To think this GP policy is backfiring?

[ConfusedYetAgain]

I’ve had eczema pretty much my whole life. After years of dermatology appointments and lots of trial and error with different emollients and steroid creams me and my GP (sadly now retired) finally found a combination of stuff that keeps it generally under control.

Until a couple of months ago I requested my prescription as usual and when I went to collect it I was told my usual emollient cream and bath emollient are no longer available for cost reasons. Instead I’ve been given a different emollient cream and no bath emollient. I asked the receptionist how I could request this is reconsidered given my history and she said to make a GP appointment.

So, GP appointment 1 I explain my concerns, GP says I need to try the alternative cream, even though I’ve used it before and it wasn’t suitable. Also told me that if I had my heart set on the original emollient I could buy it myself. Not sure who has their heart set on a product they use to treat a medical problem (!) but I asked at the pharmacy how much it would cost and for the amount I need to use the emollient cream alone would cost me around £40 a month which is just impossible. I took GPs advice and tried the new emollient and went without the bath emollient as per her advice.

I was hoping it’d be okay but within a short time my eczema had really flared up and the mild steroid cream I normally use wasn’t helping. Cue GP appointment 2 GP is sympathetic but says there’s nothing they can do. Prescribes potent steroid cream, alternative emollient cream and aqueous cream to use instead of bath emollient. Advises me to come back if no improvement in 10-14 days.

Eczema continues to be worse so I make GP appointment number 3 GP again very sympathetic. Says that he’d prefer to just prescribe the emollient that has helped for years but he’s not allowed to. Instead prescribes potent steroid and antibiotic cream. Advises to return if no improvement in 7 days.

A week later, GP appointment 4 Same GP says he’s going to refer me to dermatology again as eczema not responding to usual treatment. I say this seems ridiculous when it was well controlled with my original emollient cream and bath emollient. GP agrees and says it’s possible dermatology will just recommend the original emollient and that the GP can then prescribe it as it’ll be on specialist advice.

So, the original cost cutting exercise has now led to this extra cost:
4 GP appointments
1 dermatology appointment
2 potent steroid prescriptions, 1 antibiotic prescription, several prescriptions for emollients that were only half used due to my skin reacting badly

I can’t help thinking that all of this must dwarf the saving they’d make by switching me to a cheaper emollient cream and banning prescriptions for bath emollients. AIBU to think it all seems massively counterproductive?

Sorry that was so long!

Summary:
GP changed my prescription to save money.
The alternatives they prescribed aren’t suitable so it’s led to my eczema massively flaring up and needing lots of additional treatment. They’re now referring me to dermatology (presumably quite expensive).

Surely the amount all this is costing most completely undo any saving they’ve made from switching me to cheaper emollient cream?

YADNBU

It’s madness. And meanwhile you suffer :(

Poor you. Totally ridiculous and yes backfiring. I despair at the cuts and lack of money invested into our services.

It could get worse - time off work sick as you must feel miserable etc so your job could be affected.

That's bonkers! Not allowed by whom? I'd be speaking to practice Manager and considering changing GP/surgery if I were you.

I’m
Curious to know what the cream you were having was that is considered too expensive to prescribe?!

What a load of nonsense. What's the point of "cheaper options" if they don't work.
Waste of time and money

Can I ask sympathetically (given you haven’t mentioned a drug name) if you’ve spoken to a pharmacist? Am asking as close relative a pharm and know they’ve had ppl who have an issue with q generic brand name when it’s sane product for psych reasons. That’s not saying ur crazy bit if you know drug a works and they prescribe drug b which is sane except name and tablet shape etc...

It’s utterly fucking ridiculous. I really hope that you, and everyone in this situation, writes to their CCG, MP and to Jeremy Twunt himself. And the press.

YADNBU
Sometimes cost cutting goes too far.

"Not allowed by whom?"

Presumably the regional Clinical Commissioning Group (I think that's the right bit of the NHS, I sometimes get the alphabet souo muddled up). but a regional, if not national, level decisions and so OP is highly unlikely to find another GP locally who has different guidelines (unless she lives right on a health authority border)

YANBU. Horrid for you, and a disastrous waste of money for the NHS. Is there anyone you can complain to?

It's probably not the GP practice that's made that decision, it'll be the CCG and out of the GP's control. So yes, complain, but it'll be more appropriate to complain to the CCG rather than the GP practice.

MY ccg have just done this. They have a list of just 8 emollients that can be prescribed, no bath oils, no shampoo and no shower gel.
Dermol seems to be the most popular one to prescribe.

I doubt this is anything to do with the GP practice. They are probably just following NICE prescribing guidelines. The NHS has less money so cheaper medications will be prescribed where possible.

Yep
Dh and ds1 have had the same issue
I can see ds1 needing a referral to dermatology

It's cost more money in your particular situation,but maybe other excema sufferers have successfully switched to the cheaper stuff. Hope you get it sorted soon.

It's conceivable that most people do find they're OK on the cheaper one, so that although it's cost more in your case, overall the extra cost in treating you is dwarfed by the savings on moving a large number of other people on to the cheaper prescription.

Out of interest, what is the original cream? Wondering if it might help me!

If the person using the moisuriser and bath emollient thinks it's not worth the money though and won't buy it is it reasonable to expect other tax payers to pay for it? It's not a life saving cancer treatment, just a posh moisturiser.

Yep. Totally agree and could give many more examples.
Problem is, the bean counters are in charge of the political football that is the NHS. Clinicians are not trusted and somehow seen as “ the enemy” by our current government. The NHS is not a business, it is a service and cannot be run like this.

I don't know anyone who's kids or who have eczema themselves who have tried one cream and all good. I just have tried over a dozen with dd and I have to buy it myself as I can't get a prescription.

I would assume the cheaper options are always the one prescribed first anyway?

Its down to changes in prescription policy - marketed as stopping people getting standard creams and paracetamol on the NHS but generally having much wider implications than intended as it was a blanket ban on prescritpions with the huge assumption people can swap medications or creams with no ill effect. Hope you get your specialist recommendations and it flows down the line smoothly, get a copy of the letter to take to any subsequent appt if I were you

Showing your ignorance with the "posh Moisturiser" comment - I suggest you research eczema