Another interesting recent article on the BBC about thedangers of NHS trusts using referral services to review GP referrals with the
intention of delaying or blocking treatment to save money. Although not this
specific process, I do have painful first-hand experience of a GP referral
being delayed without proper clinical evaluation.
About six years ago, during the events that led to my CKD
diagnosis, I suffered a bout of severe back pain. I went to my GPs who
prescribed medication, wrote me a referral to the local NHS back clinic and recommended
I try their resident (private) osteopath. I took my medication, I saw the
osteopath who provided a little relief but couldn’t work miracles, and I waited
for the back clinic appointment.
A few weeks later I got a letter back from someone, their
job title was something like ‘Senior Physical Therapist’, saying they’d
reviewed the referral and decided I wasn’t worth an appointment at this time,
but I’d be put on some kind of pre-waiting list for a place on the official waiting
list (which I think was some sort of wheeze to game the genuine waiting list target).
This ‘senior’ healthcare professional had basically read the referral from the
GP and overrode his decision (which was based on clinical evidence) without examining
me or even making any attempt to discuss my clinical symptoms.
During this time my back got much worse, Tramadol, Gabapentin
and Diclofenac could only take the edge off. I was hunched over like an old
man, I couldn’t walk properly, I couldn’t sit properly, I had to sleep on the
floor. If it wasn’t for the fact that I was able to work from home I’d have
been signed off sick for a prolonged period (I worked sprawled out on the
lounge floor). Due to the lack of activity my weight ballooned by 15 kilos, the
consequences of which are still with me today.
I went back to the GPs, I saw the other partner, who read
the referral by his colleague, read the half-baked response and assessed the
consequences to me which were now well past the point of medication or basic physical
therapy. He asked me if I had medial insurance, I did, he wrote a referral to a
private consultant, a couple of days later I had an appointment (handily he did
a satellite clinic nearby), a couple of days after that I had an MRI which
showed I had two bulging discs pressing on my sciatic nerve. About a week after
the private referral I had a short procedure to inject cortico-steroid into my
spine and the improvement was rapid.
A month or so later I did actually make it onto the waiting
list for the NHS back clinic, but by this time the worst was over, my private
health insurance had dealt with the acute problem. So instead of being an assessment
to treat the acute problem I eventually ended up with a course of physical
therapy designed to help me recover from it. Don’t get me wrong, I am grateful
for that physical therapy, it taught me long-term techniques for strengthening
and protecting my back which are very useful whenever I have any twinges. But
the issue remains that without private healthcare I would have been left to rot
in crippling agony due to a non-evidence based pseudo-scientific approach from a
so-claimed health professional. So that’s how I know it’s dangerous to delay or
veto referrals from without clinical assessment. It may save some money, if the
patient is lucky enough to go private, or if more likely, they are unlucky and
they simply die (being dead is a quick way of cutting healthcare costs).
Now I quite clearly believe the NHS shouldn’t be using dodgy
processes like this, but if it’s going to use them in the name of efficiency,
there are cheaper and more efficient ways. Working in Business Intelligence I
know tools and techniques which could automate the assessment of referrals. These
processes are not based on the first hand clinical evidence (that’s the GP
consultation), they are based on textual analysis of what the GP wrote, which
is something quite different.
With just a little up front involvement from the sort of healthcare
‘professionals’ currently reviewing referrals algorithms could be developed to
recognise the patterns that delay treatment and the patterns that progress it. Plug
those algorithms into a text mining data science tool like RapidMiner and you
have a cheap way of assessing thousands of referrals an hour. Sure, from a
clinical perspective it’s just as dangerous and pseudo-scientific as the current
referral review process but it’s much cheaper, more consistent and also more
objective as a computer doesn’t care for such things as ethnicity, religion or
personal persuasions.
So my question is if the NHS is going to use dangerous
processes to be ‘more efficient’ and to ‘save money’ why not race straight to
the bottom and go with outright automation? With my kind of solution the NHS
could do away with most of the costs of the healthcare 'professionals' currently rejecting
referrals and instead spend that money on productive treatment. It won’t help
the people who need treatment who get their referrals rejected on dodgy grounds,
but at least the money currently siphoned off to these charlatans could be used
so less referrals get rejected overall?
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