GPs and Repeat Prescriptions

[20sGirl]

Hi everyone,

I'm here seeking some advice. I have had type 1 diabetes for over a decade now and have always seen the consultant at the hospital for diabetes reviews. My control is good (HbA1c around 6%), I'm just out of my teens, of normal weight, no have retinopathy and no other diabetes-related problems and my consultant is happy to see me every year (I'm happy with this too!).

More recently, my GP, who writes my prescriptions, has been insisting that I visit his surgery for diabetes reviews every 6-months. The way in which they work things is that you have to go once for your blood test and then again for your chat with the nurse, amounting to an additional 4 appointments over the course of the year. Add in the retinopathy screening, foot care checks, etc., and, well, it's fair to say that it all mounts up. I'm employed (so have to take time off for appointments) and don't drive so have to rely on a relative (who also works) to take me to all my appointments.

I have explained to my GP numerous times that I have my annual review at the hospital, that I'm happy to see the consultant and that it's a pain for me to visit the surgery for what is essentially the same tests and the same questions. However, they keep sending me request after request -human requests, not computerised requests - that I attend the doctor's surgery for blood tests for a prescription review. They even have my consultant's report to prove I have been to the hospital and had my tests done there.

Clearly, I wish to continue receiving my prescription (I need it) but I am so tired of feeling like the doctors are unable to listen to me. I just wonder whether anyone has any advice on the best course of action to take.

 

[Elc1112]

It's exactly the same where I live. I have to go see the nurse every 6 months for a blood test. A week later I see the DSN to get the results and then have to make a separate appointment to are a doctor to discuss the results. Retinopathy etc on top. The doctor will only see me for a diabetes during clinic hours, despite the fact that he sees other patients up until 8pm. It makes it really hard when you work full time and seems like a lot of wasted time for me and for them. They actually refused to do a repeat perception once as my six month medicine review was a month overdue as I hadn't been able to slot in the numerous appointments. Nightmare!

 

[smidge]

Hiya!

I have exactly the same. I've given in and just go along with it because I just can't face arguing with them any more. At the surgery I see a DSN who know very little about diabetes. I get my bloods done, feet checked, eyes screened, flu jab all on separate days and see the consultant at the hospital once a year. If I have any issues I just ring the hospital ans ask to see the DSN there - she's really good. I just have the GP checks to keep the peace. I also work full time and they've been really good about it luckily.

Smidge

 

[Unbeliever]

I think its fas becoming a racket. I am reliably informed that the clinics are a major source of income for Practices.

Fine if it helps the patients too bu we all know that they are box ticking exercises. They wonder that we get depressed. I keep telling them that it is my treatment at the Practice which depresses me not the diabetes itself.

It is mostly absolutely pointless. Now hat my bs is under control they actually want o see me more frequently than when i t wasn't. I am hearing this from various freiends and aquaintances in difffernt PCT areas.

I think if I were seeing a consultant abou my diabetes I would mention the matter to him/her. Ask why you need to be seen so often . Explain that it is difficul when working .If the consultant writes to them about it they may take some notice.
Definitely test srtrips rather than practice DSNs and reviews iIMHO.

Mine is ruly illogical. I have HBA1Cs every 3 months on the consultants instructions. They insist I do this at a "review" doing the whole weight Bp check stuff . They then tell me that this is my medication review when medication is never discussed and can;t be because hey don't have the test results .
When they receive them it is one helluva job to find out what they are.

I do no understand he thinking at all. Athe annual review with the doctor they do the test first and then discuss the results at the review . Why not do this all the time.? When I suggested this I was met with blank incomprehension." But we do different things ". "But there is no need for you to do them.
I only need the HBA1c. Had the consultant not requested 3 monthly tests I would only see you once a year." None so blind ec/

Lots of money wasted on these things.which could be used elsewhere. How often do we hear admin people mocked and belittled. It is a question of quality not quanity. A few experienced admin people with common sense and sufficient raining could save millions fr the NHS and prevent much unnecessary aniey and irritation for patients

 

[Sid Bonkers]

Hi 20sGirl and welcome to the forum. Whilst I think that GP practice nurse visits are pretty much a waste of time, I get weighed, have my feet checked and my BP taken all of which I can do at home I do feel that an annual retinopathy scan is vital in order to catch any early signs of retinopathy.

I'm a T2, drugs and diet controlled but was on insulin treatment for the first year and have to say that the specialist diabetes nurses at the diabetes clinic attached to my local hospital were incredibly well informed and a wealth of information and I was sad to have my care transferred over to my GP when I stopped insulin treatment although I was happy to stop the insulin of course

 

[Cheryl]

Sounds familiar.
I am lukcy that I have reached an truce with my GP (who is generaly very good) on this.

When I registered at the practice 5 years ago having moved 300 miles form my previous home, I immediately asked to be referred to the big teaching hospital in the adjacent PCT to my new local one. They were a bit niffy about it saying that they had a perfectly good diabetes clinic at the surgery. I justs aid that I had been recommended the hospital clinic by my previous consultant and that i preferred to be treated at a specialist centre.
So on to 'reviews'. I started getting letters after a little while, which I ignored. They kept coming, so i spoke to the surgery who said that i had to come in regardless of whether I go to the hospital. I then wrote to my Gp saying that dupication was a waste of time & he wrote back saying that he ahd a responsibility to ensure that the prescriptions that he writes are proper etc. i wrote back saying that it was a waste of both his & my time, that is caused unnecessary duplciaiton, caused me confusion as I would be liekly to get differing views & advice from the GP surgery as they would be totally unaware of what i'd been told at the hospital etc. We came to an agreement that i would not need to attend for him to sign me off each eyar and that he would do so based on the hospital reports.
I recently, after a long break, received another call tor evewi, I rang the surgery and asked to speak to the manager & was told that I'd get a call back. i didn't. I rang again & was told that there'd been a mix up & that I could ignore the letter, so my agreement with my GP still seems to be working.

My hospital consultant told me that GPs get money for every diabetic patient that they see which is why they really want to see you.

I do get my hba1c done at the GP as I find that it better informs my discussion at the hospital if I have the results with me when I go. In my local PCT area, retinopathy & foot checks are done annually at the same time at the dedicated clinic associated with the hospital.

The nurse was trying to get me to give a urine sample when I went for my hba1c this week, it took me three gos to get through to her that I cuoldn't provide one at that moment & that I wouldn't be brinnging one in as it was pointless when I'll take one to the hospital next week.

If you really want to get through to your GP try this strategy:
Write to him/her setting out:

the waste of time (yours and theirs) that duplicate appointments are;

the waste of precious NHS resources spent on duplicating tests with no justification as they have the results on their computer system anyway (don't let them tell you that they do different tests - they don't! The hospital may not tell them the result of every test, it's up to them to sort out their communication with the hospital, not to put the burden on you);

remind them that they have access to the report from the hospital sent to them after each visit that you make;

that it puts stress on your employer/employee relationship to take so much time off, especially when you can't give your employer any reason why it is necessary;

that differing advice from different HCPs causes confusion & can have an adverse effect on your health.

Ask you GP to set out in detail the reasons why it is necessary to duplciate tests, see you in person & why they cannot rely on reports from the hospital to carry out the administrative reveiw of your medicine. If they don't answer the question (come out with some platitudes or legal guff), write back to them and insist on a proper reply. Keep copies of everything.

Remind your GP that you have a right to control your own treatment & not to submit to invasive tests (blood test are) which are unnecessary & time consuming. Also remind them that they must not treat you differently because you choose to be treated by a specialist diabetes consultant, to do so amounts to discrimination. It's not your fault that our NHS system means that the hospital can't dispense your insulin/needles etc. and that you have to deal with a two tier system.

If you don't get a satisfactorry response, write to the chief executive of the local PCT asking them how this sort of practice can be justified when resources are so stretched and the money wasted on additional tests/reviews scould be spent on giving us enough test strips per month. Copy the letters to them.

Write to your MP highlighting the same issues. Times of austerity, wasting precious money blah blah.

I and a few friends have used the 'chief exec' route on a few occasions with private companies when we have had complaints. It's amazing how quickly many issues can be resolved when the top brass's office gets involved.

If you're really up for a fight: take the story to Private Eye!! :evil: (Only sort of joking, they love stories of waste in public services.)

Very long reply. Sorry, but it's something that Ifeel passionately about - stopping greedy people taking money out of my very precious NHS without justification and making unreasonable demands on my time.

 

[LaughingHyena]

I too have an regular check ups with the hospital and a letter from the GP asking me to book one with them. I did ring up as ask what was going on but didn't really find out. For now I've booked my appointment with the GP 2 weeks before the hospital one, so I can just do one set of blood tests (the hospital ask that I get them done a couple of weeks before I go in so we can discuss the results)

I thought it was just becuase I was only diagnosed a year ago and that the hospital ones would stop after a while but it sounds like there are quite a few still have an annual check with both.

 

[noblehead]

I have explained to my GP numerous times that I have my annual review at the hospital, that I'm happy to see the consultant and that it's a pain for me to visit the surgery for what is essentially the same tests and the same questions. However, they keep sending me request after request -human requests, not computerised requests - that I attend the doctor's surgery for blood tests for a prescription review. They even have my consultant's report to prove I have been to the hospital and had my tests done there.

Odd why they can't accept that you have your annual review with the hospital clinic and insist that you attend their own :?

I was always under the hospital then got switched to my gp's diabetes clinic in 2006, after 2 years I asked to be referred back to the care of my hospital team which my gp surgery were happy to do, at first I still got the appointments letters sent from my surgery but after a while they stopped after I spoke with the practise manager. Now I only attend to have blood taken for the Hba1c test and they forward it to the hospital in time for my clinic appointment.

You could have a word with the practise manager in the hope that they stop the requests!

 

[josie38]

Hi,

This seems to be happening a lot.

When I was with my old surgery, they decided that i should have my care transferred there, so I did. It lasted about 6 months. I found it was always difficult to get an appt when i wanted one on the day of the clinic, had to wait 4 weeks minimum to get an appt to see doctor. Was seen by nurse who just weighed me and did blood pressure. When I asked for a pump, referred me back to hospital!!!!! I have since changed my doctors and they are quite happy NOT to interfere with my diabetic care :clap: :clap: :clap: :clap:

Josie

 

[20sGirl]

Thank you all for your replies. I'm sorry to hear that you have all had problems too!

I have been doing my research on this issue and I understand that there is some kind of shared care agreement between the GP and the hospital. However, I cannot find out who is responsible for what. Surely they can't both be responsible for carrying out tests.

I am also wondering about my rights to refuse tests. I understand that I have a right to refuse any test that I do not want yet it seems that GPs can refuse your right to receive a prescription if you do not have these tests. The advice I have found seems to contradict itself.

In doing my research, I found an article that confirmed that GPs do get financial incentives for HbA1c tests. This article (http://www.drbriffa.com/2009/03/13/are-the-financial-incentives-given-to-uk-doctors-regarding-diabetes-doing-more-harm-than-good/) informed me that "if GPs can get half of their type 2 diabetic patients to have a HbA1c level of less than 7 per cent, then the practice gets an additional payment of £3000 ($4250)". I wonder if this is the same for type 1s? This financial incentive seems to have been brought in in the last few years and, funnily enough, coincides with my GP's reluctance to accept my hospital's test results. Maybe if these financial incentives were taken away, we wouldn't have such problems!

 

[Unbeliever]

A few years ago there was an incentive to put all "qualifying " T2s on insulin. I am not sure but think it may have just been in my PCT area. Although the nurse was fully conversant with the resons why my levels were temporarily high I was constantly harrassed about this.
Worse I was told all sorts of tall stories about there being no downside etc . Fortunately a former GP had warned me that insulin had health impilicaions in my particular case/
Unscrupulous or what?

 

[Wullie]

I have this too - collect my repeat and there's a post-it with 'Patient must book appointment' stuck to it. My attitude is to just go along with it.

Yes, it is exasperating when the GP asks "what are your blood sugars like?" as if you were diagnosed only last week but smile, grit your teeth.

My reasoning is that, when they send off your blood test, they could pick up things concerning your general health. My GP saw that I needed to reduce cholesterol so that was treated.

If I wasn't a diabetic, I doubt I'd have that kind of care. I'd be like the general public, going in when I have an ailment, pick up prescription, thank you very much, don't see the GP again until I'm suffering again, which could be a year later.

Also when it's the nurse doing the check-up, it's a good opportunity to highlight things in your prescription as the nurse is less time-pressured (again, in my experience) than your GP. I lost one of my pens on a night out (I know, I know ) and as it's a 'perennial', didn't appear on my repeat prescription. The nurse sorted it.

That's my experience. In summary, grin and bear it.

 

[AMBrennan]

My surgery asks every diabetics on the books to come for a review every 6 months (blood test, appointment the week after, etc) but the letters include an option to opt out and not receive any further letters (for one year); prescriptions are completely independent of that, I didn't see the DSN until 6 months after diagnosis, and haven't ever seen the doctor* at the surgery.

On the other hand, when I did go it just happened to be 3 weeks after a review at the hospital and they did insist on fresh blood tests (because I guess that 5.x% HbA1C is sufficiently high risk to require monthly blood tests); I just went along with it.

* apart from one of them staffing A&E for Christmas when I had run out of needles because yet another prescription had gotten lost in transist between the surgery and my pharmacy...

 

[Unbeliever]

Welcome back AMBrennan. I am glad to hear that here are still some Practices with logical systems.

I expect they all start out that way but anomalies creep in and people ry to massage figures where there is insufficient supervision.

 

[Anonymous]

im the seam ,my surgary are always writnig to get me makw=e appointments but i can never get in to see the nurse where i am so dont worry about it,it is only so the surgary can add the accounts up and get what they need for the money.i useal only see my consultent at the hospital.unless im poping into my gp then i will get him to delate the recalls.