Am I a cynic? Strained Gp relationship

[Didnt plan for this]

Hi
I have had type 1 for ten years and never posted before, but keen to hear the experience of other diabetics about GP diabetes/medication reviews when under a hospital consultant for pump therapy. Hope this isn't too ranty!

For years I havre gone along for my annual diabetes/medication review at the GP practice with a GP or nurse (i was never quite able to clarify the exact purpose of these reviews) and it became clear that communication of my HBA1c results etc was lost between the hospital and GP. Last year, during a busy and stressful period, having been relentlessly harassed by my GP to attempt the review, I eventually went along only to find the GPs main focus was to try to persuade me to switch to a cheaper BG meter. Explaining I was on pump therapy and after some discussion, the GP then questioned if I was excessively testing my BG. I was told I was allowed 100 test strips a month and the GP drilled down to my daily usage, saying I should only need to test three times a day?! When I reminded him of the need to test every time I drive (and more if having hypos or hypers), the GP seemed to loose interest in the conversation. This seemed an unfortunate focus of the "review", though it am a realist and appreciate Budget constraints, which i explained to the GP and that I am never frivolous with any of my diabetes supplies. Words cannot express how exasperated I was when the GP then continued to tell me I need to improve my hba1c - so I questioned how I could do that without testing my BG.? Aside from being totally de motivating experience, I think it was really badly managed by the same GP who had previously prescribed me antidepressants for anxiety And depression!

This year, I received the invite for the GP review, but with last years experience in mind and a suspicion that I would again be interrogated and come away feeling demoralised, I ignored the letter. This afternoon I received a message via a receptionist saying my GP wouldn't issue my repeat prescription unless I came in for a medication review. Apparently the GP wouldn't speak to me on the phone (?!) but insisted I came to the surgery. Although I challenged this and asked for clarification what the purpose of the review was, I hit a brick wall. The cynic in me thinks the real purpose of this review is so a few boxes can be ticked and the surgery can get their incentive for doing an annual review, which I understand they do for people with chronic conditions. If I could believe they were genuinely interested in my welfare, or the review would benefit my health, I would attend, but it all feels like a "tick box" exercise.

Am I wrong? Am I a bitter cynic? Or Has anyone had similar experiences?. I spoke to my diabetes team at the hospital today asking them to liaise with the GP on my behalf as I feel I am knocking my head against a wall. I would complain about my GP but from previous experience, suspect I would be wasting my breath. The only other option seems to be to change GP surgery, as people tell me there is a lot of difference been GPs.

Thanks in advance - sorry for long thread

 

[ann34+]

Hi, Dont be too worried - i had an unpleasant experience along somewhat similar lines just a few weeks ago, it is sorted now but it stressed me out at the time, making me feel very unwell, and affected my control badly, and thus my ability to recover from a long virus. Even though I have had 2 even worse experiences in the past with different GP practices. always about strips, and had sorted those, it always comes as a shock, for just the reasons you mention - you hoped there was some care for you involved. There may not be. Many doctors in a group practice may not even know your medical history, or may be acting on orders of the practice finance manager . Just phone one of Diabetes organisations, and you will find this is happening in many parts of the country, read the patient magazines - one has tips on self advocacy re this . (my only problem with this concept is it is not easy to do, as one is in a position of little power, one is not in an equal situation, and the other side is just trying to save money - whereas you are trying to live better and with more safely. Fighting the issue gets more difficult the older you get

Getting a copy of the Government early 2013 guidance letters re Type one and strips, (this has been quoted on here a number of times), may help, but not necessarily - it did not help me much at another GPs. Also, you will find that your pump doctor will probably write a letter for you. Good luck,

 

[Matilda14919]

I've had a similar experience my strips were reduced insulin reduced and I made a complaint - the reason for the cut was because the Gp didn't think I needed to test as much - I decided to wait to see the gp and behold it was a locum who had no freaking clue - the first he asked how long have you been type 2 and why haven't I attempted to lose weight - got up and walked out and requested to speak to the person in charge - made my complaint and she apologized now have another letter for bg test and I never have them at the gp because my vein are tiny - call to remind them that why I had my test at the hospital - was told if I don't come in my meds will be stopped - told them to f**k off coz if I come in I will be sent to the hospital anyways - spoke to the lady in charge again who apologized - in other words speak to the head honcho

 

[noblehead]

Hi and a warm welcome to the forum

Not sure why you need a review every year with your gp if your under the care of a hospital diabetes team, this shouldn't be necessary at all as I'm under my hospital team and never see my Dr unless its for something unrelated to diabetes.

As for the test strips issue, 100 a month isn't anywhere near enough for a type 1 to manage their diabetes, especially for someone on an insulin pump, so for them to suggest that you only need to test 3 times a day is quite ridiculous.

Back in 2013 all gp surgeries received a letter from the Dept of Health with regards to restricting test strips for type 1's, you could print it off and remind them of its content or ask your diabetes consultant to write to your gp and say that you need at least 200 strips a month to manage your diabetes, here is the letter:

https://www.gov.uk/government/uploa.../Safe-care-of-people-with-type-1-diabetes.pdf

 

[RuthW]

Hi
I have had type 1 for ten years and never posted before, but keen to hear the experience of other diabetics about GP diabetes/medication reviews when under a hospital consultant for pump therapy. Hope this isn't too ranty!

For years I havre gone along for my annual diabetes/medication review at the GP practice with a GP or nurse (i was never quite able to clarify the exact purpose of these reviews) and it became clear that communication of my HBA1c results etc was lost between the hospital and GP. Last year, during a busy and stressful period, having been relentlessly harassed by my GP to attempt the review, I eventually went along only to find the GPs main focus was to try to persuade me to switch to a cheaper BG meter. Explaining I was on pump therapy and after some discussion, the GP then questioned if I was excessively testing my BG. I was told I was allowed 100 test strips a month and the GP drilled down to my daily usage, saying I should only need to test three times a day?! When I reminded him of the need to test every time I drive (and more if having hypos or hypers), the GP seemed to loose interest in the conversation. This seemed an unfortunate focus of the "review", though it am a realist and appreciate Budget constraints, which i explained to the GP and that I am never frivolous with any of my diabetes supplies. Words cannot express how exasperated I was when the GP then continued to tell me I need to improve my hba1c - so I questioned how I could do that without testing my BG.? Aside from being totally de motivating experience, I think it was really badly managed by the same GP who had previously prescribed me antidepressants for anxiety And depression!

This year, I received the invite for the GP review, but with last years experience in mind and a suspicion that I would again be interrogated and come away feeling demoralised, I ignored the letter. This afternoon I received a message via a receptionist saying my GP wouldn't issue my repeat prescription unless I came in for a medication review. Apparently the GP wouldn't speak to me on the phone (?!) but insisted I came to the surgery. Although I challenged this and asked for clarification what the purpose of the review was, I hit a brick wall. The cynic in me thinks the real purpose of this review is so a few boxes can be ticked and the surgery can get their incentive for doing an annual review, which I understand they do for people with chronic conditions. If I could believe they were genuinely interested in my welfare, or the review would benefit my health, I would attend, but it all feels like a "tick box" exercise.

Am I wrong? Am I a bitter cynic? Or Has anyone had similar experiences?. I spoke to my diabetes team at the hospital today asking them to liaise with the GP on my behalf as I feel I am knocking my head against a wall. I would complain about my GP but from previous experience, suspect I would be wasting my breath. The only other option seems to be to change GP surgery, as people tell me there is a lot of difference been GPs.

Thanks in advance - sorry for long thread

I think you are not a cynic at all, but I think you should be going to the hospital once a year to see an edocrinologist. Then your endo can tell your GP what you should be prescribed and there's no need to get into any aggro with them. How did you get the pump if you don't go to a hospital clinic, out of curiosity?

 

[Robinredbreast]

Hi
I have had type 1 for ten years and never posted before, but keen to hear the experience of other diabetics about GP diabetes/medication reviews when under a hospital consultant for pump therapy. Hope this isn't too ranty!

For years I havre gone along for my annual diabetes/medication review at the GP practice with a GP or nurse (i was never quite able to clarify the exact purpose of these reviews) and it became clear that communication of my HBA1c results etc was lost between the hospital and GP. Last year, during a busy and stressful period, having been relentlessly harassed by my GP to attempt the review, I eventually went along only to find the GPs main focus was to try to persuade me to switch to a cheaper BG meter. Explaining I was on pump therapy and after some discussion, the GP then questioned if I was excessively testing my BG. I was told I was allowed 100 test strips a month and the GP drilled down to my daily usage, saying I should only need to test three times a day?! When I reminded him of the need to test every time I drive (and more if having hypos or hypers), the GP seemed to loose interest in the conversation. This seemed an unfortunate focus of the "review", though it am a realist and appreciate Budget constraints, which i explained to the GP and that I am never frivolous with any of my diabetes supplies. Words cannot express how exasperated I was when the GP then continued to tell me I need to improve my hba1c - so I questioned how I could do that without testing my BG.? Aside from being totally de motivating experience, I think it was really badly managed by the same GP who had previously prescribed me antidepressants for anxiety And depression!

This year, I received the invite for the GP review, but with last years experience in mind and a suspicion that I would again be interrogated and come away feeling demoralised, I ignored the letter. This afternoon I received a message via a receptionist saying my GP wouldn't issue my repeat prescription unless I came in for a medication review. Apparently the GP wouldn't speak to me on the phone (?!) but insisted I came to the surgery. Although I challenged this and asked for clarification what the purpose of the review was, I hit a brick wall. The cynic in me thinks the real purpose of this review is so a few boxes can be ticked and the surgery can get their incentive for doing an annual review, which I understand they do for people with chronic conditions. If I could believe they were genuinely interested in my welfare, or the review would benefit my health, I would attend, but it all feels like a "tick box" exercise.

Am I wrong? Am I a bitter cynic? Or Has anyone had similar experiences?. I spoke to my diabetes team at the hospital today asking them to liaise with the GP on my behalf as I feel I am knocking my head against a wall. I would complain about my GP but from previous experience, suspect I would be wasting my breath. The only other option seems to be to change GP surgery, as people tell me there is a lot of difference been GPs.

Thanks in advance - sorry for long thread

Sounds really unprofessional and a tick all the boxes GP, disgraceful. I would change to another GP for your own well being, health and safety, but making sure the practice manager knows your feelings regarding the 'care' you have received. Good luck and all the best.

RRB

 

[Didnt plan for this]

Hi All
Thank you all so much for taking the time to reply. I should be visiting these sites more as its so helpful to read and relate other people's experiences. Wish i had done it before.

All excellent advice, I read the letter from the DOH with interest and will use that. Sobering statistics about the incidence of DKA.

And very reaffirming comments about the annual reviews not being necessary (since I see a hospital consultant annually) as suspected. The hospital diabetes team had confirmed this but the GP surgery has been insistent. I just wanted to check whether other people were going to GP reviews - I was starting to wonder if it was poor communication on their part, or just me being difficult! By the by, I have never been offered such an immediate GP appointment as I was for this review, not even when I was very ill!

I think I will change my GP and give my feedback to the practice manager as suggested. I definitely believe its important to do so, regardless of what they do (or don't!) with the information. I forgot to mention in my first post, but I did immediately call the hospital after the call from the GP surgery yesterday, and the receptionist said she would arrange a letter to be faxed and sent to my GP surgery (who apparently don't always get the information electronically as a branch). Agree with Noblehead, I will willingly see the GP for anything unrelated to diabetes - but I suspect unfortunately reviewing my antidepressant wont be such a priority! But there goes the cynic again!

I will phone up the GP surgery on monday and see if the letter from the hospital does the trick and my prescription is signed off. On one hand its laughable a GP threatening to not give a diabetic their insulin prescription, on the other it seems a potentially dangerous tactic. So many things you could say about that.....

Ann34+ - yes your comment about advocating getting more difficult as you get older is something I think about .......I think that's what makes me so angry is anticipating that as I get older (I'm only thirty five) and on behalf of those people who cannot advocate for themselves as I can. Like you say, its not a equal balance when you are talking to professionals (especially those who think they know best and treat you like an idiot) - though I am quite confident to disagree with them in a calm and reasonable manner, and inform myself with the facts and my own BG evidence.

Anyway, thanks again to you all - really appreciated and think I will be a new convert to these sites

 

[Didnt plan for this]

Ps Yes - three strips a day is not near enough - on a bad day I could use that just getting to the GP surgery!

 

[noblehead]

I do think its necessary for people to have a review of their medications from time-to-time but as your under the care of a hospital clinic this shouldn't be necessary for your diabetes.

My own gp surgery would often write to me to come in for a diabetes check and I asked them to stop sending out the letters as I was under the care of the hospital consultant, since then the letters have stopped but they've said if I want to come in for a Hba1c check in-between hospital check-ups they would happily oblige.

 

[Didnt plan for this]

Yes - hopefully I will be able to have a similar arrangement with my new surgery, as interim HBa1c might come in useful. Thanks

 

[RuthW]

Yes - hopefully I will be able to have a similar arrangement with my new surgery, as interim HBa1c might come in useful. Thanks

Yes, sorry, I misunderstood. You DO go to a diabetic clinic and your GP is still giving you grief! Definitely I would change GPs then. I was confused because I did at one point stop going to my diabetic clinic for a few years because I found it useless, and my GP did take over my care. But they never put any limits on my prescriptions.

Except yes, it is normal to have an "annual review". It's just ten minutes, "Are you OK? How much stuff do you need to use? Give us an estimate, please. And is there anything you haven't told us about?"

But, if they are limiting your strips when you are using a pump, change docs.

[Who remembers the good old days when you used to go to your hospital appointment and stagger out laden with months' worth of insulin, syringes, testing kits, etc, etc.?]

 

[claire_786]

Last gp I had wouldn't give me more strips, as I use 200 in over a month and the rude receptionist refused to give me more strips and the gp said to test less... I'm type 1 and because of that my blood sugars was high. So I just changed my gp and I have no problems since

 

[gemma6549]

Gp's are required to do an annual review by the medical council and NHS guidelines so that part I get. That amount of test strips however is ridiculous!! I get 400 a month and have so far (touch wood) had no problems.

 

[shaggy1974]

My Gp has generally been good, but when it comes to test strips?.............He'll give me them, but just 50 at a time. So I go through this ridiculous routine of putting a prescription in(online), you have to wait 3 days to collect, so on that 3rd day I collect it and put another one in,wait 3 days and so it goes on. It's a pain.

Yet every time I request 2 boxes it gets rejected. So I'm at my Gp surgery twice within a week collecting a prescription, just seems unnecessary

 

[donnellysdogs]

Ok... GP's are having to do reviews of medications... My GP is 6 monthly and this is despite being under pump consultant and them having nothing to do with my pump at all. And I'm not on any other drugs at all.
Our GP's allow reviews of medications over the phone. They realise that it is an inconvenience to patients to have to visit for what is effectively them just having to tick a box.
Why not ask your GP's to consider doing telephone calls for reviews of medications as you are under a consultant and they do not manage your diabetes?
However, GPs are also targetted to get patients blood pressure, urine tests, hba1c's etc checked in order for them to hit targets and get their DES target payments...
The health service is target driven for payments etc to GP's so it is not a simple case of you nobody thinking it is just their decision not to attend check ups and reviews...
A lot of everything is forced upon the GP's.
The thing I do totally disagree with is limitting strips. That is deporable actions.

GP's are also different depending whether they are Partners or salaried, whether they have signed up to Federations or Direct Enhanced Services..... It is not a case if just finding or swapping to a different GP nowadays...

Shaggy1974... The restrictions that you have had put on you are ridiculous....complain to your PPG Chairperson if your practice has one. This is a complaint that all patients in your practice may be suffering....so is able for the PPG group to ask that the restrictions are reviewed. Especially as they could reduce staff if they did not impose them doing 9 times the work on them if they changed it to every 28days.

 

[Ali H]

I cannot understand all the grief some people go through, I have never had a problem seeing and discussing diabetes with the GP specialist in our practice, and since being referred to the hospital for basal/bolus, a 6 monthly endo appointment is the norm as well as A1Cs every 90 days if I wish. The GP's nurse does my annual foot checks etc and my prescriptions are never queried.

How anybody could threaten to withhold insulin from a diabetic is beyond me, how unprofessional is that?

Ali

 

[ann34+]

I cannot understand all the grief some people go through, I have never had a problem seeing and discussing diabetes with the GP specialist in our practice, and since being referred to the hospital for basal/bolus, a 6 monthly endo appointment is the norm as well as A1Cs every 90 days if I wish. The GP's nurse does my annual foot checks etc and my prescriptions are never queried.

How anybody could threaten to withhold insulin from a diabetic is beyond me, how unprofessional is that?

Ali

my own experience is that it depends partly where you live, at least if you are in England. Things are getting worse with the new contracts coming in next week, as NHS England is not so involved - the individual CCGs have a much loosened relationship with NHS England after next week, something i have only just begun to digest, and my concern is that any national rules and agreements may weaken. It may be that GPs are further restricted. In my area they are already restricted on type of strip, with very limited exceptions.

 

[Didnt plan for this]

Hi thanks for all the replies.

Shaggy1974 - I used to put in for six boxes of strips every couple of months (as and when I needed them) but found my GP would only give me half. At the last GP review my GP last year 'offered' me up to max of 150 test strips every month and said I needed to put the repeat prescription in every month, which seemed odd and inefficient, but I figured if that's their system, I will work with that. It did work in the sense it made me very cost conscious for all my supplies. But your position of only getting 50 strips a time and having to put in back-to-back prescription requests seems to me totally absurd!

Donnellydogs - yes thanks, I think I will push again for a telephone medication review with the GP. That might smooth the way. It was only second hand via the receptionist who said the GP was insistent on seeing me in person. Maybe I will try to bypass the receptionist and speak to the GP see if I can reason with him about doing the review over the phone instead.
I completely understand the NHS is target driven, and has been for a long time, and in some cases it may have improved things. And I would happily attend the reviews again and cooperate as I have done in the past, if it was a useful exercise in any shape or form (or if the surgery could even just explain its value or why it is required as a tick box exercise)!.
Having worked for both the NHS in a junior position and social services in a senior position, where targets and outcomes were strongly imposed, I think there are ways to show discretion, integrity, flexibility, even creativity with achieving targets. My issue is my GP being quite so obvious that the targets were their only (not even main!) concern, being unnecessarily heavy-handed, making misinformed sweeping statements with very little understanding shown of the daily challenges of living with diabetes and anxiety/depression (which aren't uncommon together). Then contradicting limiting my strips by telling me to improve my HBa1c (although I recognise testing is only part of control). I appreciate missed appointments only exacerbate the problems in the NHS, but at the same time I think that patient choice and patient experience should be given greater regard. In my case, last year I felt 'harrassed' to attend the annual GP review, and my efforts to discuss/understand whether it was required were totally ignored by the surgery. At the end of that review I did clearly state my concerns and frustrations and specifically ask they be noted for future reference. But obviously they weren't noted as again this year I have been threatened I must attend or all my supplies will be stopped. As you say, deplorable......luckily I know its just a silly futile
threat.
But hey - there are worse injustices in the health service and I realise I am lucky to have an insulin pump..... But its exactly that kind of issue about the different types of GP set up (salaried, partners, etc) that I need to understand better, before making any decision, thanks for the advice.

Ann34 - i don't know about the new contracts coming in - I will google search it - only what i have seen in the media over recent years about GP commissioning. That underlies my concern about my deteriorating relationship with my GP practice was whether as a (expensive) pump user, not complying with the GP, even if it is an unpleasant experience, would adversely affect my diabetes care (or even funding) in the long run. I know that officially this wouldn't/shouldn't happen......but ..... I really need to do more reading about all this online so I am better forewarned and forearmed.....

Thanks all, appreciated

 

[ann34+]

Hi thanks for all the replies.

Shaggy1974 - I used to put in for six boxes of strips every couple of months (as and when I needed them) but found my GP would only give me half. At the last GP review my GP last year 'offered' me up to max of 150 test strips every month and said I needed to put the repeat prescription in every month, which seemed odd and inefficient, but I figured if that's their system, I will work with that. It did work in the sense it made me very cost conscious for all my supplies. But your position of only getting 50 strips a time and having to put in back-to-back prescription requests seems to me totally absurd!

Donnellydogs - yes thanks, I think I will push again for a telephone medication review with the GP. That might smooth the way. It was only second hand via the receptionist who said the GP was insistent on seeing me in person. Maybe I will try to bypass the receptionist and speak to the GP see if I can reason with him about doing the review over the phone instead.
I completely understand the NHS is target driven, and has been for a long time, and in some cases it may have improved things. And I would happily attend the reviews again and cooperate as I have done in the past, if it was a useful exercise in any shape or form (or if the surgery could even just explain its value or why it is required as a tick box exercise)!.
Having worked for both the NHS in a junior position and social services in a senior position, where targets and outcomes were strongly imposed, I think there are ways to show discretion, integrity, flexibility, even creativity with achieving targets. My issue is my GP being quite so obvious that the targets were their only (not even main!) concern, being unnecessarily heavy-handed, making misinformed sweeping statements with very little understanding shown of the daily challenges of living with diabetes and anxiety/depression (which aren't uncommon together). Then contradicting limiting my strips by telling me to improve my HBa1c (although I recognise testing is only part of control). I appreciate missed appointments only exacerbate the problems in the NHS, but at the same time I think that patient choice and patient experience should be given greater regard. In my case, last year I felt 'harrassed' to attend the annual GP review, and my efforts to discuss/understand whether it was required were totally ignored by the surgery. At the end of that review I did clearly state my concerns and frustrations and specifically ask they be noted for future reference. But obviously they weren't noted as again this year I have been threatened I must attend or all my supplies will be stopped. As you say, deplorable......luckily I know its just a silly futile
threat.
But hey - there are worse injustices in the health service and I realise I am lucky to have an insulin pump..... But its exactly that kind of issue about the different types of GP set up (salaried, partners, etc) that I need to understand better, before making any decision, thanks for the advice.

Ann34 - i don't know about the new contracts coming in - I will google search it - only what i have seen in the media over recent years about GP commissioning. That underlies my concern about my deteriorating relationship with my GP practice was whether as a (expensive) pump user, not complying with the GP, even if it is an unpleasant experience, would adversely affect my diabetes care (or even funding) in the long run. I know that officially this wouldn't/shouldn't happen......but ..... I really need to do more reading about all this online so I am better forewarned and forearmed.....

Thanks all, appreciated

maybe try your local Healthwatch site? , also they hold public meetings at times, and also list any open health related meetings in your area. It is unlikely that they could help you individually - only a few have funding to support cases - but more information is useful, hpe things sort out, Ann

 

[Didnt plan for this]

Thanks Ann, I will look into that. Like you say info is useful, and I am keen to get involved to try to advocate for people with Type 1.