to find trying to deal with my GP surgery a complete nightmare?

[greygeese]

Nearly 6 months ago went to GP for advice re contraception and was encouraged to go for the depo injection. First one was ok, since the 2nd I have bled constantly, anywhere from slight spotting to a full on period. I've had one day's grace in the last 3 months. Went to GP after the first couple of weeks who prescribed tranexamic acid (didn't stop it) and suggested I should wait for 3rd injection which should resolve problem, or I might need to go on the pill as well. Last few weeks it's been getting worse so last week I went back and saw another GP at same practice who has put me on Norethisterone (finally stopped bleeding, hurray!) and said no, that's nonsense you can't be on pill and injection at same time, you have to choose, but that my best option would be the coil, and that to have that I have to a) come back for a swab in the next 7-10 days once the bleeding had stopped and b) that I have to go to another surgery 7 miles away for the coil to be fitted…

Wasn't impressed with this, but in talking it through with my partner he is of the view that I don't want another 3 months like the last 3, and it's better to get the coil now than risk a repeat, and having to wait 3 more months post injection to try another method.

So, I have an appt with GP booked for Sat, I originally booked this 3 weeks ago (before I managed to get an emergency appt next week) so rang up today - now the bleeding's stopped - to check it was ok to use that for the swab.

Apparently not. GP's can't do swabs, only the nurse, and her next appt is 16 days time. By which time I will almost certainly have started bleeding again, and my injection will have run out (currently have an appt for injection 3 in 2 weeks time, which is nearly 13 weeks since my last one).

GP never mentioned I needed to see a nurse not a dr! and was well aware when my next injection was due, but didn't seem to see any problem with getting the coil before then, although clearly it's going to be impossible. Am a bit at a loss now, and feel like all I can do is have the injection, which I suspect will just put me back to Square one :(

There are no other local surgeries with spaces (otherwise I'd take my chances) and the family planning/contraceptive advice clinics in our area are only for under 25s (I found this out prior to seeing my GP back in May when I spent weeks waiting for an appt…)_

Another GP here. Few points:

• you may or may not continue to bleed on the depo
• you may well not be able to have the combined pill due to age/other factors
• you may well have irregular bleeding with the coil (the mirena), but it may stop bleeding altogether
• there's no ideal solution unfortunately
• you could also try a double dose mini pill

Hope you get it sorted!

To be fair, I'm going by what my GPs have said. I have no medical knowledge. I was happy to accept GP 1 saying the injection was best.

After the 2nd injection when I started bleeding she gave me the tranexamic acid and said if that didn't help she'd prescribe the pill as well.

Last week, different GP said I cant have the pill and injection it's one or the other but she recommended the coil.

I can't do another 3 months bleeding constantly, not less because it has completely ruined our sex life, and damaged several sets of bedding/ mattress protectors, without wishing to be too graphic. And I know that bleeding does improve after the 3rd injection but my understanding is that's more when you've bled constantly from the first injection - whereas I was fine for the first and only started after the second.

I'd be happy to try injection with the pill if I started bleeding again, but last GP didn't think that was an option. Hence I will probably try the pill instead as otherwise I'm stuck for 3 months, and the faffing about I seem to have to do re the coil is making that pretty much impossible!

I got told by my practice nurse they'd keep prescribing me the pill as long as I wanted. As long as I was a no smoker and my blood pressure was OK.

I spoke to two GP and practise nurse - over a period of time - I don't smoke never have - blood pressure even in pg was is/fine- until recently not overweight ( changed last 12 months) - they won't do it.

First place I've lived that it's not easy to change GP as well.

Brujo - I wonder of my practice nurse has had better/different training in contraception?
She's always the recommended person if you ring and ask about it.
My doctors surgery is in a 'deprived area' so I wonder if there is a renewed focus on preventing pregnancy?

GPs can do swabs. At out surgery it has to be the GP that does them before you can get the coil.

If you ask for the pill ask for micronor. Its norethisterone in a lower dose than what you'll have been given to stop the bleeding. You have to take it in the same 3 hour window every day but is much better than cerazette IME.

I had cerazette first and bled constantly so switched to micronor and its much better. I still get periods but they're 5-7 days long instead of 7-9 days long.

Everyone had slightly different reactions to the pill but I've rarely heard anything good said about cerazette.

Unfortunately our GPs don't do swabs. They refuse to do smears as well, they all have to be done by the nurse. As do all injections etc. Might make sense if there was more than one nurse!

That's noted re micronor, thanks. I know when first GP mentioned the pill she was talking about cerazette. Norethisterone is amazing stuff, after bleeding for ages to have it stop completely within 72 hours is great :)

I'm not a GP and can't give medical advice, but I have worked in GP practices. I do think that the main problem is the appointments on a Saturday morning. The practice depends on an NHS courier service to collect samples from practices and take it to the path labs. Unfortunately this service does not operate on a Saturday (which is a major problem with this stupid govt's demands for GPs to work 7 days a week - but that's another thread). I do understand that for some people extended hours appointments are vital as they can't take time off work.

I'm a bit concerned about the fact that there are no other GP practices near by that are accepting patients. It is incredibly difficult (ok used to be I'm a bit out of date!) for a practice to close their list. You may want to Google your local CCG and then give them a call - you could just say that you have moved into the area - and get alist of practices in your area. NHS Choices will also give you information.

Ideally you need a practice that has a GP who specialises in sexual health/contraception. Their websites will have this information.

If you can't change practices, then you do have a cause for complaint. For this you will need to speak to your practice's practice manager and then put the complaint in writing. If your practice is a good one then they will accept that they made a mistake - communication or whatever - and work with you to resolve it.

Sorry I can't be more useful. Good luck.

The only family planning in our area is for under 25s unfortunately.

GP only does one Sat session a month, it's a new thing has only started in last couple of months (not a bad thing as the surgery is only open 9-12 weekdays, and 4-5.30 on 3 afternoons. Which isn't much use to me as I can't get there before 6. I usually end up having to take half day holiday for appts. Thing is, the oath lab thing is a red herring because the GPs won't do the swabs on a weekday either.

Guess I'll have to wait and see what the 3rd Gp says on Sat.

You can bet if it was men who could get pregnant all this carry on wouldnt be happening.

OP re coil (mirena)

I had one fitted and bled on and off for almost 6 months. By that I mean some form of bleed for 2 -3 weeks then about 4 days off then start again.

Previous to that I was on the mini pill for about 7 years and from about the second month I didn't have anything (Well apart from mood swings but that's another story!).

crazycat, I've got to say I was on Cerazette for about nine months, with no noticeable side effects except that I didn't have any periods at all while on it. After I came off to TTC, my periods were very light, just two days a month, and I got pregnant without any problems too. So it does just vary completely from person to person. I'm not saying Cerazette is better, just not necessarily worse for the OP.

I've just moved practices... I do hope the new one lets me go back on the pill after I give birth, I don't want to use condoms or have a coil. Is it common to stop women over 36 using the pill? Even the mini pill?

What sort of Dr "can't" do a swab!?? WTF were they doing at medical school if they never learned how to take a swab!??

This all brings back memories. Dealing with the NHS GP system is one of the few things I really don't miss at all from the UK.
Here I would never have to wait more than a couple of hours to get an appointment with a GP if I needed to. Probably no more than a few minutes if I called around before turning up.

My old GP in London used to make you tell the receptionist what you were there for while there was a queue of people standing behind you!!

I suspect re the swab it's more a case of won't rather than can't. It's the sane with smears etc. And any kind of blood test you're expected to trek all the way to the hospital (whose hours are even more limited than my GP).

It's actually quite depressing to realise the level of service provided by my childhood GP in the 1970s and 80s was vastly better than that I get now!

OP, I'm not sure if it's just the way you are wording your posts but it sounds like your GP is dictating which type of contraception you should use. I'm an FP nurse and when I trained we were taught there was no overall best option, just what suits the patient best and that our job is to facilitate the patient to make their best choice.
A change in contraception, whether to a coil or something else might just be what you need but you need to bear in mind that each comes with its own side effects and often these need a number of months to settle so it won't be a miracle improvement.

I love the 'my contraceptive' tool on this website - www.fpa.org.UK,it's provided by the same people who make the contraception leaflets in the surgery. It's a questionnaire you fill and at the e d it makes suggestions about which contraceptive would suit you.

I've just been in bed all weekend under the doctor (hee hee, not literally!)
And have you ever tried to get a doc after hours? They first suggest you call an ambulance or go to A&E. They must be thrilled to have their ambulances called out for non-emergencies. And A&E is packed to the gunnels already.
Then they tell you there's an after hours clinic. In a town 40 miles away. Could we drive there? (honestly, this is the truth) When my dh insisted I couldn't even get off the bed, he faced 20 minutes of ridiculous questions. On and on and on. Finally they said a 'clinician' would arrive within 6 hours. True. (Well, 5 and a half hours) It was a very nice but rather useless young chap who said the meds I needed weren't in his car and the pharmacies were all closed. He found in his bag a tatty packet of some tablets that I've had before and don't work. He left saying to contact my GP (not open until Mon) Honestly. What has happened to the NHS??

That sounds awful.

Just to answer the smears query. To be 'allowed' to send smears to the lab for testing, the person taking them has to have a special number. To have the number they have to have training and do at least 50 smears a year. As GPs mostly delegate smears to nurses to free up GP appointments most GPs wont do more than 50 smears a year and therefore are barred from taking them at all. Most of us are more than capable but bound by red tape. Here I Australia I do all my own smear taking without such beurocracy. Most of us in th UK will do our own swabs though.

There seem to be 2 main problems for you. Lack of continuity of seeing the same GP who gets to know you and follows a plan and lack of timely appointments. These are both likely to be due to the national GP shortage, and may explain why other local GP lists are closed. Good luck with getting thing sorted.

The GP situation at this practice has been the same ever since I joined a number of years ago. They seem to have no permanent GPs, only a succession of locums who constantly change. I've only ever seen the same GP twice (the one I saw before my first and 2nd injections). If ever I'm asked for details of my GP I always say the surgery name because I actually don't know the names of any of the GPs there!

At the practice in my home town, I had the same GP for 21 years.

I sympathise re home visits. When my DC were much smaller one was quite unwell on a Sat evening. I had previously called OOH GP in the area I used to live for a then sickly baby with no issue. However I was advised by the OOH service attached to my current GP that unless my child was terminally ill, they would not do a home visit as these were limited to end of life care. So far as I am aware that is still the case.

I wouldn't say GP is dictating what I use but there has not been much discussion of options. First said injection would be best for me. There was no mention of bleeding which would have put me off as I've had that problem previously and it was something I was/am keen to avoid.

I explained to 2nd GP re the bleeding, and asked for the pill as well. She said no, I couldn't have both and would be better off with the coil which would stop the bleeding. No suggestion the bleeding could be an issue with the coil as well!

Just to update this thread, went to GP this morning and am fuming.

Saw another GP. Relayed situation to him. Said I've decided against coil (he was very po faced at that) and wanted pill. He refused to prescribe it. He said I need to leave at least 8 weeks after the injection for it to be out of my system, and have 2 periods.

I said so you are refusing me contraception and he said yes.

I asked why he couldn't give me a prescription fir the pill now and he said he wouldn't know if I was suitable for it til I came back in 8 weeks! What?!!

Asked for practice managers details. There isn't one. Fucking hell.

Good Lord! Is he going to take responsibility if you become pregnant in the next 2 months?
Where are you, OP? Let me see if I can find somewhere that can help you out.

I've had a look at the advice given by the Faculty of Sexual and Reproductive Healthcare which seems to be saying that if you want to change from the depo to the pill the ideal time would be before the depo has ran out, not after so I'm not sure what his rationale is for leaving you without cover.
If there is no mechanism for making complaints directly to the surgery (is that even allowed?) you should contact your local primary care trust and see if they can advise of the best way to complain.
If I were you I'd also think about contacting your MP. That women in your area have such poor access to contraception in 2014 is a scandal.

Thank you :) sorry for delay in responding, I've been out for the day with my DC.

Tried contacting the local pct earlier but the number I have is Mon-Fri only. Am going to see if I can find an email address, failing which I will call on Mon...

Am also going to call every surgery in my area and try to find one with a space!