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Clinic Appointments during and after Coronavirus

Discussion in 'Type 1 Diabetes' started by db89, Jun 10, 2020.

  1. db89

    db89 Type 1 · Well-Known Member

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    Hi, been a while since I've been around and posted here. I'm interested in how clinic appointments have been handled and are planned to be handled in future for other people in light of the outbreak.

    I don't see or interact with my team often and had pretty much 1 clinic appointment a year (unless I really needed help and chased trying to get in touch with them outside of this) which I was due to have in about a month. Up to now I thought they would probably change this to some form of virtual arrangement but I've just had a letter which basically says that they've taken the decision to redesign their service, they've cancelled my appointment and won't send out routine appointments in future. We now have to be referred if we want an appointment like this in future.

    I have to say I'm fairly dismayed at this. I'm quite bad at asking for help at the best of times and I saw these as my opportunity to discuss the bigger picture and set myself any goals that arose out of the discussion away from dealing with the day to day. It was also where I got any blood test results and we were able to discuss them. Whilst I understand routine has gone out of the window the last few months, it feels like I'm going to be left in the dark in future unless I go out of my way to waste my GPs time getting referred to have an appointment here and there. I also feel more widely people are going to fall through the cracks who don't necessarily need emergency help from the team but who would still benefit from occasional contact and review.
     
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  2. Rokaab

    Rokaab Type 1 · Well-Known Member

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    I know my local diabetes team at my local hospital are now doing phone appointments (I rang them up today to check as my next appointment is at the beginning of July) - I doubt it'll be a video call mainly cos they're still a bit in the dark ages for some things.

    If you'd already being referred to your clinics care, I'm surprised they're actual dismissing you from their clinic - is there any way you can double check and ask why?

    You may however have to talk to your doctor about get re-referrred - especially since you have queries for them, even though it does sound a bit strange
     
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  3. Hopeful34

    Hopeful34 Type 1 · Well-Known Member

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    Diabetes team at my local hospital now doing phone appointments as well. I agree with Rokaab, I'd contact them to ask why, and also say you're bad at asking for help, and see if they would be willing to do a phone appointment. Hope you can get sorted out, as it sounds very strange. Failing any help, maybe go to your gp and ask for a referral.
     
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  4. db89

    db89 Type 1 · Well-Known Member

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    Thanks for your replies. It doesn't actually say that they're dismissing me personally from the service. It says that they're redesigning the service and if you want to see a consultant in future (and I'm assuming it means everyone here) then the GP or practice nurse will have to refer you each time.

    To me that reads as though they are essentially withdrawing routine care going forwards. I understand this may have been needed at the present time with everything happening, but I can't see how this isn't going to lead to people like myself just left to get on with it and fall through the cracks. Staff at my GP practice have openly admitted they won't get involved in my care as they don't have the knowledge to discuss it. They do my yearly basic tests like feet and take my samples when needed which I then got the results of at clinic appointments. As the practice have said they can't get involved I imagine that whilst I'll be able to request the results from them, but I'll then just have numbers and no one to discuss any questions I might have or the bigger picture until I wait for a referral to go through each time.

    I think I'll try and respond to the clinic at first and see if they can clarify how it will all work. I was just quite taken aback to receive that as I try not to be a bother and would have thought one appointment each year to go over my condition would have been meeting some minimum requirement somewhere.

    PS. I have a nagging feeling this affects the answer to one of the questions asked on the DIAB1 form we fill in every 3 years for our driving licence renewals. Can anyone confirm if there is a question on there asking if you've had an appointment at least once a year (or within the last 12 months however it's worded)?
     
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  5. EllieM

    EllieM Type 1 · Moderator
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    It doesn't need to be a consultant, it just needs to be a healthcare professional.

    https://assets.publishing.service.g...ta/file/778827/diab-medical-questionnaire.pdf

    It's a long time since I lived in the UK but when I did none of my GPs wanted to do anything about my T1 other than give me a prescription for whatever drugs the consultant ordered. I would have been horrified to be in your position.

    But, I can see how it could be made to work, if done correctly. The people without any issues just need to have their feet, eyes, hba1c checked and go on their way. Everyone else gets referred to the consultant if there is something up with any of their checks.... But, I can see this potentially causing enormous and harmful delays in treatment.... And access to products like cgms and pumps gets that much harder.

    In New Zealand, where I've lived for the last 3 years, it is done like this. I have an annual check with my GP and I when I first signed up with her she asked me whether I wanted to be referred to the hospital clinic as well. Up to now, that has meant two annual checks a year, but I think I may have been thrown off the hospital's list last year after my last check up. Not too worried as I can still ring the DNs there and I am also still getting my regular eye checks there.

    But as regards @db89 's situation, it sounds to me like a delaying tactic by the clinic because they are too overwhelmed by numbers. I am hoping that you have misunderstood the situation. And if you haven't, make a (virtual?) appointment with your GP to get put back on the hospital list asap.

    Good luck.
     
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  6. db89

    db89 Type 1 · Well-Known Member

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    Thanks @EllieM, I knew there was something on that form about it but couldn't remember what. Not sure whether having basic foot check and bloods taken would count as seeing someone about the condition when you're unable to discuss it with them properly.

    I take your point that it could work theoretically but I think its leaving it to chance if it then becomes the GP practice's responsibility to interpret each patients results and decide whether to refer or not. It could quite possibly be a temporary situation arising out of Coronavirus but the letter definitely reads as a service redesign which is likely planned to be permanent. Again, I don't think I've been taken off a list per se - more that they've decided to withdraw the routine appointments completely for everyone. I'll hopefully be able to get a response from them to clarify the situation soon.
     
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  7. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    My hospital diabetes appointment have been cancelled a few times ( once by me) last cancellation was for this month and now I have ( hopefully) a new appointment in November. So that will be about two years since I have seen my diabetes consultant ( unless that one is cancelled too) :rolleyes:
     
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  8. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    No wonder you are concerned, to me it sounds ridiculous, now, going all around the houses, when you had more of a direct, efficient route. Questions do need to be asked.
    Good luck.
     
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  9. Kirstyuk

    Kirstyuk · Member

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    Totally understand where you coming from. The gps seem to take me off anything. After always saying I was under control. All have is bloods. But I ended up becoming poorly lots off high and discoloured toes. Gp totally wrote me off and just sent me for bloods. Bit worrying when can’t get any help cause we don’t beg for appointments etc
     
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  10. Nicola M

    Nicola M Type 1 · Well-Known Member

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    I was supposed to have an appointment at the Hospital this month which was changed to a Mobile phone appointment only then to be changed again to another date in 2 months' time. Rather frustrating as I struggle with my diabetes and my 6 monthly appointments are sometimes what keeps me motivated, I assume mines been cancelled so they can see us in the clinic rather than over the phone.
     
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  11. UK T1

    UK T1 Type 1 · Well-Known Member

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    Hi, as others have said I'd request a referral again already as you were due an appointment soon and it sounds like they have a waiting list otherwise they wouldn't presumably have gone for the redesign.

    I remember seeing links to NICE guidelines on here somewhere saying type 1s should have annual clinics with the diabetes consultant or a member of their team eg registrar. Can't search for it now sorry, but maybe someone else can help?

    Re driving, until last year when I was put on the libre my previous 3 clinics were 1 1/2 - 2 years apart due to their long waiting lists (meant to be annual) also some had to be postponed due to snow days and consultant illness. When I applied for renewal driving licenses I listed retinal screening, foot checks and blood tests as well as the clinics and have never had a problem getting my driving license renewed. My GP has never helped with my management either, but is good at reminding me about blood tests due (pre lockdown). I've signed a form so I get all results online and don't think I've ever actually met my official GP! Glad I have my diabetes team, agree it would be easy to slip through the net otherwise.

    Hope that helps!
     
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    #11 UK T1, Jun 12, 2020 at 12:43 AM
    Last edited: Jun 12, 2020
  12. db89

    db89 Type 1 · Well-Known Member

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    Thanks everyone. I contacted the GP practice initially to get their take on it and they told me they don't have their copy of the letter yet. Supposed to be getting a call back to discuss it on Monday now so will see what they say to begin with. I need to ask them what they're currently doing and plan to do in relation to blood tests etc. as they usually take them and then I would get the results at the clinic up to now.
     
  13. Neonataldiabetes

    Neonataldiabetes Type 1 · Member

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    They're doing phone appointments at my diabetes clinic at the local hospital.
     
  14. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Both the GPS and the Hospital Clinic I go to are doing phone appointments now, and the Diabetes Consultant said back in March that he’d be ‘seeing’ people like that for the rest of the year.
    Do you use the Feeestyle Libre sensor @db89? One way of ensuring that your management is available to the Consultant for discussion and advice is to use LibreView which allows a clinic to access it. If you haven’t had it prescribed, and are having trouble staying on track, why not contact your GP and ask them to request that it’s prescribed. It’d maybe help you if you also wrote to them outlining your concerns and including a few days’ records to show why you need referral as soon as possible.
    I confess, I feel a little sorry for those working with diabetes right now as there has been an upward surge in the numbers diagnosed, plus the people who get Covid-19 who have diabetes may need extra input to help recovery.
    I think there may also be a shortage of Consultants in some parts of the country: the Consultant I see was asked to return from retirement to fill a vacancy.
     
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  15. db89

    db89 Type 1 · Well-Known Member

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    Thanks @Fairygodmother - I do use the Libre yes and my consultant originally prescribed me with it a while back. However, they've never asked for any results from it and since they've now sent this letter I guess it's unlikely.

    I understand there will be pressure/shortages in the system due to everything going on and I would have totally been onboard with them deferring appointments etc. for those who feel they are doing OK, I'm just disappointed they've chosen to seemingly stop offering them even once a year on a seemingly permanent basis. I'm awaiting a call back from someone at my practice to get their take on this letter and how they would expect it to work going forward but so far nobody has called me back from there either (despite a chase and a promise of a call back at the end of last week).
     
  16. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    I don’t know if this will work, or if your team’s accessing it, but there’s a webinar Abbott put out about LibreView. I’ve not watched the whole of it, I accessed LibreView before Abbott sent it out, but you might want to ask your team about it.

     
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  17. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    Wow, I actually pasted something that looks useable, not bad for an old biddy hehe!
     
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  18. GeordieMark88

    GeordieMark88 · Active Member

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    My appointment in March was carried out over the telephone, just received a letter that my next appointment on 14th July is to take place at the hospital and I have to wear a face covering.
     
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