Inappropriate advocacy
Sharing the decision is not the same as doing what the patient asks
This consultation is dealt with extremely rapidly and perhaps this is in part due to the response the GP receives to his claim of Gold Standard management being instantly batted back by the patient stating "They're not working Doctor" in a matter-of-fact fashion.
We're left feeling that the GP can't wait to get this patient with an opinion out of the consulting room, whether that's the intention or not.
While this may outwardly appear to be efficient, it's not an effective use of NHS resources when conservative management hasn't been fully explored.
GPs have been called 'The Gatekeepers' in the NHS, and this important role ensures workload isn't inappropriately transferred to secondary care. The skills of appropriate gatekeeping are explored in this article
SCA Feedback Statements
The management plan relating to referral was inappropriate and not reflective of current practice
You are expected to show that your clinical management skills are in line with current UK best practice. You may not have developed a plan at all, where a referral was needed. Or you may have referred to an inappropriate place. Or you may have referred when this was not necessary/appropriate in this case.
You are expected to understand and value the role of the multi-disciplinary team. In addition to secondary care, the referral in question may be to counselling, community or social services. It may also be about encouraging/signposting self-referral.
For example, a referral to a rheumatologist for gout may be unnecessary. Or a two-week wait, rather than routine referral for unexplained PR bleeding in a 54-year-old could have been more suitable.
Suggestions
Your management plan should be coherent and feasible. You should be familiar with current national guidelines such as those published by NICE (National Institute of Clinical Excellence) and SIGN (Scottish Intercollegiate Guidelines Network).
Use the concept of PUNs (Patients’ Unmet Needs) and DENs (Doctors’ Educational Needs) to improve management. This means learning on the job from dilemmas and challenges as they arise, case by case: Make a habit of referring to guidelines after you have seen each patient at work. Notice areas in the MRCGP (curriculum clinical topic guides) that you need more experience with. Plan tutorials or peer learning to support these areas, or use your self-directed learning sessions to attend specialist clinics.