Orthopaedic referrals

In my part of the country, I am now no longer allowed as a GP to refer directly to an orthopaedic consultant. Instead, I have to refer to an orthopaedic triage system.

And what does an orthopaedic triage system do? It looks at my referral, and decides who will see that patient. This could be a physiotherapist, a nurse practitioner, a fellow GP with a specialist interest in orthopaedics (known as GPWSI and called in the profession "Gypsies"), or, if I'm really lucky, a consultant.

So why is this happening? Management will tell you it's so that patients are seen by the most appropriate person.

But the real answer of course is money. It is cheaper for the NHS to have my patient seen by a physiotherapist than a consultant.

Jack is 75 and has gross osteoarthritis (wear and tear) of his knee. He needs a knee replacement, so I referred him with this in mind. He was seen initially by a nurse practitioner, who decided he would benefit from some physiotherapy. 3 months later he is no better. He returned to see the nurse practitioner again. The nurse practitioner asked the consultant to see him, who told him immediately that he needed a new knee.

Jack, quite understandably, can't understand why he didn't see a consultant to start with, and feels aggrieved that he has had to wait an extra 3 months before he can even go on the waiting list for an operation.

So has this saved money?