Owen Yang
Not suggesting it is necessary a bad thing, I am saying NHS is a monopoly in the UK. When there is this monopoly, there are a few bigger issues that can go on. There is a lot of strikes going on when this article is written, but I am not talking about them today.
What do you think outpatient means in the UK
I realised not many people know the UK health system, specifically how GP (general practice) works. In the UK, GP is the gatekeeper doctor for most of our healthcare, except for emergency, pregnancy, or dentists. There are a few other exceptions, but in general, one has to go to his/her registered GP to access care. GP will decide whether this is something that can be treated at the primary care level (i.e. by the GP him/herself) or whether this is something that needs to be referred to the secondary care. Secondary care will be your specialists, such as cardiologists or paediatricians, or surgeons.
When you are referred to the secondary care and seen by the consultants specialists in the hospitals, you either go to the clinics, that is outpatient secondary care, or go to be admitted to the hospital if it is needed, what is in-patient secondary care. So outpatient in the UK refers specifically to the outpatient section of a hospital, give or take.
Therefore, in the UK GP appointments would not be classified as outpatient. Of course you can define your term in your own way. Here I only try to clarify that in the NHS official term, outpatient simply means the outpatient sections in a hospital (or secondary care equivalent of a hospital.
The relationship between GP and specialists
This is obviously a huge topic, and a very sensitive topic at the moment. To introduce very briefly, I do not want to go into the controversy just here. In brief, When GP refer a patient to a cardiologist, the patient still has this ‘named’ GP. The cardiologist should assess and see the patient (ideally), and make a plan either continue to be treated or be followed up in the secondary care, or make a plan to discuss with the GP to continue this (recommend drug treatment and when to refer back), or make onward referral when the cardiologist sees fit. Whichever the decision is, the cardiologist should write a letter to the GP explaining what happened and what the plan is expected to be.
If you are not from the UK, you will have many questions following this, and the first will be how are the GP and the cardiologist paid. This is a big question and not for me to answer to you here. What I can tell you is the patient does not need to pay. I mean we (patients) pay a fiver for a prescription, and pay for the parking fee when we go to the hospital. Other than that it is on the NHS tab.
It would be the same when someone is admitted to the hospital. When this person is discharged, a letter should be written to the GP to explain what happened, and what the plan might be. Having to write a discharge letter before sending patient home has become a big trouble nowadays in the hospital. This is not always the case in other countries.
Some conditions may not need GP consultations
Some conditions, for example children’s epilepsy, could well be nearly entirely managed by paediatric epilepsy team. Patients go to the outpatient clinics in the hospital regularly, and never need to see the GP for this. When they see the GP of other reasons, say eczema, the GP can still keep up-to-date with their current epilepsy medication and contingency plans through the letter sent by the epilepsy team.
