"Experience of 'phoning Devon Referral Support Services."

Dear ‘Torgoldhen’,

I would like to thank you for taking the time to get in touch and let us know about your experience. I was clearly not a good one and we rely on feedback such as yours to let us know where we’re going wrong so thank you.

Firstly, I am very sorry that we failed to return your call. This can only have been an oversight on our part and I apologise, it should not have happened.

With regard to your referral being returned to your GP, I don’t have enough detail to say for certain what happened but I would like to tell you what I think may have happened. If you would like me to investigate further and give you a concrete answer, please phone me on 01626 883702 and I will be happy to look up your referral and let you know. I work Monday-Wednesday 8-4 or you can contact my colleague Gemma Smith on 01626 883712, Monday-Friday 9-5.

The NEW Devon Clinical Commissioning Group (CCG), which DRSS is a part of, have a number of policies in place that restrict access to certain procedures and treatments. There is one that covers Meibomian cysts and I wonder if this might be what you had. If you did, your referral can only be forwarded to a hospital for treatment if certain criteria is met. If the criteria do not appear to be met in the referral letter we receive, we return it to the referring GP asking them to double check the policy and re-submit the referral with additional information if there is any that’s relevant. For example, a meibomian cyst must be continuously present for 6 months before referral is considered. (There are other criteria as well). If the GP doesn’t mention in their original letter how long the cyst has been present, we have to return the referral. The GP can then re-submit the referral if and when the criteria have been met.

The DRSS have a number of GPs who come and work on site to, among other things, double check these referrals. I can say for certain that your referral will not have been returned to your GP without one of our GPs having looked into it first, whether or not it was because of one of these policies, and so there will definitely have been a qualified medical person involved in the decision.

These policies are in place partly for cost-cutting purposes and all of the policies that are in place are written by a panel that has at clinicians on it, usually GPs and specialists are consulted where necessary. They are in place to either stop treatment purely for cosmetic purposes or treatment that is proven to have limited clinical effectiveness.

I am sorry that the above was not explained to you over the phone (although, again, I am only guessing that this is what caused your referral to be returned). I feel that if it had, you would have come away from the experience much less frustrated. I will take your comments to the team concerned.

I will be very happy to hear from you again, either by phone or via Patient Opinion if you have any further comments or concerns for us to take into consideration.

Best wishes,

Susan Pearce

Project Support Manager

Dear Torgoldhen,

Thank you for responding and for your further queries.

It is a little difficult to answer some of your questions because, as I stated in my previous response, I only gave meibomian cysts as a possible example of a policy that we may have been referencing and I only gave the time-frame as a possible example of why we may have returned your referral. Without your details I cannot look up your referral and so I am only giving an example scenario.

Regarding the extra information that was required to make a final decision, the staff on the phones here are not medically trained and so, whatever the reason for returning a referral might be, we always let the DRSS GP communicate directly with the referring GP as it is more appropriate. Where possible, the GPs at DRSS will phone the referring GP in order to be able to discuss the referral and to come to a conclusion as quickly as possible.

Regarding other criteria that you may need to meet, I cannot list it as I don’t know which policy you fall under. I think, from your description, that it is likely to be one of two policies; either Meibomian cysts or Beningn skin lesions. Both the policies can be found on the NEW Devon CCG website here:

http://www.newdevonccg.nhs.uk/who-we-are/medicines-and-treatments/commissioning-policies/eye/100387

under Meibomian cysts (Chalazia) guidance

or

http://www.newdevonccg.nhs.uk/information-for-patients/medicines-and-treatments/commissioning-policies/skin/100389

under Benign skin lesions

If you can’t follow the links for some reason, please let me know and I’ll put the whole policy up on Patient Opinion.

I really can appreciate why you would feel anxious about the decision made and annoyed at this process. Your GP, who is fully trained and capable of making a diagnosis has decided that you would benefit from this procedure and an unknown entity has delayed or halted your referral. I would be annoyed too.

The fact is that the NHS, and NEW Devon CCG in particular, is currently under immense pressure to reduce costs. One of the measures in place to keep spending under control is to limit access to procedures that are either for cosmetic purposes or are of limited clinical value. These policies are written by clinicians who have to consider the needs of the population as a whole and they have to make difficult decisions about how best to spend the limited funds available. Referring GPs are obviously making decisions and referrals based on what is best for their patient but unfortunately, not all treatments can be funded and it is not a reflection on the referring GP if more information is requested. There are many of these policies in place and GPs in local practice are not always aware of the finer details of each of them, which is why we have GPs here at DRSS to work with referring GPs and assist in administering the guidelines.

There is a panel which can be appealed to if you or your GP feels that you are an exception to the rules of the policy. Your GP will have their details and the appeal must come through your GP, not from you directly.

I hope that this has answered your questions adequately. I would be happy to talk to you over the phone if you would like me to look into your particular case or I am equally happy to converse further through Patient Opinion. My phone number is 01626 883702 and I work Monday to Wednesday, 8 until 4.

If you would prefer to speak to someone else in the organisation, the CCG Patient Advice and Complaints team can be reached using the details below. They can either help you investigate further or record an official complaint for you.

Telephone: 0300 123 1672 or 01392 267665 (Monday to Friday 9am – 5pm)

Calls to 0300 numbers cost the same as calls to 01, 02 numbers and are included in most mobile call bundles.

E mail: pals.devon@nhs.net / complaints.devon@nhs.net

Or write to:

Patient Advice and Complaints Team

FREEPOST EX184

County Hall

Topsham Road

Exeter

EX2 4QL

Best wishes,

Susan