It was meant to be a quiet week.

At the end of last week, the Consultant Respiratory advised me to discontinue the GP-prescribed spray for sinusitis, as it conflicted with the asthma spray I need to use twice a day. Overuse of steroids is contraindicated.

Monday I put in an E-consult to GP. Please may you sort antibiotics as per Bart’s.

The text reply was: we do not have a clinic letter so we cannot do that.

Well every day another twist. No clinic letter. No antibiotics.

Then they sent a referral to Pharmacy First ‘ they will treat you ‘

An amazingly nice Pharmacist from a chemist I have never been to, rang. He patiently explained that even though the GP had made the original mistake they needed a clinic letter. Pharmacist First said they were not allowed to do a 3 week course of antibiotics. They said they wouldn’t do a short course as there is no point as the infection would only return.

Back to square one. Pharmacist First said write to Bart’s get the clinic letter yourself. Take the clinic letter to GP. Insist on correct treatment.

I could go on…you get my drift. Bart’s consultant did ring me. She said she would send clinic letter immediately. It has not arrived.

GP practice manager rang me. She said: we are waiting for clinic letter. FFS.

Just to add to the fun…I told practice manager that it was strange that a negative smear result had appeared on my NHS record. I have not had a smear test since hysterectomy in 2009. Ah she said. The ‘government’ has told us to convert all paper records to digital so you will find all sorts of records appearing.

Perhaps this is all a nightmare, and I will wake up to find it’s not true. But what happens to everyone else? GPs prescribing the wrong medications, Pharmacy First attempting to fill the gaps, and insufficient antibiotic courses. Negative test reports on our records some will cause deep concern and anxiety. What is the cost of incompetence—patients ending up in A&E, hospital, or even worse? The opportunity cost of the waste of time and resources.

As for the rest of stuff. Pin still in roof of mouth. Bladder bonkers. Old foot injury is back. Rest assured all is normal!

Extract from Times 31 .3 .2026

For the past year, GPs have been paid £20 extra for every case where they seek advice rather than sending a patient to hospital. It means that, for example, if a patient has heart problems, a GP would email their details to a cardiologist to help come up with a treatment plan instead of referring the patient directly to the cardiologist.

The NHS is aiming to increase the annual number of “advice and guidance” requests from GPs

to four million this year, up from 2.4 million the year before. The scheme has been running for a decade, but is only becoming mandatory for all GP practices on April 1. 

The RCGP said: “Our members have raised concerns over how its use varies across the country, how delays and potentially blocked referrals can jeopardise patient safety, and how it can push workload from secondary to primary care without clear resourcing.

“We have heard reports of risks of delays, with tests being required before any referral, lost messages and staff without appropriate senior clinical oversight handling requests.”

The expansion of the scheme is part of a new GP contract being imposed on practices