5.2 Patient pathways
Patient pathways are fairly similar across the United Kingdom, with
comparatively more emphasis on choice of provider in England. GPs act as
gatekeepers to more specialized care, which is generally provided in hospitals.
The GP is usually the first point of contact, although there are other primary
care pathways, including telephone services and walk-in centres.
Anywhere in the United Kingdom a woman in need of a hip replacement
because of arthritis would follow the same basic pathway:
• Once it is agreed that she needs a hip replacement, during a free visit to
a GP at a practice where she is registered, the GP refers her to a hospital
orthopaedic department and will prescribe any necessary medication.
• She may be given a choice of local hospitals, potentially including some
private hospitals, and she can make her choice on the basis of waiting
times and other criteria which are made available online through the
relevant web site.
• She can choose to go to a private hospital directly, but she must pay for
her treatment either out of pocket or through private medical insurance if
these resources are available to her.
• She will have an outpatient hospital appointment with a specialist team
where she will be assessed and the necessary diagnostic tests will
be made.
• Within 18 weeks (12 weeks in Scotland) she will be admitted for surgery,
but waiting times have fallen markedly since the 1990s (see Section 5.4).
• Following surgery and primary rehabilitation at the hospital, the patient
goes home and is discharged to the care of her GP and their team of
community nurses.
• The GP receives a copy of the discharge summary and is responsible for
any further follow-up, such as referral to a physiotherapist.
The patient will not be expected to pay out of pocket for any of these
appointments or for treatment under the NHS. In England she would have to
pay a prescription fee for any medications prescribed by the GP if she is not
exempted (for example by being over the age of 65 years). Prescription fees have
been abolished in Scotland, Wales and Northern Ireland