Forum Topic

NHS repeat referrals?

What has happened to NHS repeat referrals.  A few weeks ago I asked my GP to refer me back to Pain Management Clinic at CXH.  It appears that the referral has been sent to Ealing PCT who have forwarded to request to the hospital. (Letter received today.)  I do appreciate that a spinal block is a costly procedure, but, would it not have made more sense to refer to the hospital in the first instance.  Who now holds the purse strings?The procedure involves laying on an imaging table, strong I.V. pain killing injections and sedatives if required.  Local anaesthetic and steroid are the primary injections followed by cortisone injections.  All this has to be done by a Consultant Anaesthetist, hence the cost. Now to make your eyes water while you wince, anything from 16 to 32 injections. LOL.Whatever happened to a GP referring direct, rather than going around the houses, when it comes to some procedures?

Nicola Howard ● 5291d2 Comments

The PCTs have introduced something called PPwT. This is Planned Procedures with a Threshold, and they apply to treatments for which there is limited evidence of clinical effectiveness. The PCT therefore have to consider the cost benefit analysis of each referral.Interestingly, this kind of thing should stop with the new system as the GPs will be commissioning, and so should be able to refer without recourse to a higher body (although they will be more accountable to their colleagues for their spending.An example in my field is the routine D&C for heavy periods; there is no proven benefit to it, so the PCT will no longer pay for it.More info here:http://www.northwestlondon.nhs.uk/publications/?category=1670-PPwT%2FIFR-dYou can find the Pain Management Strategy under policies, but basically all pain management referrals have to fulfil these criteria:1. Clinical staff from the pain management programme has assessed the patient and agreed that they would benefit from the programme;2. The patient has chronic non-malignant pain of least 3 months duration, which is causing significant disability and/or distress, and a negative impact on quality of life. Patients satisfying these criteria do not have to wait until other treatments have failed before referral to PMP.

Andy Heeps ● 5291d

Thanks for that Andy.In my case a spinal block does work, and, usually lasts for between 6 - 9 months.  I have already had four, so this will be the fifth.  I have noticed that after each treatment, the effect lasts longer.  Although I have put off the referral back to CXH Pain management clinic, there comes a time when one has to say enough is enough, when the pain levels become too much.  I also appreciate that this is a risky procedure, because if it goes wrong, like the needles penetrate the spinal cord, you are at risk of paralysis.

Nicola Howard ● 5291d