"Experience of 'phoning Devon Referral Support Services."

About: Devon Referral Support Services Devon, Cornwall and Isles of Scilly

(as the patient),

My Doctor referred me to DRSS because he had decided, (his decision, I hadn't gone to see him about this particular matter), that because a cyst on my lower right eyelid was beginning, at times, to intrude on my line of sight that it needed removing. Because of it's position he decided that it would be preferable for an Opthalmologist to 'do the job'.

I received a letter from DRSS asking me to contact them in order to choose a hospital and to process my referral.

I rang DRSS and heard a recorded message telling me that there was a queue but I could leave my name and 'phone number and they would get back to me shortly and so I did just that. However, after waiting three days and having not heard from DRSS I 'phoned them again. At first I was told that they had no record of me but after giving them the details of the letter they had sent me they did 'find me. I was told that because my Doctor had not given enough detail it had been referred back to my Doctor. (It would have been 'nice', polite even, if they had bothered to 'phone me back to tell me that instead of leaving it to me to ring them a second time).

My Doctor was on holiday that week but on his return he contacted me and asked me to go in and see him. When I did see him again he expressed some considerable surprise that I had been told that there had not been enough information given. In fact there was no further information he could have given except perhaps to list my hair colour and maybe food preferences! My Doctor however said he would remove the cyst himself although, because of the position of it, he would still have preferred an Opthalmologist to have 'done the job'.

I have since heard from a friend in the profession who said that they thought in fact it was nothing to do with lack of information that resulted in the matter being referred back to my Doctor and that no qualified medical person would have even been involved in the decision. It is simply a cost cutting decision.

So, my GP's opinion and 60 plus years of paying into the NHS makes me feel counts for absolutely nothing. I wonder who did make the decision to refer the case back to my surgery?

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Response from Devon Referral Support Services

Dear ‘Torgoldhen’,

I would like to thank you for taking the time to get in touch and let us know about your experience. I was clearly not a good one and we rely on feedback such as yours to let us know where we’re going wrong so thank you.

Firstly, I am very sorry that we failed to return your call. This can only have been an oversight on our part and I apologise, it should not have happened.

With regard to your referral being returned to your GP, I don’t have enough detail to say for certain what happened but I would like to tell you what I think may have happened. If you would like me to investigate further and give you a concrete answer, please phone me on 01626 883702 and I will be happy to look up your referral and let you know. I work Monday-Wednesday 8-4 or you can contact my colleague Gemma Smith on 01626 883712, Monday-Friday 9-5.

The NEW Devon Clinical Commissioning Group (CCG), which DRSS is a part of, have a number of policies in place that restrict access to certain procedures and treatments. There is one that covers Meibomian cysts and I wonder if this might be what you had. If you did, your referral can only be forwarded to a hospital for treatment if certain criteria is met. If the criteria do not appear to be met in the referral letter we receive, we return it to the referring GP asking them to double check the policy and re-submit the referral with additional information if there is any that’s relevant. For example, a meibomian cyst must be continuously present for 6 months before referral is considered. (There are other criteria as well). If the GP doesn’t mention in their original letter how long the cyst has been present, we have to return the referral. The GP can then re-submit the referral if and when the criteria have been met.

The DRSS have a number of GPs who come and work on site to, among other things, double check these referrals. I can say for certain that your referral will not have been returned to your GP without one of our GPs having looked into it first, whether or not it was because of one of these policies, and so there will definitely have been a qualified medical person involved in the decision.

These policies are in place partly for cost-cutting purposes and all of the policies that are in place are written by a panel that has at clinicians on it, usually GPs and specialists are consulted where necessary. They are in place to either stop treatment purely for cosmetic purposes or treatment that is proven to have limited clinical effectiveness.

I am sorry that the above was not explained to you over the phone (although, again, I am only guessing that this is what caused your referral to be returned). I feel that if it had, you would have come away from the experience much less frustrated. I will take your comments to the team concerned.

I will be very happy to hear from you again, either by phone or via Patient Opinion if you have any further comments or concerns for us to take into consideration.

Best wishes,

Susan Pearce

Project Support Manager

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Update posted by Torgoldhen (the patient)

Dear Ms Pearce

Thank you for your response to my feedback.

Thank you also for the apology for the fact the organisation failed to 'phone me back and appeared to lose me in the system'.

I note what you have to say about the extra information the organisation felt they needed although my doctor disagrees with that. If you needed to know how long the cyst on my eyelid had been present, couldn't that question have been put to me when you called me back?

It has been coming up to nine months now and that would have saved the time and cost of referring the matter back to the surgery and saved the delay which has now ensued. Apart from the question as to how long the cyst had been present I am concerned that possibly other criteria may have been needed to be met. Can you tell me please what are those other criteria but again could this information not have been obtained by phoning me.

It is good to be assured that 'one of your GPs' would have looked into the matter before making the decision to refer the matter back to my doctor. As my doctor has known me for some 30 years, and had reached his decision after seeing me face to face, I can only be left wondering how a doctor who knows nothing about my diagnosis (I was assured that it would have been a Doctor), can overrule that decision without even the benefit of examining me? It would appear to show a certain lack of professional respect towards my own doctor.

I must admit to feeling some little trepidation and annoyance that although my doctor recommends that, because of the site of the cyst in question, an Opthalmologist should carry out this minor op, that is not going to happen because of a decision made by some remote, anonymous person.

I do so hope you can appreciate why I should feel like this.

I look forward to your reply.

Yours sincerely,


Response from Devon Referral Support Services

Dear Torgoldhen,

Thank you for responding and for your further queries.

It is a little difficult to answer some of your questions because, as I stated in my previous response, I only gave meibomian cysts as a possible example of a policy that we may have been referencing and I only gave the time-frame as a possible example of why we may have returned your referral. Without your details I cannot look up your referral and so I am only giving an example scenario.

Regarding the extra information that was required to make a final decision, the staff on the phones here are not medically trained and so, whatever the reason for returning a referral might be, we always let the DRSS GP communicate directly with the referring GP as it is more appropriate. Where possible, the GPs at DRSS will phone the referring GP in order to be able to discuss the referral and to come to a conclusion as quickly as possible.

Regarding other criteria that you may need to meet, I cannot list it as I don’t know which policy you fall under. I think, from your description, that it is likely to be one of two policies; either Meibomian cysts or Beningn skin lesions. Both the policies can be found on the NEW Devon CCG website here:


under Meibomian cysts (Chalazia) guidance



under Benign skin lesions

If you can’t follow the links for some reason, please let me know and I’ll put the whole policy up on Patient Opinion.

I really can appreciate why you would feel anxious about the decision made and annoyed at this process. Your GP, who is fully trained and capable of making a diagnosis has decided that you would benefit from this procedure and an unknown entity has delayed or halted your referral. I would be annoyed too.

The fact is that the NHS, and NEW Devon CCG in particular, is currently under immense pressure to reduce costs. One of the measures in place to keep spending under control is to limit access to procedures that are either for cosmetic purposes or are of limited clinical value. These policies are written by clinicians who have to consider the needs of the population as a whole and they have to make difficult decisions about how best to spend the limited funds available. Referring GPs are obviously making decisions and referrals based on what is best for their patient but unfortunately, not all treatments can be funded and it is not a reflection on the referring GP if more information is requested. There are many of these policies in place and GPs in local practice are not always aware of the finer details of each of them, which is why we have GPs here at DRSS to work with referring GPs and assist in administering the guidelines.

There is a panel which can be appealed to if you or your GP feels that you are an exception to the rules of the policy. Your GP will have their details and the appeal must come through your GP, not from you directly.

I hope that this has answered your questions adequately. I would be happy to talk to you over the phone if you would like me to look into your particular case or I am equally happy to converse further through Patient Opinion. My phone number is 01626 883702 and I work Monday to Wednesday, 8 until 4.

If you would prefer to speak to someone else in the organisation, the CCG Patient Advice and Complaints team can be reached using the details below. They can either help you investigate further or record an official complaint for you.

Telephone: 0300 123 1672 or 01392 267665 (Monday to Friday 9am – 5pm)

Calls to 0300 numbers cost the same as calls to 01, 02 numbers and are included in most mobile call bundles.

E mail: pals.devon@nhs.net / complaints.devon@nhs.net

Or write to:

Patient Advice and Complaints Team


County Hall

Topsham Road



Best wishes,


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