Managing multiple doctors & NHS intractability
Discussion
I’ll try to avoid too many personal details here, it’s not about me but does involve a real situation.
If someone has a number of conditions that require different specialists and the priorities of each can conflict or overlap, or can cause excuses to be given for lack of treatment or progress, how do you coordinate or compel the various people who are involved in the case? Assume there is a combination of long term conditions and some recent/critical issues that are not being dealt with at the normal pace and the delays are likely to make the final outcome worse.
In an ideal world I would want one medically qualified professional who could oversee, prioritise and direct the different specialties, someone who understands the NHS system well enough that they would know how to push things forward when encountering unreasonable delays. In truth I could see this being a useful service for a lot of NHS patients.
Ideally I suppose this would be the job of a GP but that’s not a realistic thing to hope for, is there a private option for overseeing the entire medical care of someone with multiple conditions? I can’t imagine it would be a very popular job as it would involve a doctor who is broadly qualified and experienced telling specialists how to do their job, but that’s what is actually needed.
I’d welcome any professionals view on this, or anyone who has found a solution for themselves/a loved one.
If someone has a number of conditions that require different specialists and the priorities of each can conflict or overlap, or can cause excuses to be given for lack of treatment or progress, how do you coordinate or compel the various people who are involved in the case? Assume there is a combination of long term conditions and some recent/critical issues that are not being dealt with at the normal pace and the delays are likely to make the final outcome worse.
In an ideal world I would want one medically qualified professional who could oversee, prioritise and direct the different specialties, someone who understands the NHS system well enough that they would know how to push things forward when encountering unreasonable delays. In truth I could see this being a useful service for a lot of NHS patients.
Ideally I suppose this would be the job of a GP but that’s not a realistic thing to hope for, is there a private option for overseeing the entire medical care of someone with multiple conditions? I can’t imagine it would be a very popular job as it would involve a doctor who is broadly qualified and experienced telling specialists how to do their job, but that’s what is actually needed.
I’d welcome any professionals view on this, or anyone who has found a solution for themselves/a loved one.
GP will be the only clinician with oversight of all the different threads of care and the only person in a position to do this.
If your GP is either crap or overwhelmed then your options are to go to a private GP or the patient to drive it themselves. The latter is difficult and involves contacting secretaries and chasing results and outpatient appointments but in my experience is the only real way unless you have a gem of a GP. Good luck
If your GP is either crap or overwhelmed then your options are to go to a private GP or the patient to drive it themselves. The latter is difficult and involves contacting secretaries and chasing results and outpatient appointments but in my experience is the only real way unless you have a gem of a GP. Good luck
Biglips said:
GP will be the only clinician with oversight of all the different threads of care and the only person in a position to do this.
If your GP is either crap or overwhelmed then your options are to go to a private GP or the patient to drive it themselves. The latter is difficult and involves contacting secretaries and chasing results and outpatient appointments but in my experience is the only real way unless you have a gem of a GP. Good luck
Or possibly an elderly care (I'm assuming age from the number of issues) specialist.If your GP is either crap or overwhelmed then your options are to go to a private GP or the patient to drive it themselves. The latter is difficult and involves contacting secretaries and chasing results and outpatient appointments but in my experience is the only real way unless you have a gem of a GP. Good luck
Thanks for the ideas chaps. The GP is ok but not up for getting consultants in a neat line unfortunately and hoping they would do it on their own for the benefit of their mutual patient is a pipe dream.
We have been doing the chasing and legwork ourselves but all you get is secretaries and admin staff who will pass messages on but when the answer comes back all they can say is “that’s what the doctor said”.
There’s some great people in the NHS but as an organisation it’s utterly self-serving and in many ways just unfit for purpose
.
We have been doing the chasing and legwork ourselves but all you get is secretaries and admin staff who will pass messages on but when the answer comes back all they can say is “that’s what the doctor said”.
There’s some great people in the NHS but as an organisation it’s utterly self-serving and in many ways just unfit for purpose
.That's what their GP is for - as they are generalists. However, GP's nearly always defer to hospital specialists.
Specialists in hospitals don't always talk to each other, unless it is a referral, or if they work together in a multidisciplinary group, and the next treatment may well be held up by the ongoing previous one.
Multimorbidity is a thing but there is no specialist covering this, as it isn't really a recognised medical condition. So unless their GP is offering advocacy they are stuffed - so to speak.
Specialists in hospitals don't always talk to each other, unless it is a referral, or if they work together in a multidisciplinary group, and the next treatment may well be held up by the ongoing previous one.
Multimorbidity is a thing but there is no specialist covering this, as it isn't really a recognised medical condition. So unless their GP is offering advocacy they are stuffed - so to speak.
Steve H said:
I ll try to avoid too many personal details here, it s not about me but does involve a real situation.
If someone has a number of conditions that require different specialists and the priorities of each can conflict or overlap, or can cause excuses to be given for lack of treatment or progress, how do you coordinate or compel the various people who are involved in the case? Assume there is a combination of long term conditions and some recent/critical issues that are not being dealt with at the normal pace and the delays are likely to make the final outcome worse.
In an ideal world I would want one medically qualified professional who could oversee, prioritise and direct the different specialties, someone who understands the NHS system well enough that they would know how to push things forward when encountering unreasonable delays. In truth I could see this being a useful service for a lot of NHS patients.
Ideally I suppose this would be the job of a GP but that s not a realistic thing to hope for, is there a private option for overseeing the entire medical care of someone with multiple conditions? I can t imagine it would be a very popular job as it would involve a doctor who is broadly qualified and experienced telling specialists how to do their job, but that s what is actually needed.
I d welcome any professionals view on this, or anyone who has found a solution for themselves/a loved one.
Consultants talk to each other, invite colleagues to MDTs, run joint clinics etc. There is likely to be one of them who would "co-ordinate" the care depending on which condition takes primacy. I disagree that one "oversight" position would be in anyway beneficial to the patient or the clinicians involved. Best thing would just be to ask the clinicians involved who will be the "lead" when attending appointmentsIf someone has a number of conditions that require different specialists and the priorities of each can conflict or overlap, or can cause excuses to be given for lack of treatment or progress, how do you coordinate or compel the various people who are involved in the case? Assume there is a combination of long term conditions and some recent/critical issues that are not being dealt with at the normal pace and the delays are likely to make the final outcome worse.
In an ideal world I would want one medically qualified professional who could oversee, prioritise and direct the different specialties, someone who understands the NHS system well enough that they would know how to push things forward when encountering unreasonable delays. In truth I could see this being a useful service for a lot of NHS patients.
Ideally I suppose this would be the job of a GP but that s not a realistic thing to hope for, is there a private option for overseeing the entire medical care of someone with multiple conditions? I can t imagine it would be a very popular job as it would involve a doctor who is broadly qualified and experienced telling specialists how to do their job, but that s what is actually needed.
I d welcome any professionals view on this, or anyone who has found a solution for themselves/a loved one.
Your GP is definitely not the one to do anything as they will not be involved in the specialist care once the referral has been made
pavarotti1980 said:
Consultants talk to each other, invite colleagues to MDTs, run joint clinics etc. There is likely to be one of them who would "co-ordinate" the care depending on which condition takes primacy. I disagree that one "oversight" position would be in anyway beneficial to the patient or the clinicians involved. Best thing would just be to ask the clinicians involved who will be the "lead" when attending appointments
Your GP is definitely not the one to do anything as they will not be involved in the specialist care once the referral has been made
This is true but it only works where there are not multiple unrelated morbidities and where there are pre-existing links between the conditions/ clinicians in place already.Your GP is definitely not the one to do anything as they will not be involved in the specialist care once the referral has been made
A good example is above that one poster gave of neurology vs neurosurgery. They will have MDTs and joint clinics.
When conditions are multiple and disparate it falls down. Care can be spread across different Trusts with no access to correspondence or test results from other hospitals in another part of the country. Throw in a few private consultations to the mix and this makes it even more challenging….
Biglips said:
GP will be the only clinician with oversight of all the different threads of care and the only person in a position to do this.
If your GP is either crap or overwhelmed then your options are to go to a private GP or the patient to drive it themselves. The latter is difficult and involves contacting secretaries and chasing results and outpatient appointments but in my experience is the only real way unless you have a gem of a GP. Good luck
Just as a warning, I was recently admitted to A&E principally because various medical disciplines were not communicating with each other and despite me having made specific agreement with the GP practice that they would retain oversight they clearly failed. Even trying to manage it as the patient was continually fobbed off with inadequate telephone consultations and it will all settle down reassurances. If your GP is either crap or overwhelmed then your options are to go to a private GP or the patient to drive it themselves. The latter is difficult and involves contacting secretaries and chasing results and outpatient appointments but in my experience is the only real way unless you have a gem of a GP. Good luck
Even insistence on a f2f consultation and blood test was almost too late. The day before 999 admission the f2f consultation missed the red flags being raised. A&E consultant "this can go either way".
Moving to another GP practice is not an option due to mergers removing that option.
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