners to establish GP peer review schemes this year.

‘As you will be aware there is now an ask from NHS England for us to ensure we have 100% coverage of prospective peer review in practices. The attached document sets this out. [The local area team] needs assurance that we have a plan to do this and how that will be rolled out across practices.’

Pulse says the email includes an attachment from NHS England on plans to incentivise these peer review schemes.

So, unless we challenge waiting lists, Gran is going to have to wait longer to fix her painful hip;  investigations of worrying symptoms that might be cancer returning are going to have to wait longer, and waiting lists are going to be extended.  But you can bet that there will be manipulating of statistics, and more “we haven’t received your referral”, etc. to prove we are all getting seen ‘within the 18 weeks timeframe’.

1 Comment

  1. Jo Thomson

    so useful, thank you – and another thing: Locums! – being almost forced time and again to see yet another new one whose only knowledge of you and your history is what they can find on the screen. Over and over again have I had to discuss immensely personal, harrowing events when I needed more antidepressants.

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