Inappropriate A and E use letter from GP?

[HurtleTheTurtle]

Opening last week's mail and I've received A letter from the partner's at my GP surgery stating that I have used A and E inappropriately. It notes that I "am a frequent visitor to A and E, and that I must access other resources to treat minor ailments".

Does anyone know if these are sent out after a set number of A and E attendances? I had three attendances in a week last week; I would expect that if there was an issue A and E would have raised it with me? It was on their instruction that I returned.

AIBU to actually point this out with the GP surgery and ensure this isn't placed on my medical records?

It is probably an automatic letter, but I would still bring it up with the GP and explain the circs.

It's stupid for them to send an automatic letter without knowing the full story - it might make people with genuine reasons (like you) less likely to go to A&E and that could have dangerous results.

@HurtleTheTurtle yep my neurologist put me on lamotrigine as the first line AED of choice as a woman of childbearing age ready to TTC

I believe Keppra has a similarly low risk profile, but essentially if you're TTC the ideal is monotherapy with lamotrigine

And I'm sure you know already, but you'll need prescription strength 5mg folic acid to start at least 3 months prior to starting TTC

Good luck xx

(And as you know SV is to be avoided as far as possible. HOWEVER. If that's the only AED that will control your seizures, it's better to be controlled on SV than not controlled without. I know someone who was on SV and her first pregnancy was unplanned so she wasn't on even basic folic acid. She has two healthy boys.

However there is an argument for saying if you're on an AED like SV, and there's even a slight possibility of pregnancy, that it would be worth taking a multivitamin with a lower dose of folic acid anyway as a precaution)

So minty may I ask then why GP practices aren't highlighting this additional work in the broadsheets and with their elected representatives if it unnecessary. Surely they should be joining forces collectively and speaking up for patients if it is eroding patient care. The CCG can't close all the practices.

Interestingly with DD's MH and the complaints I made, it was the CCG who were helpful, who listened and supported some change by funding some camhs nurses in a&e. Everyone else made excuses. They made an apt for me to see the children's lead asap.

In our area, A&E charge your doctor's surgery for each visit you make to A&E, so it's possible that the surgery is just following up the repeated visits.

If having an epileptic seizure that's larger than usual and having them repeatedly - and therefore heading towards status is an inappropriate use of A and E - what's an appropriate use?

Because the cost of those a and e visits will be much lower than time spent in itu because of status. And the hospital admitted her - so they clearly felt she needed to be monitored by a medical professional.

Thanks bananafish81 I have been given very similar information to what you are saying - I'm also seeing a pre-conception specialist (Obstetrician with a research interest in Epilepsy) alongside the two neurology consultants. Just really need to get the seizures back under control again frustratingly.

In our area, A&E charge your doctor's surgery for each visit you make to A&E, so it's possible that the surgery is just following up the repeated visits.

Inappropriate attendance or in every case?

I have recurrent small bowel obstructions sue to adhesions. I have a care plan for this and the GP told me at the time they were used to help patients avoid A and E if possible. It lists things to do at home first before going in. I also have consultants letters to the GP saying I must come straight in to A and E with an obstruction. You do need NG tube and monitoring in that situation, and an emergency op if it doesn't resolve.

Therefore would they get charged for my admission with my care plan?

Wow I'd ask the surgery - if letters like that go out and stop people going to a&e they could get in trouble!
Thought you were going to say something that an out of hours could deal with clearly not!
Hope you feel better soon

@HurtleTheTurtle that sounds terrific. I was under the care of a consultant obstetric physician for pre conception counselling (didn't matter as turns out I can't carry and can't hang on to a pregnancy!) and he was very very firm about not letting a GP tell me to stop taking my AEDs because of a hypothetical risk to a foetus.

Really hoping they can get yours under control. I felt so exhausted after mine, can only imagine how you're feeling dealing with this on top of everything else. Good luck

@bananafish81

"(didn't matter as turns out I can't carry and can't hang on to a pregnancy!)"

Sorry to read this :-( This has been my experience to date too. A plethora of reason's have led us down the IVF route, but not just yet. My missed period was just a dodgy missed period - I wasn't pregnant, although I did freak out that I may have been and questioning whether that was what caused the seizures to reappear.

I've also been told never to stop AEDs in pregnancy, but to stop folic acid at twelve weeks. I assume they measure medication blood levels through pregnancy and try and adjust if they see them dipping.

Have you ever been on a ketogenic diet to control your epilepsy?

www.matthewsfriends.org/

www.matthewsfriends.org/keto-therapies/keto-therapies-for/adults-with-epilepsy/

JsOtherHalf No. I have raised it before, but I have always been told it doesn't work in adults; I have seen anecdotal evidence that says otherwise. I may mention it again.

Cross post - thanks I will go and have a look now.

@HurtleTheTurtle you don't actually need folic beyond 12 weeks because by that point the neural tube has closed - the folic acid is to reduce the risk of neural tube defects, this forms at around 5-6 weeks, hence why it's actually pre conception folic acid that's most important, for the levels to build up

There's two schools of thought for epilepsy monitoring in pregnancy - some neurologists monitor your plasma levels of the AED, because of haemodilution (think orange squash, more water = less concentrated squash), but all my consultants said they preferred not to and just to watch and wait.

We did IVF but turns out I can't sustain a pregnancy due to uterine issues and the only way forward is surrogacy - this has nothing to do with my epilepsy, and epilepsy has absolutely nothing to do with miscarriages. Good luck

The ketogenic clinic in this area is based at a large teaching hospital. I don't know if they deal with adults, but the waiting list for children to be seen and start their diets is 9 months at the moment.

My daughter had one a few months back - she'd attended twice in a month (albeit unwillingly, she's an adult, but she'd claimed that she'd taken overdoses of her prescribed medication late at night, on a weekend...). We ended up talking to the Practice Manager about that because, quite frankly, what would they rather I did? Run the risk of my adult daughter (with a clinical diagnosis of bipolar and NPD) actually having taken a serious amount of medicated drugs and dying...?

In both cases, she needed to be seen by the emergency Psych team (not that they were much help, as she'd grown bored by that time and claimed that she wasn't a risk to herself or anyone else...) as opposed to a strange "out of hours" GP who not only wouldn't have her medical notes in front of him, but would have sent us to A&E regardless.

Sometimes they have to be seen to be doing the "right" thing - but that right thing? Isn't the same for everyone. The last time I went to A&E, for example? Was 10 years ago. The time before that? Thirty years ago. My son went a few months ago, but a few years ago, he was in and out of there due to his paternal family thinking that his head was a tennis ball (severe head injury... and, like the OP, asked to return immediately if vomiting or extreme sleepiness presented themselves).

OP, if I were you, I'd discuss the letter with your Practice Manager. That's what they're there for.

bananafish81 Thank you for sharing so much great information. I really wish you all the very best with surrogacy.

JsOtherHalf I've just found an adult trial for the ketogenic diet near where I am, going to contact them tomorrow morning to see if I can speak to someone. I've also found a private dietician who I shall make an appointment with if I can't get onto the trial. Thank you so very much!

contrary13 I hope your son and daughter are both OK now.

OP - you can always try the Atkins Diet and see if that works for your epilepsy? The ketogenic diet is a more extreme version, but needs to be under medical supervision, whereas anybody can try the Atkins Diet.

Just go along to A & E you are perfectly entitled especially with your history. Hope you are recovered now. Ignore letter.

Hurtle I saw an article about the ketogenic diet in adults with epilepsy being used at the hospital in Bristol. If you wanted to try it have a look at diet doctor or there is a good blog by a GP called Fat is my friend- she uses it in diabetes.

Maybe GO could do a care plan for you stating exactly when you need to go to GP and when to contact the surgery? Mine also put info about my condition on the 111 system so they are aware. HTH. The template my GP used is online, if you google emergency admissions care plan you should find it.

GP, not GO.