GP Second Opinions

At Leatside we have been thinking a bit about referrals to specialists.

When we refer a patient to a specialist it can be for a number of reasons.

If someone has, lets say, a hernia, then referral is basically just for a procedure to be performed. Not tricky.

If someone is feeling unwell and we think it might be a heart attack then straight to hospital. Again, not tricky.

If someone has been poorly for a while, been to the doctor a few times, had some blood tests run and so on then the doctor might be thinking about referring to a specialist.

At times like this we have been wondering if it might sometimes be helpful before referral for the patient to have an initial second opinion from one of the other doctors at the surgery.

This accepts that sometimes the doctor you have been seeing might have developed a set of ideas about what might be going on. It can be difficult, once your ideas about what is going on don't match the evidence, to expand your ideas about the illness. This is where getting another GP's opinion on what's going on can be helpful. A fresh look at the problem.

For GPs this can actually seem quite a threat- "What if the other doctor can see what is going on where I couldn't?" "I must be a rubbish Doctor to need to ask for advice".
Well, I think we should get over that.
The benefits to the patient seem to be that they can be reviewed by another doctor quite soon without having to wait many weeks to see a specialist,. They won't have to travel, and then won't have to spend an hour finding a car parking space at Torbay Hospital.
If the second doctor feels a referral to a specialist is actually needed then they can make that referral and the patient will have been delayed by at most a week or so.
The benefits to the GP surgery are less clear-cut. We would have to duplicate seeing patients where a referral was otherwise a possibility. Actually, we wouldn't even benefit financially in any way either, as Devon PCT currently has no way of rewarding GPs for keeping referral rates low. In the end it is really just for the benefit of patients and this seems to be the model that the NHS hopes to take forward.
The benefit seems to be more to the NHS as a whole. Not immediately but hopefully accruing over time. The less we feel we need to refer, then funds that would have been spent at hospital seeing the patients (apparently needlessly as you'll see below) can be spent elsewhere on things that actually are needed.
We've been trying second opinions here at the Surgery for a few months with skin moles.
Where a doctor might have been referred to a specialist to review a dubious mole, instead we have been getting one of the other doctors to see it first to see what they think of it.
Actually it turns out that out of 43 moles reviewed, only one was serious enough to have been referred on. So we potentially saved 42 referrals in the space of only about 3 or 4 months.
(All along if the Doctors really thought a mole serious they would have referred it to a dermatologist anyway without the second opinion)
Clearly things that we were referring were often just for reassurance. If we can get that referral from a GP colleague then we all benefit. (Except perhaps a rather bereft dermatologist!)
If you have any thoughts on this topic please comment on the blog by clicking the comment link below and let me know what you think.

NHS Patient Survey

The NHS has just shown the results of a national survey they have undertaken of GP practices.
They sent out questionnaires to patients of all the GP surgeries in the country asking how they thought we were doing in a number of areas.
The survey can be viewed online at their website.
(Interestingly, you can look at any GP surgery, not just the one you are registered at)
We've had a skim through the results and actually feel like we might have done quite well in some areas. We can at least compare the Leatside data with the data as a whole for Devon PCT, the South West Peninsula (SHA) and the UK as a whole, so we get nice comparative data.
The limiting factor is of course that they haven't surveyed all our patients- just 250 odd.

I suppose some areas of interest are that:
1. You invariably find the receptionists very or fairly helpful.
2. 84% find getting through on the phone easy, and only 10% find it not very easy.
3. Speaking to a doctor on the phone, 69% find fairly or very easy as compared with 25% Nationally or 38% in Devon. Similar figures for speaking to a Nurse. I think we've done quite well there.
4. If you have felt like you needed to see a Doctor quickly then 88% have been able to, which is about average I'm afraid.
5. We are much better however if you wish to book an appointment ahead. 90% could do that compared with 82% across Devon.
6. Waiting times at the Surgery don't seem too bad. 88% thought they were usually seen at the appointment time or up to only 15 mins late.
7. 75% could always or usually see the Doctor they preferred to see.
8. Most were satisfied with the hours we are open, but, if pressed to see when they would like us to be open when we are currently not, most would like us to be open on a Saturday.
9. 96% were overall very or fairly satisfied with their care at Leatside.

Feel free to go to the survey website and pick over these results if you wish.
We are always interested in feedback.