Response

These comments from two recognised researchers in the area of medical referrals are helpful and it is good that the document is generating debate (which was its intention).

It is worth stressing that the report is aimed at all physicians and specialists in particular (not only generalists as implied by Drs Bradley and Whitelaw), given that it is the practice of multiple referrals to other specialty teams by a specialty team for advice on the management of common medical conditions that the RCP is seeking to develop the conversation on. The document is not intended to be a guide for generalists and should not be viewed in that light.

We have a shortage of consultants in almost all specialties, with only 55% of consultant posts being successfully appointed to in 2016. Most specialty teams are very hard pressed and we need to view the specialty ‘consult’ as a precious and limited resource that should be used wisely.

It should also be noted that this was not a survey. We worked closely with all the specialty societies to produce the document. The ethos of the document is one of collaboration and how we as physicians can ease unnecessary delays in all of our patients” care. We hope it will facilitate a refocusing on what it means to be a physician as well as a specialist and the positive engagement of all the specialties is to be welcomed.

It is arguable as to whether the publicity around the release of the document was propaganda. Propaganda is defined a message that helps a particular group or view – if patients are the group that benefit and the view we promote is improving collaboration between teams, is that a such terrible thing?