How to get GP to refer me to Consultant

[michita]

Hello

I live in London. I wonder what % of type 1s are referred to consultants. I moved GP a few times and my current GP think not all type 1 need to be referred to consultants. At moment all my GP do is to provide my repeat prescription. I would like at least to get my blood test done for Hba1c, kidney liver and thyroid functions etc. Nowadays its quite difficult to just get an appointment with GP. I was asked to first fill out online form which will be reviewed by a GP.

Is there anything I can say to my GP to get them to referred me to consultants..? I am not suffering with daily management hugely and at the moment have no complications but i was tested for positive (not too high but above normal range) thyroid antibodies. I wake up relatively often at night having hypo sometimes more than once.. i wonder what is the standard service offered by NHS in UK for type 1 ?

Thank you in advance for any comments you might have.

 

[Jasmin2000]

In theory all T1s should have access to a DSN as this is part of your Diabetes Healthcare Team (https://www.diabetes.org.uk/guide-t...es/interactions-with-healthcare-professionals). But getting referrals depends on convincing the GP that there are "complications" that actually need a referral (https://www.nhs.uk/nhs-services/hospitals/referrals-for-specialist-care/).

The fact that GPs are very busy should make a referral easier. The most common referral is to an endocrinologist and you can ask for this as you need, e.g. more insight into how to control your diabetes wrt diet, exercise, etc. I asked about the various counter-regulatory hormones and what to expect as I get older and was immediately referred as the surgery nurse was not able to answer.

Btw, your standard blood tests are ordered by your GP surgery, so just ask for them. If you haven't had an A1c done for 3 months, then that's an easy ask, and serum lipids are also a must have.

 

[searley]

If you are generally well controlled many consultants pass you back to the GP.. your gp can issue.. and should issue blood test and urine forms if that the only thing concerning you. And should provide access to a DSN

 

[In Response]

If you are generally well controlled many consultants pass you back to the GP.. your gp can issue.. and should issue blood test and urine forms if that the only thing concerning you. And should provide access to a DSN

Whilst GPs can (and do) issue test strips, insulin, etc., in my experience, they are far behind the curve with regard to offering "newer tech" such as CGMs and insulin pumps. Most have caught up with the Libre for people with Type 1 but alternatives such as Dexcom One are rare.
The same is true with regards to changing insulin.

Just because you do not have any issues, does not mean you should not have access to these newer options to reduce the impact on lifestyle that Type 1 may have.

I am lucky to have access to a diabetes clinic at the local hospital and have always done so. I have had a couple of occasions where I have had to talk to the DSN at the GP surgery. She may know type 2 but I was not sure she was able to spell "Type 1" based on the ignorant questions she asked me. Access to someone with the title "DSN" at a GP surgery is not likely to have the knowledge or experience to provide more than basic support for someone with Type 1.

Eight years ago, I felt that my diabetes was well-managed (I never talk about "controlling" diabetes). However, my endo identified the added value I could get from a pump and I have never looked back. I am concerned that areas that follow the approach you describe would prohibit these options apart from for very proactive (demanding) patients. A GP is a General Practitioner and cannot be expected to proactively recognise the need for a change in Type 1 treatment.

My recommendation to @michita is to contact the Diabetes UK Helpline for advice.

 

[michita]

Thank you all for your comments. They are very helpful.

When I first diagnosed about 7 or 8 years ago I had twice yearly appointments with consultants plus twice yearly appointments with GP plus annual GP nurse appointment.... I somehow thought type 1 get regular consultant appointments (read this somewhere in the past?)

I guess I thought wrong. I will try & ask Gp for periodical blood test.

Btw I recently had my retinopathy screening and the email said going forward this will be done every 2 years rather than every year if no issues found. I worry the state of NHS

 

[Jaylee]

Whilst GPs can (and do) issue test strips, insulin, etc., in my experience, they are far behind the curve with regard to offering "newer tech" such as CGMs and insulin pumps. Most have caught up with the Libre for people with Type 1 but alternatives such as Dexcom One are rare.
The same is true with regards to changing insulin.

Just because you do not have any issues, does not mean you should not have access to these newer options to reduce the impact on lifestyle that Type 1 may have.

I am lucky to have access to a diabetes clinic at the local hospital and have always done so. I have had a couple of occasions where I have had to talk to the DSN at the GP surgery. She may know type 2 but I was not sure she was able to spell "Type 1" based on the ignorant questions she asked me. Access to someone with the title "DSN" at a GP surgery is not likely to have the knowledge or experience to provide more than basic support for someone with Type 1.

Eight years ago, I felt that my diabetes was well-managed (I never talk about "controlling" diabetes). However, my endo identified the added value I could get from a pump and I have never looked back. I am concerned that areas that follow the approach you describe would prohibit these options apart from for very proactive (demanding) patients. A GP is a General Practitioner and cannot be expected to proactively recognise the need for a change in Type 1 treatment.

Interesting,

My experience differs.. I see my endo & team once a year.
The last time was a call set up by appointment that never happened. (I waited eagerly.)

My overall experience is the endo appointments are just further away geographically from what I could get from my local surgery.
The blood tests…

My GP actually supports me regarding any appropriate changes regarding the day to day management I could benefit from…
However, his hands are tied & need to get signed off by the endo.