Today I had my long-awaited NHS appointment with a new CRS (one I hadn't seen before) at a nearby private hospital. The CRS examined me - briefly - and then wrote out a private prescription for Rectogesic. I explained to him that I had previously had numerous tests and medications, including Rectogesic, but he insisted that I give Rectogesic another try, and then come and see him again in 2 months' time.

When I took the private prescription to my local GP's surgery, they told me that the script had to be exchanged for an NHS prescription, and the process would take until after the weekend to complete.

I'm not sure what I feel about this appointment. The CRS certainly seemed capable and knowledgeable - I expected him to recommend surgery, but he told me that he really didn't want me to have an operation if it could possibly be avoided, and trying the ointment again would not do any harm.

The margin between private and NHS treatment does seem to be growing rather blurred. The GP receptionists were as puzzled as I was about why, as an NHS patient, I was given a private prescription - but perhaps the CRS didn't know I was an NHS patient, etc. etc.

At all events, in view of the short consultation time (10 minutes) I'm glad I didn't pay to see the consultant!

As far as my fissure goes - it's still very uncomfortable, but I'm not having the severe pain I was in earlier this year, and to a large extent the condition is manageable.

About 20 years ago, I began to suspect that "borderline" patients are probably treated based on how empty or full a surgeon's surgical schedule is at the time of your appointment. Clearly, urgent cases are dealt with quickly, and patients who don't need surgery at all are refused consideration. The "borderlines" though, will be scheduled for surgery if the surgeon has openings coming up that need to be filled, and told to wait, and extend conservative treatment, if his/her schedule is full. I'm not sure that private or public would make a difference though, because both systems probably have times when the surgical slots are completely filled already, and other times, when the surgeons need to find patients to complete the roster. This doesn't specifically relate to colorectal surgery either, but extends across all medical specialties.