I am very embarrassed — nay, pissed off — when I hear that some of the specialists to whom I refer patients often charge initial consultation fees when following up patients for established conditions.

The specialists do this when the patient’s referral has just been renewed and/ or they haven’t seen them in the previous 12 months.

To those of us at the bottom of the food chain, this seems like a rip-off. There are no special, initial consultation item numbers or fees for us!

As I see it, the main purpose of referrals is to ensure that patients really do need to see non-GP specialists, that they are referred to the appropriate specialists, and that the specialists report back to the referring GPs in a timely and meaningful way.