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AIBU to ask for a reimbursement from the GP practice?

(38 Posts)
Nicola19 Fri 03-May-13 21:33:58

DD is six. Since she was nearly three she has had a constantly blocked nose, night time cough, lots of coughs and colds, indistinct speech. Our nursery teacher said she thought dd had large adenoids. We took her to speech therapy and got referred to ENT.

The specialist felt she had large adenoids and saw her large tonsils. We tried some spray but after a couple of visits he said that she would likely have a shrinking of the tissue and he gave us an open appointment if she cont'd with symptoms. So just over a year later last xmas we tried to take her back, the secretary said we had been discharged in our absence and needed to be referred again by our GP.

DH took her about nov 2012 and a GP said no need to refer. I took her a few weeks later, distressed by ongoing symptoms, seeing dd so blocked, fluidy and mouth breathing all time. This GP said no, she's not too bad, they won't do anything etc.

Really felt she just needed an opinion from the specialist, so i paid £160 to see him privately. He listened and examined, said she was suitable for adenoidectomy and tonsillectomy and we waited for op at NHS hospital. DD is so much better. Surgeon actually said adenoids were massive!

I feel i should have got referred for to secondary care and am out of pocket! I told the GP all the symptoms. Her response is that the consensus from the practice is that 'the likelihood was that she would grow out of the symptoms.' The specialist could also have said no, she does not need an op, and i would have accepted that, and been happy to spend the cash. But now that my concerns were vindicated i am cross. Am keen to know if iabu as obviously i am v biased!

DeskPlanner Fri 03-May-13 23:47:41

YABVU, you should have asked for a second opinion. I really hope you don't get any taxpayers money back.

Diamondcassis Fri 03-May-13 23:54:17

The private ENT surgeon isn't allowed to put your DD on an NHS waiting list for surgery. He/she must have felt very strongly that it was needed tonbrak the rules.

Nicola19 Sat 04-May-13 00:02:34

I realise i lost the specialist though by not going back to him within a year.

Dont know if my OP says, the NHS specialist and the one i paid to see are the same guy! He'd seen dd before.

Thanks again for all responses

Nicola19 Sat 04-May-13 00:05:28

Diamond, what do you mean?!You can pay for a private consultation only and then wait for an NHS slot. Like i was thinking i was going to pay £2000 for an op! It was his opinion i wanted not a private op

caroldecker Sat 04-May-13 00:33:10

Suck up the cost but also complain to help others who cannot afford the private opinion

CloudsAndTrees Sat 04-May-13 00:36:31

Sometimes private surgeons are the same person that would authorise an operation on the NHS. In effect, they write to themselves and recommend the patient goes on the waiting list, and the patient gets put on the waiting list.

sashh Sat 04-May-13 05:39:01

Take her to see the same Dr at his NHS practice and see what he says. He may well not recommend an op.

I've seen it happen

ballstoit Sat 04-May-13 07:04:48

YANBU to be annoyed with the system and as someone else says, you should complain, if only to help out others who can't afford the private route at all.

Glad your dd is better, ds also waited a long tine (due to SALT rather than GP) for the same op. In the end, this has cost the NHS more, as he has had a further 3 years speech therapy to attempt to correct the speech patterns he learned while struggling to breathe.

christinarossetti Sat 04-May-13 07:37:14

But you did have the ENT's opinion. He saw your dd saw a few times and was sufficiently concerned to give you an open appointment, which you didn't take up for 14 months.

I think you're cross with yourself.

I'm glad that your dd is now better.

Diamondcassis Sat 04-May-13 07:59:30

The system dictates both that patients aren't permitted to jump any NHS wait by seeing a specialist privately and also that GPs make the decision about whom to refer to specialists (since the money for the surgery flows from them to the hospital).

Within the rules, he could advise you and your GP that you needed surgery but to put you on his NHS list would have to get the GP to re-refer to to his NHS practice first.

So he must have felt strongly that your DD needed surgery to over-ride that. He's allowed to exert his clinical judgement if that's the case - fortunately patients do still come first even working within a clunky system. Very glad your DD is better.

christinarossetti Sat 04-May-13 08:20:48

It's not clear that the ENT specialist did over-ride the system. It sounds like he requested OP's dd's GP to refer her to NHS waiting list, and she waited for the operation, which she has now had.

Of course GPs don't always get it right (although this one did make a specialist referral in the first instance), which is when a second opinion ie another GP in the same practice can be helpful.

Madamecastafiore Sat 04-May-13 08:31:20

Symptoms couldn't have been that horrific if you left them for a year without seeking further advice!

DS literally had one incidence after another of tonsillitis to the extent where he was losing weight and became immune to the antibiotics. We had to fight tooth and mail to get a tonsillectomy for him. It is because for small children a tonsillectomy is quite a serious op. doesn't seem it when they bounce back so quickly but risk of bleeding from operation site is very high in relation to other paed ops.

Wishiwasanheiress Sat 04-May-13 08:53:15

I'm sorry u were in this situation. Agree money not VIP issue here. Am glad dd finally ok. Maybe u weren't insistent enough with GPs? Don't mean to sound rude but I find now u have to be very tough and questioning. Much more so than I feel ever before.

Either way is moot really as dd is well now! Good.

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