AIBU to ask for a reimbursement from the GP practice?

[Nicola19]

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!

[Wishiwasanheiress]

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.

[Madamecastafiore]

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.

[christinarossetti]

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.

[Diamondcassis]

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]

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.

[ballstoit]

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.

[sashh]

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

[CloudsAndTrees]

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.

[caroldecker]

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

[Nicola19]

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

[Nicola19]

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

[Diamondcassis]

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.

[DeskPlanner]

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

[Nicola19]

Christina, i didnt leave it that long! She was three when we started the process, speech therapy, hearing checks, ENT guy saw her a couple if times or mebbe three. By that time she was five. I watch and wait for 14 months and then ring the hospital secretary. It was not one year and then another on top of that. In fact GP said i'd 'only left it fourteen months' as if that was not reasonably long enough. She thought there was plenty more time for the adenoids to recede!

[zoobaby]

And let's not forget that GPs may soon have all the commissioning responsibilities/powers soon. Won't that be a wonderful step forward for the NHS?

[cumfy]

I've had this a couple of times in the last 10 years.

GP: No

Private Consultant: Yes + Puts me on their NHS list.

Basically, I've got used to paying a moderate fee to get fast-tracked.

It does feel odd playing Double or quits with your GP over your health though!

[christinarossetti]

That's a shame that you didn't realise, although if you were waiting for the adenoidal tissue to shrink, you probably wouldn't have taken her back from what you've said.

As I see it, you were referred when your dd was coming up for 3 and, as far as the ENT specialist knew, after your initial consultation you had no further concerns for over a year.

I appreciate your frustrations about NHS bureaucracy, but don't understand how you could expect the GP surgery to reimburse you when you didn't contact the specialist for over a year and then left it a similarly long time again after that.

[greenformica]

I think you should have got a second opinion from a different NHS GP.

[Jakadaal]

You would be better off writing to your local Clinical Commissioning Group as they are the group that commission services for GPs to refer into and ask them their commissioning intentions and priorities. In a bid to make cost savings there are now many restrictions for GPs making referrals for 'non urgent' procedures such as tonsillectomys and grommets for glue ear. By paying for a private referral you have circumnavigated this gate keeping of the gP and have got a direct placement on the waiting list - value for money perhaps?

[DiscoDonkey]

I can understand your frustration, it's a shame you weren't told that the ent appointment was only open for a year.

I don't think for a minute you will get any money back.

[Nicola19]

Christina, i should have said, i didnt realise there was a time limit on the open appointment. I just thought i'd leave it to give the theory that the adenoidal tissue shrinks a long enough chance. I didnt want them to say, ah she is still too young, still time for the adenoids to shrink. But they didnt, and i tried to take her back but was dismayed they had discharged her while i was still watching and waiting

[OzBrit]

You could write a letter to the GP surgery asking for the reasoning behind their decisions not to refer and discuss what the actual outcome ended up being (operation). You will not get money out of the situation, but an apology or discussion about their decision making process may lead to some answers to your questions and let you find some peace with the situation. It sounds like you got the right outcome in the end and perhaps this is the positive you should focus on.

[CloudsAndTrees]

Yabvu. And ridiculous.

[christinarossetti]

Reading your OP, it sound like the ENT specialist (which your GP referred you to) gave you an open appointment, which you didn't take up for over a year by which time you'd been discharged.

This was in 2010 from the information in your post, and you still didn't take your dd back until end of 2012.

Sounds like you were watching and waiting too, just like your GP. It's a completely reasonable course of action.

[Nicola19]

Thanks for responses, food for thought. Perhaps i should focus not on the money i spent but on my view that she did not refer me when there was reason to. The specialist wrote to gp to tell her of his findings and added us to the children's hospital waiting list

Holly, private doctors don't just do what you say! He thought she needed op and his research fellow who actually did the op confirmed the consultant's findings, he said when he put his mirror thingy in the nasal passages were totally occluded by massive adenoids!

GP was just determined not to refer. I hear what has been said about referrals being more rationed now. Am bracing myself for future refusals!!