Mostly people practice as a group practice with patient registered to
the practice effectively (though still nominally to a named doctor)
and able to see who they want as they want, but still some practices
sticking to a registered list system with cover only for hols and
illness. I think if you are a small practice (in my head 6000 ish or
less) the patient can still probably get to know the 3 or 4 doctors
well enough and the list size is small enough to get good continuity
of care. I think for much larger practices (we have a local one with
20 doctors and 20000 patients) there probably has to be more attention
to achieving good continuity and avoiding the "collusion of anonymity"
within the practice never mind between primary and secondary care.

As others have said, he who requests has responsibility is the
cleanest line to start from, if they don't want or need to see the
result why would the Less Responsible Practitioner order the test?
Unfortunately it is not infrequent for a hospital colleague (usually
not a consultant) with an over inflated sense of their relative
importance/workload to "delegate" the follow up of a test result to
me.

I write back a standard letter where there is ambiguity or
inappropriate attempt to delegate follow up and decline to accept the
responsibility to follow up, confirming that they still remain
responsible.  I point out that a clear line of responsibility is in
the patients best interest, and remind them that I do not ask them to
take responsibility to follow up on the tests that I order..

But then I'm a miserable old git. I don't get many repeat attempts though.

I would be prepared to take responsibility for the actions of
specialist colleagues if I were given authority over them, as I have
in the past accepted responsibility for the actions of subordinates,
but in the absence of that arrangement ... no



On 8 December 2010 10:45, dr brian crowley
<[log in to unmask]> wrote:
> No, it's still the outdated system of registering with a named GP which
> certainly caussee who thees some patients a degree of confusion about whom they
> 'should' consult, and definitely causes problems with hospital
> communications to primary care.
>
> As for test results, we had a number of issues occur in our area and
> although all sensible practitioners understood the principle that those
> ordering the test were responsible for following it up, the PCT eventually
> stepped in and issued very clear guidance as to who should be responsible.
>
> Having said that, I increasingly find the acute trust copying results to us
> which we do not need eg a screed of blood results from an admission 1 month
> ago, and leaves me somewhat concerned that we might be left picking up the
> pieces again.
>
> On the flip side of that equation, our electronic pathology requesting
> system now allows us access to the tests requested by the acute trust, so
> circumstances can occur where a patient has been seen in hospital and had
> bloods/scans/XRs but not yet had any results and is anxious about what has
> been found.
> We may then be able to view those results prior to any decision being made
> by the acute trust as to how to manage the patient.
> In viewing those results, and potentially acting upon them, I guess we
> absorb a significant amount of responsibility ourselves.
>
> -----Original Message-----
> From: Graham Balin [mailto:[log in to unmask]]
> Sent: 08 December 2010 08:56
> To: [log in to unmask]
> Subject: Re: Patient registration
>
> Hi Jel,
>
> Others may be more up-to-date but IIRC, the pt registers with the
> practice nowadays, whereas it was with the GP before the new contract.
> As for tests...
> The principle 'he who orders the test is responsible for acting on the
> result' was always a guide, but not 100%, as I found out when I first
> started in GP, The gynae OPD had done a smear as they discharged the
> woman. Of course it was abnormal and the practice [before my time]
> assumed the OPD would follow-up and vice-versa.
> When my newly developed smear recall system found her, she had Ca.
> Luckily survived, but we got hit 25% and the hospital 75% of the
> damages. [I never did get a thankyou for saving her life:-( ]
>
> Her in Aus, no-one registers with anyone. One of the hardest things
> adjusting to, having to remember the punter might have been somewhere else .
>
> --
>
> Cheerio,
>
> Graham
>