Specialits through NHS?

So I'm moving to the UK in 2 days to join my husband. I had one last appointment with my doctor on Friday to follow-up before leaving about my recent gastritis. While there, I asked her many questions about what I need to be aware of with my current issues and as I get older so that I can be pro-active with the NHS. So my main question is - how do you go about getting your GP to make referrals to specialists? There was no time to schedule and endoscopy to determine if my issue is just gastritis or an ulcer, but my doctor put me on medication for gastritis and I have responded well. She told me how to continue and if I relapse, to see a gastroenterologist. I also had Achilles tendonitis before Christmas, have flat feet and just pinched a nerve in both feet last week (don't tie your shoes too tight!). So basically, I'd like to have a podiatrist that I can go to.

I have two other issues that I am concerned about not being able to make my own appointment with a specialist and having to wait for the NHS. The first is a mole on my ear - been there since birth and has been monitored by myself and doctors through most of my life as they advised me it might become cancerous later in life. How may I go about finding a dermatologist in the UK to help me keep it in check?

Most shockingly to me - how on earth does the NHS not have gynecologists be more active with patients? I just spoke with my friend about this and she said that nurses do the cervical exams and you only see a gynecologist if there is something off. I'm sorry, why is a NURSE performing a medical exam like that? And its bad enough that the NHS scoffs at regular preventative care (yearly physicals and such), but if there's one kind of doctor you should have a good relationship with, its your gynecologist.
And what about checking for breast cancer? The NHS already dropped the ball last year when they wouldn't give a pap smear to that poor 19 year old who died of cervical cancer. Are breast and exterior uterine exams done on a regular basis? What about mammograms? There's quite a history of different kinds of cancer - especially female oriented cancer - in my family. My mom's, sister's, and my doctors know this history and check us for it regularly. I feel like I'm going to have to come home to the US and pay a ton of money just to get myself checked from time to time for early intervention.

Any advice would be greatly appreciated. My husband says you have to nag at the GP's for reference to anyone.

This gives you an idea of what NHS offers for checkups:
http://www.nhs.uk/livewell/screening/Pages/Screentesthome.aspx

You will be "invited" for a mammogram every three years up to the age of 70.  Even though I brought medical records of my past exams and had been told to get screened every year (two at the most), there seems to be no interest in following up.  I was a  little taken aback by the mammography facilities at a big teaching hospital here.  You walk into the room with the machine and the technician stands there and tells you to remove your upper garments.  (No gown to drape over you.) There is no radiologist there to look at the images there and then in case they want another shot.  You get the results by post some weeks later (I suppose if it was bad they would let you know sooner). 

If you have concerns and your GP doesn't feel they warrant a consultant, you can always see one privately.  If the consultant is also an NHS doctor you can hope that if he/she finds something needing further attention he will agree to do it on the NHS.

Do you have time to get into everyone before you leave the US?  It's very different here.  Mammograms don't start until the age of 50.  Cervical screen every 3 years versus annually.  No skin checks.  You may want to consider private insurance.

Disclaimer:  Based on my (sadly) extensive use of the NHS; your mileage may vary.

So my main question is - how do you go about getting your GP to make referrals to specialists?

If you have a medical issue that requires a specialist, bring your medical files from the US.  Speak to your GP about your medical history and explain the conditions you have, the treatment you've been getting, and what type of specialist you've been seeing.  I've done this and have not had any issues getting a referral to a specialist. 

If it's something new, the GP will likely do routine tests first to ensure it's not something basic that can be treated by them.  If the tests are not informative, they will likely refer you to the necessary specialist.  Or, if your symptoms are severe enough, you can get a referral to a specialist without going through the GP's usual tests first.

I have two other issues that I am concerned about not being able to make my own appointment with a specialist and having to wait for the NHS.

While the NHS does make you wait, I've never found it to be especially troublesome.  In my experience, they have a pretty good triage system.  It does take some getting used to compared to the US, but I've never personally suffered from having to wait.

If your symptoms are frequent, disabling, not well controlled, etc - you can get an appointment with a specialist in 1-2 weeks.  If very very severe, from experience, they will get a specialist to see you in a day.

If your symptoms are troublesome but otherwise controlled with medicine and/or not very severe and there aren't any red flag warning signs of anything being an immediate threat to life - you can get an appointment with a specialist in 3-4 months.  (if something changes during that time though, contact your GP or the specialist - you may be able to get your appointment sooner)

Most shockingly to me - how on earth does the NHS not have gynecologists be more active with patients? I just spoke with my friend about this and she said that nurses do the cervical exams and you only see a gynecologist if there is something off. I'm sorry, why is a NURSE performing a medical exam like that?

Personally, I don't have an issue with this.  The nurse is taking a sample for testing; s/he's not running the test, not interpreting the test results, and not prescribing medicine or treatment... s/he's just taking a sample that will be sent to a lab somewhere.  In my mind, it's the same as someone taking blood from me for a blood-based test.  The person taking the blood doen't need to be doctor; the person subsequently directing my care after the results are in though needs to be a doctor.

It may be a US/UK thing.  I've found that in the US, nurses are much more restricted in what they can or can't do.  Same for pharmacists.  In the UK, I've found both nurses and pharmacists are more hands-on with patients and can do more.  So long as they have the training and are able to know when something warrants a higher medical opinion, I'm okay with nurses and pharmacists being able to do some initial frontline care.

And what about checking for breast cancer? The NHS already dropped the ball last year when they wouldn't give a pap smear to that poor 19 year old who died of cervical cancer. Are breast and exterior uterine exams done on a regular basis? What about mammograms? There's quite a history of different kinds of cancer - especially female oriented cancer - in my family. My mom's, sister's, and my doctors know this history and check us for it regularly. I feel like I'm going to have to come home to the US and pay a ton of money just to get myself checked from time to time for early intervention.

Sure, there may have been negligence involved if there were signs and/or symptoms to suggest she was more at risk, but that's probably more the doctor's fault than the NHS.  And to be fair, cervical cancer in someone under 25 is considered quite rare so if there weren't any warning signs, I can see how it was missed.  The NHS does have blanket policies aimed at target groups, but if you have symptoms or a medical history to suggest you may be affected outside the usual demographic, you will get what you need.

I, unfortunately, have rare conditions not expected for my gender, age, overall health, and so on.  The NHS literature will advise I don't need this, that, or the other until I'm age whatever... but I've never had any problem getting what I need once I've explained my medical history to my doctors.  They've all been understanding that unfortunately, weird and odd stuff happens in medical science, and if there's a good reason to get you a test or procedure the NHS wouldn't normally recommend for your particular demographic, you'll get it.  (same for DH with his moles; he gets them checked regularly as he has family history to suggest being vigilant about such things)

I think you'll get quite a bit of resistance if you tell your GP you want this referral or this test without good reason... but if you can explain why you think you need it, I think you'll be fine.

My husband says you have to nag at the GP's for reference to anyone.

This has not been my experience at all; sorry to hear he's been having such a tough time.  I've found they won't outright recommend tons of tests for everything or immediately jump to refer to you a specialist, but if you explain yourself, most doctors are willing to listen and take you seriously.  You do have to be your own advocate, but I've not felt like I've ever had to nag.

Hope you can get everything sorted; I was terrified of getting care with the NHS before I arrived and since then, the NHS has literally saved my life.  I came over thinking I would definitely need private insurance, and never ended up getting it.  (I did look into plans though; pre-existing conditions may not be covered so be aware of stuff like this if you do think you want to get private insurance)

I suppose one of the things that modern American healthcare has created was the ability to book directly with specialists, instead of going to see a family doctor.   Of course specialists are going to lobby wtih health insurance companies that they "should be a first point of call for anything related to their part of the body, no one else will know as much!"  The American system "says" that we won't get the best care unless we go straight to the (so called) expert.

But in the UK, your GPs are your first point of call and from my (unfortunately like Aquila) fairly extensive experience of seeing GPs, they really are amazing.   

GPs go through a lot of training to handle all kinds of medical cases from physical, mental health, to emergency care, to routine baby ailments, to joint and bone problems, to digestive issues, to MS, to whatever you can throw at them.  And most of the time, they really can handle things that are complicated and advanced. They can access the same types of tests that specialists can, they can help be a focal point for coordinated care if you have a complex case. And in many rural parts of the UK, GPs are really the only people you'll be able to see without having too travel many hours and stay out of town. 

My GP's surgery (I don't always see the same one) has been able to deal with my complex joint and breathing issues, removed deeply embedded splinters, given me antibiotics for a UTI, deal with a nasty painful lump on my foot, sent me for all kinds of xrays and tests and have always referred me to a specialist when they've ruled out everything and could go no further without needing more advanced testing or care. 

Half the battle is finding a good GP's practice. You definitley have the right to see a specialist, see this link below:
http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/gp-referrals.aspx

As for the cervical smear, mine is completed by an advanced practice nurse, which means she's had a huge level of training (like master's degree and all kinds of advnaced courses) and she can prescribe medicine.  She deals with all kinds of things at my surgery (especially chronic diseases) and she has longer appointments, so she has the time to explain things and take her time and ensure that care is coordinated.   Nurses are highly trained indviduals and they are a huge asset in your healhtcare!   
Likewise, chemists and pharmacists can really help with minor ailmemnts, keeping you out of the surgery or A&E!

It's a different system. It's not a perfect system, but don't be afraid to be your own advocate for you health. Afterall, you know you best.   

NHS wins hands down on the really big stuff.  You will get referrals with no question.  It's the things that you want someone to keep an eye on that is the problem.  The GP expects you to take the responsibility of alerting them to a possible issue.  In the US system I would wait for an annual checkup to ask any questions and then be reassured or sent on to a specialist.  I think with the NHS you tend to feel like you're over-stepping the bounds if you were to go in over every niggle.  
For example, I am getting arthritis in my hands   and I don't feel there would be any point in making an appointment with the GP.  But I probably would have mentioned it to my PCP or a nurse/practitioner when I saw one of them -- which may or may not have lead to a referral.
ETA: and of course under the US system, doctors are so fearful of being sued that they probably over-refer just to cover themselves.  And if you've got decent health insurance they know it would be paid for so they can get a bit carried away!

It's the things that you want someone to keep an eye on that is the problem.  

Yes. It's called preventative care or something.

This idea of "self advocacy" is a bit ridiculous. The internet is great for many things, but finding out about medical stuff is not one of them. Type in your symptoms and a very scary word always comes up. Some book or something? Ask a friend?

How are you supposed to know what is important? I read somewhere that tiredness and acheiness is one of the first signs of something awful....but it could be - and probably is - just getting older or something. Maybe stress. How do you know?

Yes. It's called preventative care or something.

This idea of "self advocacy" is a bit ridiculous. The internet is great for many things, but finding out about medical stuff is not one of them. Type in your symptoms and a very scary word always comes up. Some book or something? Ask a friend?

How are you supposed to know what is important? I read somewhere that tiredness and acheiness is one of the first signs of something awful....but it could be - and probably is - just getting older or something. Maybe stress. How do you know?

Very true.  When I was pregnant, I stayed away from Dr. Google.  I went for a vaccine at 30 weeks and my blood pressure was 160/101.  The nurse was concerned and made me wait to see the GP.  He asked if I had been having headaches, I said yes along with light disturbance.  He said I was fine and "the best way to give a patient high blood pressure is to tell them they have high blood pressure".  I trusted that and went on my way....  Hindsight is 20/20!

I'd say that anyone who thinks they are getting arthritis in their hands should visit their GP for a diagnosis. They can prescribe painkillers if necessary which, if you are going to take them daily, will probably be cheaper for you on the annual prescription plan (sorry can't remember what it is properly called). And, should you need to see a specialist in the future, you will already have a diagnosis.

I'd say that anyone who thinks they are getting arthritis in their hands should visit their GP for a diagnosis. They can prescribe painkillers if necessary which, if you are going to take them daily, will probably be cheaper for you on the annual prescription plan (sorry can't remember what it is properly called). And, should you need to see a specialist in the future, you will already have a diagnosis.

Yes, definitely.  If it is "just" osteoarthritis, then a GP can certainly treat this effectively, as well as with self care (which they should teach you how to manage).  But if it's an inflammatory arthritis condition, this is much better off being treated by a rhuematologist.

And if you've got decent health insurance they know it would be paid for so they can get a bit carried away!

Ain't that the truth.
It does take a little while, but once you're over here for a while you, too, will sense the excess in the US healthcare system.

Ain't that the truth.
It does take a little while, but once you're over here for a while you, too, will sense the excess in the US healthcare system.

Quite. In the US, overpriced procedures can be paid for with overpriced insurance policies. When health care is publicly funded, you only get what you need. But if you need something you will get it.

I'd say that anyone who thinks they are getting arthritis in their hands should visit their GP for a diagnosis. They can prescribe painkillers if necessary which, if you are going to take them daily, will probably be cheaper for you on the annual prescription plan (sorry can't remember what it is properly called). And, should you need to see a specialist in the future, you will already have a diagnosis.

Fully agree.  Last year my sister in England went to see her GP thinking she had arthritis in her hands, but the GP thought it was the more serious rheumatoid arthritis and immediately referred her to a specialist who quickly confirmed that she had in fact got Lupus.  There was no wait time in seeing the specialist.

In her mid-30's my sister had a negative result from the 3-year routine smear test, turned out she had cervical cancer and was in and out of hospital 3 times over the next 8 weeks for 3 procedures to remove the cancer. She was then tested every 3 months for a couple of years and then every 6 months until after 5 years she was declared clear of cancer and put onto an annual check-up.  (That was 7 or 8 years ago).

I do not have a ton of experience with the NHS, mainly just regular appointments for infections, etc. but I have needed to use the US healthcare system quite extensively at various points in my life.  The biggest issue I have had with the switch is finding a new doctor with whom I can establish a connection.  I met my family doctor on the day that I was born and see many of the same specialists as my parents meaning that they already know my medical history.  Coming here has been interesting because I have to rehash all this information to new people.  I haven't quite found a doctor at our local surgery that I love but there are a few that have been really helpful and have not fobbed me off for the next patient (which was my experience at another place).  There are some things I really like about the NHS and then there are some things that drive me crazy, but that is to be expected with any system.  Best of luck with your move and transition!

Half the battle is finding a good GP's practice. You definitley have the right to see a specialist, see this link below:
http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/gp-referrals.aspx

Yes, yes, yes!  Finding the right GP can make all the difference, because they really are 'gatekeepers' for everything else. 

Waiting times are, unfortunately, a bit of a postcode lottery.  Where I live, it's a very small GP practice, so I've got no trouble getting in to see the GP quickly.  But any specialist care is complicated and drawn-out.  On the flip side, in densely-populated areas, it can take days to see the GP, especially if you're not very acutely ill, but if they do decide you need specialist care, you're liable to get it a lot quicker (assuming it's for something urgent).

You're always going to compare the NHS to the U.S. healthcare system-- it's inevitable.  But try to be realistic in your comparison.  For example, when I had an autoimmune issue, I saw a specialist within a week of referral, and treatment was scheduled within days, because it was potentially life-threatening.  When I landed in the ER with gallstones, I waited 4 hours to see a doctor, because although I was in pain, I wasn't actually dying.  Then I saw a specialist within the week, but it still took a couple of months to schedule the surgery, because I wasn't in any immediate danger.  And when I moved to a new city, and saw a new PCP, she was quick to refer me to a variety of specialists for monitoring of my chronic conditions.  But, since I wasn't actually having any problems at the time, it took anywhere from 1-6 months to get a first appointment with the specialists, and I was advised to book other routine follow-ups ~3 months in advance.  Those time-frames were based on triage, and wouldn't be significantly different in the NHS.

Also...you've seriously never been to a nurse practitioner?  They have advanced degrees and training, and routinely carry out things like pap smears.  I guess maybe they're more common in small town/rural clinics, or campus health centers, but honestly, it doesn't take a board-certified OB/GYN to wield what is, essentially, a super-long mascara wand.