UK members - GP complaints procedure?

[y-gwair]

2 months ago, I saw my ophthlamologist about my ongoing problems which weren't responding to treatment, and she wrote to my GP to ask her to refer me directly to a colleague at Moorfields Eye Hospital who specialises in inflammatory eye disease. I stupidly assumed that this had been set in motion, until I saw another GP at the same practice 3 weeks ago and found this referral request, plus another to local dermatology, had been ignored. The second GP promised to sort it out. 3 weeks on, no confirmation from Moorfields had arrived, so we rang the consultant's secretary/Moorfields bookings office and found that there was still no record of any request. I rang my GP yesterday morning to ask why, I'm still waiting for a reply over 24 hours later.

This is the second time my GP has failed to refer me for a problem. I nearly made a formal complaint 18 months ago (I had to refer myself privately to a rheumatologist who finally made a diagnosis of my connective tissue disease problem), after the same GP had refused to refer me for a second opinion.

Has anyone ever made a complaint about their GP, or have any advice about the procedure ? It's not something I would consider lightly, but I am really angry about it now (I've spend a lot of money pursuing private treatment for my eye condition, precisely because I knew trying to get NHS referral would end in this sort of mess, but I need to go down this route now as getting a precise diagnosis will involve scans etc, and potential treatments like topical cyclosporine would be both prohibitively expensive, and probably unavailable outside of the Moorfields pharmacy).

[littlemermaid]

Hi. Same. Par for the course. In my experience, and I've tried it, complaining in anger just gets their backs up because life in the UK NHS is hellish and stressful enough already and it's more fun treating the grateful people, preferably in private practice.

Best first plan is to 'phone up and sob to the referral secretary to find out whether GP has given her the letter. She has a massive in-tray and thinks the docs don't appreciate this, piling up the tasks. Ask about her holidays, give her gory treatment details and hospital gossip. They love that stuff. Sorry to be flippant but it's so disorganised it's basically a medieval system of patronage now.

Any staff employed to deal with complaints are just making appropriate noises to make you go away, particularly in hospital Patient Liaison. The staff you actually need tend to go into lock-down. PALS can be good for advice about working the system though.

Some GPs and consultants are super-quick and dictaphone/draft on computer while you're in the room. If GP isn't working for you, bypass the dude quickly eg make an appointment with someone else in the practice. They probably find him equally annoying. Sometimes I write later 'I thought you might like to know that ... turned out to be ...' which means you can go back and they are more helpful.

Complaints not good for the doc/patient relationship, unless your lawyer is present. Keep notes for that scenario, which also makes you feel a bit more empowered. However, think Machiavelli.

Always nice to have a polite summary letter in the file to get them focussed, cataloguing the disasters as a record, but remembering that you are, in the last analysis, asking for their professional medical services which they are contracted to perform. This can get them jumping because it's in writing even if it's email. The assumption is that they want to help and do a good job. This is how the docs say it: 'I was surprised to find...'. Or sometimes I say 'I have been advised that ...', which gets them wondering who by, and conclude 'I am most grateful for your kind support/attention' ie whatever attitude you would prefer them to have. My favourite so far is doc to doc: 'thank you for your expertise in referring...' which seems flattering but has a lovely poisonous vein if they haven't actually done it.

[y-gwair]

You're probably right, it's probably not worth it but it makes me so angry. I think part of the problem is the set-up. It's a large practice, but virtually all GPs are part-time, working only one or two days a week. Established ones are impossible to book much less than a month in advance. If they don't get round to something within their few hours in the surgery, they probably just forget by the following week, and it's difficult to keep chasing them when they are hardly ever there. I have tried to bypass my main GP, the others I've seen aren't very happy and always tell you to make sure you see Dr S next time; the last one I saw actually said 'I don't want to see you again, you must always try to see your usual doctor' and I had a feeling that saying we didn't see eye-to-eye would go down very well. They seem resentful about having to wade through your notes, or sometimes clearly have only bothered to skim a few details. The only one that was helpful has now left on sabbatical for 6 months.

I'll have to change, as my official GP will retire at the end of the month, but I feel they should get some feedback about their shortcomings before we both move on, I'll start sharpening my sarcasm now!

[littlemermaid]

I'll start sharpening my sarcasm now

Perfect. Same scenario at our practice - where are they all? Have you ever used a private GP for referrals?

[y-gwair]

No, but I did seriously consider it way back in the early 90s after GP fundholding had come in and it was virtually impossible to get any sort of referral out of a GP (certain feelings of Déjà vu?)

[britgirl]

I see a new GP now due to similar issues.

On the NHS, when referrals are routed through GPs, the GP has to authorise it. Some GPs will instead wait until you hassle them enough.

I'm seeing a new GP now. I wanted to complain but I'm not sure whether it will get me anywhere.

[y-gwair]

It's annoying that consultants can't refer you directly to other specialists or departments, it wastes so much time going via the GP. With flaring/remitting conditions, quite often the symptoms have almost disappeared by the time you actually get to see someone, which leaves you feeling like you are wasting their time and exaggerating your problems.

I do feel that they should be made to account for their actions though, even if it doesn't go as far as official complaint. I've given up on calling mine for now, they simply won't ring back personally, so I think a stiff letter asking some direct questions is probably best.

[littlemermaid]

I do feel that they should be made to account for their actions though, even if it doesn't go as far as official complaint

So agree. It has been the key to success writing to tell the consultant, GP, patient liaison: exactly what happened, what problems are getting specific treatment, asking what they think we should do next, telling them how we feel ie desperate. Best results have been from 'mirroring back' the experience in all it's awfulness with very short dated notes: advice, prescription, referral, treatment from referral, aspects still not attended to. Partly because it's a quick clear history to work with, which is what they want. We've had stonking referrals from this between hospital depts and been subsequently asked for advice by GPs. Plus getting copies of the notes, plus paying when there's no other option.

Rebecca's advice in http://www.dryeyezone.com/talk/showt...1983#post61983

I think it's really important for those who feel up to it to write to medical practices about the inadequate care you have received. It really can make a difference. Being a bit diplomatic about it can help with getting them to take the concern seriously.

It's the diplomatic part I've had problems with (for a child, remember): refused treatment, repeatedly discharged undiagnosed and untreated, smirked at many many times, told to 'shut up, you're not my patient' 'if you just be quiet..' by consultants, patronised by junior staff to cover ignorance, told she would be refused treatment if I didn't reduce interference from other docs. Worst was, Patient Liaison redirected undiplomatic email straight to offending consultant, who was absolutely foul at meeting, and we completely lost the county eye service.

I'm just saying, imagine you were them for one tiny moment and the key to a successful approach is unlocked. Ideally they are thinking - that poor patient, we have let them down, let's see what I can do. In the current climate, the toughest phrase for a hard yet diplomatic letter is 'I've realised your service can't... can you suggest where I can...' It is hurtful so use with care.

[y-gwair]

Depressingly familiar list; equally difficult when you are there with the elderly, they sometimes insist on seeing patient alone and you know they either can't hear or understand what the specialist is asking them. Either that, or the assume the aged parent can't hear/understand at all and say things with a bluntness that is very upsetting.

told she would be refused treatment if I didn't reduce interference from other docs.

Would that be 'interference' from second opinions within one discipline, or conflicting advice from outside ones? I've noticed they tend to clam up if you mention you've seen someone else (ophth., derm, etc) about a particular manifestations and say 'Oh, you'll have to go back to them'. The trouble is, with immune disorders that have an underlying systemic cause but quite specific manifestations on particular parts of the body that require diagnosis/treatment by those with the correct expertise in that area, it's impossible to avoid some conflicting advice/diagnoses.

[littlemermaid]

I just try to keep everyone happy and on the job these days, doing their best. We have to convince them collaboration is more fun.