To go private because GP won't refer me?

[JustGettingStarted]

I had a basal cell carcinoma removed from my face 8 years ago. It required a skin graft and left a scar the size of a 50p piece. This was in Scotland. I hadn't recognised it for what it was and left it several months due to being pregnant and then having 3 children under 5.

I was told at the time that I would likely get more and that I should be checked by a dermatologist periodically.

Then I moved to England. I have had very little cause to see doctors and I haven't been checked by anyone. But I keep an eye on things and I recently noticed a new, tiny bumpy patch very close to the site of the first lesion.

So I went to the GP this morning to ask her to look at the thing on my forehead and refer me to a dermatologist. She barely leaned forward in her chair and she was very dismissive.

She just said it's nothing, don't worry. I asked her to refer me to a dermatologist and she said no. No referral unless "it grows really big or starts to ulcerate."

She didn't even get up to lean over and really look at it. She just said that nothing would be done unless it looks like a carcinoma to her, a GP.

I told her that I have had one removed and was told I was likely to get more. I told her that I had let it grow last time and was told that I should have gone earlier. In fact, I was told that I should have periodic checks by a dermatologist. She said that wasn't going to happen in England.

I just can't believe that unless she thinks it looks like a carcinoma... After it's grown and gone scabby... there's nothing to be done.

So I am paying for a private dermatologist to look at it Friday afternoon. If a dermatologist who specialises in treating BCC's tells me it's nothing, I'll let it go. I also figured that I would rather get a carcinoma treated privately as then I would have control over the timing of everything instead of just waiting for letters. I was impressed with being able to get an appointment with only two days notice! I have to travel for my work and I like the idea of being able to schedule things around work.

I am paying 225. But if a dermatologist tells me not to worry, I won't worry, so money well spent. And if he thinks it is a carcinoma, money well spent! Alternatively, I can also request a referral to the NHS for treatment, thereby getting around the obstructive GP (should it be a carcinoma) while saving money.

But an acquaintance of mine believes very strongly that paying for private medical care is wrong because it perpetuates a two-tier system that favours those who can afford it. She encouraged me to seek a second opinion from another NHS GP.

I'm not made of money. I wouldn't be able to pay for anything major. But I can afford to pay a few hundred if necessary. I figure I'm saving the NHS money.

AIBU?

definitely go private, GPs are being discouraged from referring patients to specialists because the waiting lists are getting so out of control (not enough resources). BUT its the patients who suffer. Don't waste time worrying about the morals of it all, just get seen.

You can be referred back into the NHS for treatment if you need it by the private Consultant (who will most likely be the NHS Consultant as well). Its not queue jumping as such because all potential cancers are supposed to be fast tracked anyway.

YANBU if paying for your treatment is the quickest way to get results and put your mind at rest, which it often is, and you are able to afford it then absolutely do it.

What is unreasonable is that you should even have to. The NHS is so overstretched that paying will help relieve even one person from their system but an overstretched system should not result in obstructive GPs. If you weren't so worried or had previous history I would request to see a different GP at your practice to see what they say.

I agree your friend is an idiot. Your Doctor has been very negligent in view of your past medical history. I'd raise it first with the practice manager.

I'm going to see a dermatologist at a clinic that advertises treatment for skin cancer (many clinics emphasise cosmetic treatments, but I picked one that has a lot of stuff about melanoma and carcinoma on the Website)

go to one at the private wing of an NHS hospital, or a reputable private hospital. there are a lot of high street private clinics around for moles and standards aren't uniformly good.

Do many people start private and then reenter the NHS for the expensive bits?

Yes but you don't necessarily queue jump.

I have had do use both with my conditions and tbh it can be frustrating as you can have to explain stuff over again or go back a step because without seeing x you can't see y.

I would also say there is also an assumption in this country that private is best. Unfortunately from bitter experience I have learnt this isn't the case.

In your situation however I would go private, but don't expect to be able to queue jump back into NHS iyswim.

Do it. As a very fair Aussie, I would say that you should NEVER dick around waiting for a mole to change. I hope it's nothing, but I also hope your GP gets schooled in how the skin cancer rates in Europe have skyrocketed with affordable international travel. Unfortunately due to complacent gp's, diagnosis rates are very low in comparison to Australia (where we are terrified of the sun because it's poison.)

I haven't been treated in the UK Just and your experience now has me worried. I've had a basal cell carcinoma removed overseas and numerous pre cancerous lesions removed. At an early stage treatment is much simpler and cheaper. If your skin is susceptible to basal cell carcinoma and is likely to be just as susceptible to other cancers which can be removed by a blast is skin acid etc. Ask your private dermatologist to give you an all over check -- he can tell you if there are blemishes that need to be watched in case they develop into anything more sinister. A consultants letter to your GP re this may make your GP more attentive in future.
Good luck

YANBU! I would pay if I could afford it! If it is cancerous you could have it removed privately if you can afford it - you don't have to go back to the NHS.

(Not really related but just wanted to let you know that reading this thread has made me get around to booking in to get some moles checked so thank you!)

I could understand if she took a proper look at it ( how long does it take to switch a spotlight on, grab whatever magnifying thing she uses and have a proper, closeup stare at it -1 minute?) having listened to your medical history. To dismiss it out of hand seems rash ( no pun intended) and short sighted. Much money could be spent further down the line, not to mention OP's discomfort, worry and scarring. I find this a bit disturbing, esp seeing as you were there already, taking a proper look would have cost nothing.
PP suggested going straight to a dermatologist. Maybe this? Expense bloody rubbish, but peace of mind worth a lot...I really hope you get it sorted.

I concur that I'd go to a private wing at a NHS hospital. You would be seeing the same dermatology team as you would on the NHS where my family is from.

It is true that there is rationing of care going on. It's highly irritating when you are affected.

Yanbu.

BCC's are generally simple to treat so I'm not as worried as I would be with something systematic like leukaemia.

I think I will be able to pay for the treatment myself, although a skin graft would make it more expensive and perhaps would require an actual hospital.

In Scotland, it was noticed by a GP when I took my baby in for something. She said "that looks like a carcinoma... You need to be seen." I think I had to come back by myself, but she may have referred me to a dermatologist then and there.

The dermatologist referred me to a plastic surgeon. I don't remember if I went straight in for the operation or if I had to come back after meeting with him.

There was extensive follow-up... I had a wad of yellow sponge sewn to my face and they had to deal with a local infection at the site.

So I know it could be complicated and expensive.

If the dermatologist says "this should be excised and biopsied" and I wanted to go to the NHS, how would that work?

It's worth it to you, OP.

Going private isn't really perpetuating a 2-tier system, imho.
Heaven forbid, but if your spot is something dangerous... if you needed a lot of treatment you'd go straight back to NHS treatment, just that you'd be leapfrogging the stage where people wait for initial consult, is all. So you'd be right back in NHS, just fast tracked thru the first stage, is all you'd have bought yourself.

I had private physio recently. Expensive but quicker & more convenient than NHS (which had been offered to me, too).

I would definitely go private in your circumstances.

Xpost: I think if you wanted/needed all subsequent treatment from NHS, then if the dermatologist is also in NHS, they can refer you to the next stage within NHS.

If the dermatologist is purely in private practice (is there such a thing in UK?) then you'll have to ask them what can happen next.

Go back to the GP with the letter from the Dermatologist and ask for referral on the NHS .Most Dermatology departments have a designated pathway for BCC so you will be seen within a certain number of weeks according to this.

YANBU.

I've gone private on pregnancy scans after having terrible first trimester bleeding (after a previous miscarriage) and the hospital A&E, early pregnancy unit etc refused to scan me because I didn't have an appointment!

Two tier or not, if it puts your mind at rest then do it! xx

I work in private practice. You can see a specialist direct (don't bother with private GP - costs a lot and most specialists will see you without referral from a GP ). If you need to have further treatment via NHS, then, if the specialist also works NHS, he/she will ask your GP to send a referral to them at their NHS address (this is what they HAVE to do, by the rules, though some seem to be able to switch patients over by some sneaky dodge - I don't approve!) and, having received that letter at their NHS hospital, can arrange your follow up/ treatment on NHS - advantage being they already know whether you need seeing quickly or not. If the specialist does not also work in an NHS post, they will only be able to suggest (to you and your GP - they would usually write to your GP anyway about the clinical findings) that you be referred to an NHS dermatologist locally. I have no private insurance and I saw my NHS GP with a skin lesion which I didn't like the look of. He misdiagnosed it (thought it was BCC but it was an SCC, it eventually turned out) and referred me via the "two-week rule" - I was seen quickly, lesion removed on first appointment, called back for more treatment when it proved to be a carcinoma and they have been wonderful. That's what you need!

With your history I would definitely have it looked at straight away. I had a bcc for years because a doctor told me it was a sebaceous cyst when it was very small! It almost grew into the corner of my eye it was only because I mentioned to another doctor for disability pain management that it was in my sight line that I got an urgent referral.

I saw a fantastic private (but paid for by my Swedish health authority) plastic surgeon on a Friday and he operated the following Tuesday. I was lucky that I have very stretchy skin so he could decide not to do a graft (the only good thing of having EDS). But he did say if I saw anything suspicious every again that I should call him at once.

Yanbu at all.
If it is a carcinoma I would expect you to be able to get referred back into the nhs for treatment but regardless you're doing the right thing and if you can afford it, do it.
Another route would possibly be to see another gp but I also have a skin condition of which the gp has been dismissive so I wouldn't necessarily expect them to take it seriously either.
It's a real shame that you've had to pay out but I would have done exactly the same.
Hopefully the private doc will be reassuring and it is indeed nothing to worry about.

Many consultants do private and NHS work. You need to find one who does both. You may be given the choice whether to continue privately or on the NHS. I have in the past. However you may have to wait to have the tests done on the NHS and it's possible that the consultant may advise you to have them done asap.

Alternatively, if the dermatologist confirms that it is what you think it is, you can go back to the GP with the consultant's letter and ask to be referred to an NHS consultant.

I'm going to see a dermatologist at a clinic that advertises treatment for skin cancer (many clinics emphasise cosmetic treatments, but I picked one that has a lot of stuff about melanoma and carcinoma on the Website)

I find the way that some medics attempt to drum up private business is pretty distasteful. Maybe I'm just too wedded to the NHS!

I have done this several times, paid privately for the initial consultation and then gone back into the NHS system for the treatment, the consultants even suggested it and have willingly put us on the NHS lists after the private consultation. The reason I do it is that you need the initial consultation to tell you what is wrong and what needs doing, or if there's nothing wrong, and that wait can be months and months with a chronic condition that then deteriorates during that time- in two cases in my family, to have left it 4-6 months, the person would have been more disabled/had worse condition than if they were started on treatment immediately. By allowing these long waiting times just to even see the person and review the problem, the NHS is allowing conditions and pain to take hold further, and this creates worse health problems than if they are dealt with promptly, not to mention you get to bypass the psychological stress and pain and distress of not knowing what's wrong for several months.

The initial consultations I've paid for have been £125-250 and you can literally go to the top consultant in the country, not your local one, and then go back into the system. Getting a diagnosis is half the battle- once you have that, you can then decide if you want to sit it out and wait for treatment or take action, but honestly, if you have the money, I cannot understand sitting in psychological stress, pain or with your condition deteriorating on a waiting list to see a consultant if you have a choice for ideological reasons.

It isn't fair- and one thing you can do if you have no money is find out which consultant you want to see, then ring their secretary and say you will take any cancellation. That wouldn't have got round the OP's problem- where I would get the NICE guidelines, see the best GP in the practice and demand a referral. There also used to be a scheme where GPs could take a photo of the problem, and upload it to a consultant which documents the problem and allows a second opinion, sounds like this wasn't in operation here.

YANBU OP. I think personally I would have attempted to get a second opinion before going private, but if going straight to a dermatologist will put your mind at rest then go for it.

I might also have tried a private GP first, as they are cheaper and can refer back in to the NHS (and will have no commercial interest in wanting to treatbit themselves).