Time to rant at GP

[LittleSue]

Today I received a letter from my GP practice (signed with a squiggle but no typed name - so I don't even know who to blast!) informing me its time for my diabetic annual review.

No it isn't. It was done in December. At the specialist clinic at my local hospital, where I've been going for about 6 years. Where I also work, so it's more convenient too. Where I suspect they know a tad more about managing T1 than the practice nurse does. (This is the practice nurse who wanted a T1 of 35 years to have a glucose tolerance test. She also calculated mum's BMI - by weighing and measuring mum with her coat and shoes on!)

I went to their "diabetic clinic" once, in 2002. Took half a day off work (unpaid) for the practice nurse to tell me "Oh, you're on insulin. This clinic isn't for people who are on insulin. I don't understand insulin, it goes right over my head." The 2 types of insulin on my repeat prescription might have been a clue :roll:

Fortunately (for them) the surgery was closed by the time I read the letter. I'd have quickly resorted to heavy sarcasm or verbal abuse!!! Maybe I should fax some old recalcitrant bs readings to the practice nurse and ask her to sort my insulin out for me - some chance :lol:

 

[sugarless sue]

You could just send them a very polite letter saying that you get checked out at the specialist clinic but it was so nice of them to think of you!!<note heavy use of sarcasm> :twisted: :twisted:

 

[LittleSue]

I suspect I will end up writing a polite letter, shame though as it won't fulfil my impulse to slap somebody.

They clearly don't check whether folks are on insulin or whether they're seen at the hospital. So, I wonder if they just send all registered patients a diabetic clinic appointment on the basis those who aren't even diabetic will cancel??? I think I've found the reason for their high rate of people who fail to attend appointments....

 

[deadwood2]

signed with a squiggle but no typed name - so I don't even know who to blast!

To quote an old and long retired joke "Yesterday I couldn't spell "Practice Manager" - now I are one!"

Save your breath; life's too short

 

[LittleSue]

Not only is life short, but I suspect it'll make little difference... other than making me feel better. Its such a waste of NHS money which could be better spent on test strips for T2s. When we want something it's "no, too expensive", but they'll happily waste money on unnecessary things.

I've phoned to cancel the blood test appointment, simply saying I don't need it. I have an appointment with the GP about something else the week after next so I'll get her to put on my record that I prefer to have my diabetes care at the hospital.

 

[hanadr]

a polite letter is the thing. Being less than polite belittles the writer, not the recipient. Address it to the practice manager. Is it posssible that your PCT is transferring diabetes care away from the hospital to the GP practices?

 

[Trinkwasser]

Very likely they get a bonus for sending out the letters

 

[LittleSue]

Is it posssible that your PCT is transferring diabetes care away from the hospital to the GP practices?

They may wish to, but it's usually (NICE, DUK) recommended that T1s receive specialist care (and if GP clinic is still "not for people injecting insulin" that rules out T1s anyway). The letter was not offering me the chance to transfer, just stating "it's time for your annual review" as if I always have it there. Bearing in mind the occasional stupid letters asking me to provide a urine sample - they seem not to believe that the specialist clinic realise it should be tested for protein - and the knowledge that they get paid extra for providing a diabetic clinic even if inappropriate for my needs, I think they're trying to drum up business. They do get paid extra for providing <heavy sarcasm:> "specialist" clinics.

Patients have the right to insist on specialist referral. Those specialists have never suggested discharging me from their care.

In 35 years, DAFNE is the first thing that enabled me to get any kind of control of my T1. The practice nurse doesn't understand DAFNE, still spouting the old rules which no longer apply. If I was struggling she'd be as useful as a chocolate fireguard. At least with the hospital I can attend DSN drop in clinic faster than I could get a GP appointment, or speak to a DAFNE-DSN the same day, and they at least respect one's years of experience and don't treat you like a 5-yr-old.

They won't be transfering me, mark my words!

 

[deadwood2]

Littlesue?

I'm very new round here, but long enough in the tooth to know that "rage against the machine" won't work.

Whatever the stupidity, you need to treat the NHS with soft-soap - even the most incompetent of them, and they're not rare. But they do gang up under threat...

They don't do reality and responsibility

Firstly, confirm that your current clinic is happy to treat and then write to your practice along the lines of: Thanks for the enquiry, but I'm happy with the treatment at my current clinic. Your records will hopefully show that for diabetes treatment I transferred to the clinic at XYZ hospital several years ago. If you can offer a better service, please feel free to send me details.

This would appear to be the GPs trying to garner more than their fair share of the revenues!

Don't roll over!

 

[jopar]

The main problem here isn’t the surgery drumming up trade to expand the budget pot, but the computer system that they are using and partly the person sat at the keyboard...

Your diabetic status is tagged on the system, and the surgery will have someone whose duty it is to regular run through the system and call up all diabetics and whether you’ve been to see the diabetic nurse for review within the last 12 months… If you haven’t then they print off the standard letter to remind you that your review is due…

What need to be remembered are medical records kept by your G.P and the hospital are completely different also kept on completely different data bases. When you have an appointment or tests carried out by the hospital a copy of the result or conclusion is sent via a letter/hard copy to your doctor to be manually added to your medical records kept there…

To whether it’s a good idea to have diabetic clinics with doctor’s surgery, my experience diabetics only being seen by a diabetic specialist at a hospital clinic, was a nightmare, and lead to patients not receiving quality care as you couldn’t get into clinic and when you eventually go a illusive appointment you were in for a very long waiting time from arriving for your appointment and being actually seen by the consultant or nurse…

The system of having clinics provided at surgery is a good idea, as not only is it easier to arrange a convenient appointment and easier access, but for those diabetic that have good control and are doing fine (and believe me there are plenty of them out there) then it keeps a eye on them, Leaving more time for the ones that really need the attention and support of the consultant to be seen quicker…

How well this works from health authority and doctors practice, will depend on several factors… The biggest one being what is happens in the background, I know that in my area that the practice DSN work very closely with the hospital diabetic team, with regular training sessions, reviews, question and answer sessions with the consultants on a regular bases and have direct contact and support with the diabetic nursing team at the hospital… So the practice DSN is in the main an extension of the hospital team/service… And yes you are given the choose of being referred to the hospital if you desire this option…It does seem that this way of lionising isn’t happening in some areas, either not being set up by the Health Authority or not being accessed by the practice or the practice nurse.

 

[hanadr]

My T1 husband attends the hospital. I(T2) see the GP practice.
I think I get better care and I know my GP discusses what I'm teaching him with the consultant at the hospital. He told me so.
I've never heard a patient say a good word about our local "Expert Diabetologist".

 

[kegstore]

Breath, count to 10 and politely decline!

Probably has a lot to do with the wonderful (for them) contract GPs now have, which focuses to a great extent on targets.

I had a similar experience regarding eye screening. I've been seeing an opthalmologist at the eye hospital for over 10 years, and was recently asked to attend the local surgery for examination. Which I did, and was promptly sent straight back to the eye hospital. I was told it had something to do with the overlap of health authority care. Yeah right, nothing to do at all whatsoever with the flash car my GP now has...

 

[LittleSue]

Saw the GP yesterday about another matter, and got to the bottom of this one.

It seems when they said "it's time for your annual diabetic review", they meant "it appears you haven't had your feet checked in the past year". If only they'd said so! That much was true this time - at my hospital review in December, it was the end of the clinic and we had another key issue to discuss, so the Registrar forgot the usual annual check of foot pulses and sensation. Because one of the "good diabetic care" boxes hadn't been ticked, this triggered the surgery into "lets do the whole routine even though everything else has been done and documented" mode. Seems a little OTT to me.

They really don't seem to trust the specialist clinic. Clearly they've never tried attending hospital diabetic clinic without written evidence of retinopathy screening - you barely get out alive :lol:

I've suggested it's easier to ask them to check my feet and mention it in the GP letter at my next specialist appointment in June.

 

[Edwardia]

The date by which I should have my next review is always printed on every prescription/repeat prescription with the warning that I won't be prescribed further drugs past the prescription review date unless I have seen my GP. I don't get a letter though.

Whenever I have a blood test,I make an appt to see nurse(routine test) or GP (if problem) when I leave the surgery but I always get a letter telling me an appt has been made for me,on another day/time. I think it has to be computer generated.

 

[Insulinman]

About 10 years ago my GP Doc said you know more about Diabetic-Diabetes than I do!
(since found out he is a type 2. and I teach Him along with many Consultants as we all do)
He explained he watches my Back for me, as does the Pharmacy,
I also know some Doc's try their Best to keep us alive to fight another day!
But sorry I Don't know the answer's

B

 

[salsasue]

Very likely they get a bonus for sending out the letters

Very probably! :roll: :x

 

[oilyboid]

Nothing new there. T2 since 1993 - dispite rather obvious symptoms, not diagnosed untiol afer a very nasty infection which wouldn't clear up. GP had never encountered the then BDS.

So I did my own research and invoked the St.Vincent declaration, transferring my card to a Hospital, where I got and continue to get a good service.

Every year I get an invitation to Retinal Sreeening via the practice (I get it at the Hospital), so I phone and tell the staff of the arrangements. I then get a letter telling me that I have failed to turn up for my appointment, so I again phone the practice and again, in a restrained manner, tell the staff of the arrangements.

Some years I get another letter, offering me a new appointment and then I write a letter to the Practice Manager - delivered by hand, and I now obtain a signature to confirm receipt by the practice. I NEVER receive a reply.

I do attend the Practice Patient Consultative Group and I have raised the matter.

While in work one of our guiding principles was Right First Time, Every Time.

The NHS is short of resources - and I can't help thinking that my case is unique.

Oilyboid :?

 

[LittleSue]

The date by which I should have my next review is always printed on every prescription/repeat prescription with the warning that I won't be prescribed further drugs past the prescription review date unless I have seen my GP. I don't get a letter though.

The same applies here, for everyone with a repeat prescription - but that is a prescription review, entirely separate from what they call my diabetic review. Although if people use the service where the pharmacy handle the repeat prescription paperwork, they might not actually see the reminders.

I had another "it's time for your diabetic review" letter this week. This time that actually meants "we have no proof you've had a urine test in the last 12 months". The urine test is done on a little machine in the T1 clinic and the printout stuck into my notes, the sample doesn't go through the main labs so results don't appear on the computer, and sometimes the hospital may not specifically say its been done when they write to my GP. She also wanted me to have my eye screening done again because she hadn't got a report - it was done 7 days earlier and I'd received my result letter that morning (no evidence of diabetic eye changes ). I didn't take letter with me as I know they get one anyway, but rather than wait for the letter to arrive she wanted to put drops in my eyes and do it again...

What a waste of precious NHS resources to say oh one test out of several may not have been done (the specialists won't realise it's necessary!) so lets repeat all the tests and tie up a triple appointment with the nurse, just so we can tick a box to say we've done the urine test.

I've never failed to attend a GP or hospital appointment. I get my bloods done in advance of hospital appointments, I'm rarely ill, have my annual eye screening, have my flu jabs, use 150+ test strips per month, and my HbA1c is if anything going down. Nothing to suggest that I'm 'non-compliant' or 'at risk'. I'm very polite when I query the appointment, I don't rant at them like this, much as I would like to! Just don't like them wasting taxpayers money and behaving as if Nurse Chocolate Teapot knows more about T1 than the specialist consultant does.