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This week I read a report in the Health Service Journal about a baffling plan to reform the process of referring patients to hospital outpatient clinics.1 Under the proposed new scheme a GP would no longer be able to refer directly to a consultant but would need to ask for “advice and guidance” first. At the same time, plans are afoot to enable patients to self-refer to hospitals. When I first became a GP, after an admittedly circuitous route, I knew many of the doctors in the local hospital. I used to ring them up for informal advice if I was stuck with a clinical problem my immediate colleagues couldn’t solve, and I’d then refer to a …

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