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?

Can you try pushdoctor? I've not used it myself but maybe they could do a private prescription for less money than buying your items over the counter?

I think you need to be more definite with your questions and specific.
And much more firm with GP.

I've had duty doctors phoning me telling me that my diabetic blood testing strips cost too much. I'd advised them to speak to my consultant (top consultant in country at top London hospital) or to advise DVLA that they are recommending I do less blood sugar monitoring?

Who is saying I can't be prescribed? GP practice trying to save money? Or higher governing body?

I would see what alternatives there are, which brands, and then at my next GP appointment, very politely say that you aren't leaving without it.

And quiz them as to what the reasoning behind the refusal is.

I am firm and don't leave the practice/appointment till I've got something I'm happy with.

I feel a bit guilty reading this as when my daughter had mild eczema diagnosed I was surprised she had bath emolient prescribed (which actually seemed to make it worse) and has a rant about the NHS providing free bubble bath that would end up being unused. In her case I still would have been happy to pay for the emolient or it would have been good to have had advice about products that tend to be ok for other children. I don’t know why but in my head I viewed the cream as a medicine and the bath stuff as secondary.

I can see that for those with a chronic condition, changes can be challenging and counter-productive if you’re stable on a certain product. Like other posters have said there are differences between those that are chronic sufferers and those who have occasaional flare ups. The prescription changes are likely to work at a population level but be super crap for some individuals.

I work in medicines management and the rule we follow at our practice is "aim for the majority"
So we switch everyone as instructed, for say, 90% of people the new, cheaper products will be fine. For those such as yourself, the CCG say switch back. We've still made massive savings and yet the people who have genuine need for the more expensive products still get them.
I find it odd, that having tried the new alternatives and the fact they are clearly not suiting you that you haven't been switched back. It might be worth contacting your dermatology department and asking them to put something in writing. If we see a patient has a letter from a specialist saying that they need specific brands etc, we don't even switch in the first place.

You should write to your MP about it.

Hope you get your eczema under control again soon. Make sure your consultant indicates on your repeat prescription that it is hospital consultant prescribed so it can not be altered by any doctor without consulting him.

I have very mild eczema, not worth going to the doctor with but when it flares up it really does take over the itching is so bad. I can only imagine the hell you must be going through. It took me ages to find a cream to soothe it - Boots own brand aqueous though it's starting not to work now. Bizarrely I started on the more expensive until my GP suggested to go back to basics - this appointment was over a scar itching badly (I was not getting any sleep because of it) and not a flare up. Will try some of the childs farm emollient.

I think this policy is ridiculous and such a waste of time and money. I do hope you get it resolved.

I too found that cutting out on gluten helps.

I buy aveeno myself as it helps with my dry skin, boots and superdrug usually have it on offer with a 1/3 off the price or some other deal and that is when i buy it.

eczema is not just 'dry skin'. it's an inflammation of the skin. and yes it can be life threatening. the skin is our first defence against infection.

the 'odd' bottle of moisturiser doesn't help. patients need to moisturise every day, often multiple time. and apply much more than a regular person puts on after a shower. someone upthread said they use a 500ml bottle every 3 days!

I worked at a CCG, where the husband of the Executive Nurse has epilepsy. It was well controlled until the day the pharmacist called the GP to substitute the script with a generic. Unfortunately the formula for the coating inhibited a function of the drug and he suffered a serious debilitating fit which almost cost him his life, caused brain damage and has meant that he is no longer able to hold down a full time job.

She is now very careful about his scripts, the substitution was done for the best of trash no but the results were catastrophic.

confused that is indeed the report on which NICE’s guidance to CCGs is based. Aveeno isn’t much more expensive than epaderm, but even a few pennies make a several million pound difference nationwide and that is the bottom line for the CCGs.

Plus bear in mind that most CCGs also place limits on epaderm prescribing, expressly ordering that it only be used as a third line agent after cheaper alternatives have been exhausted.

It isn’t ideal particularly considering a) a lot of eczema sufferers anecdotally swear by Aveeno and b) there simply isn’t a very large body of trial data to definitively decide there’s no benefit with Aveeno so you can question how accurate it is to make a funding decision on the data available, but this is how it goes within a chronically underfunded NHS.

oldbean, antiepileptic drugs are one of the few areas where generic preparations should never be subbed in for trademarked preparations which are working, due to the formulation having an effect on absorption and consequently symptoms. That would be an error on the pharmacist’s part rather than a CCG policy.

I’ve had issues with a switch to something with the same active ingredients but different co-crystal agents. This was a change in my contraceptive pill - and I went from never having breakthrough bleeds to regularly - a switch back returned me to none. I can see why they made the switch - it’s worth switching people off if most are fine, but they really should be switching back again if people are not.

I had a very similarly experience to you for a skin condition. Must have seen 8 different GPs who pretty much refused to help. Until I saw a locus who realised how bad it was and went pale. He gave me six months of antibiotics (when the others refused to give me anything) and told me to buy HIBI scrub, a antiseptic kind of shower gel, which I didn’t know about and made an immediate difference.

I think if the NHS wants to save money we need GPs who 1/actually know a thing or two about medicine and 2/ actually give a shit, even a small one.

Anyway I would never ever rely on a GP to advise on a skin condition.

Locum, not locus!

My DSisIL had her epilepsy medication swapped for generics last year and was made really unwell because of it. Penny pinching really screws with people. I hope you get your Aveeno back soon OP.

To the pwrson saying eczema isn't life threatening - I was rushed to A+E a couple weeks ago after being bedbound for a week because there was an appearance of eczema induced sepsis. I could have died if I'd stayed in bed.

Was similar with DS sneaky when he was three, if we hadn’t got him to hospital when we did it doesn’t bear thinking about.

Our CCG actually sent their own Pharmacist in to GP practices to review the prescriptions of 'high users'. My DD was one of the unfortunate ones to be picked on. They amended one of her anti convulsants (alongside a number of other less critical items) which was apparently on a list of drugs where generics were fine to be used - only they weren't fine in DD's case. After the change, we had to call an ambulance twice in 10 days which resulted in hospital admissions. Both the discharge consultant and her own neurology consultant told me that this policy of the CCG's had caused no end of issues with their patients across a whole range of life long medical conditions. Thankfully we were able to get the epilepsy nurse to authorise the GP to switch the prescription back to the original brand and DD suffered no long lasting effects (unlike the case mentioned up thread).

OP. Have you written to the CCG outlining the costings of the impact of this change - ie all the appointments against the tiny amounts saved on the actual product itself. Money is the only thing they understand - the fact that you have suffered flare ups will be of no interest to them - it's ££££'s all the way. Ask them to justify the extra expenditure they have caused as a result of this blanket policy. Someone will have been tasked with saving XXX amount off the drugs bill - the consequential increase in GP/Hospital appointments won't be a consideration in that person's targets!!!

Thanks OP :-)

Sorry you're in the same boat. It's a bugger isn't it! Thankfully I'm starting to get it back under control.

I guess a lot of the problem is that a lot of people experience eczema.

I've lot count of how many times people have said "Oh I have that too!". However what they really mean in that they have an occasional patch of eczema contained to a small specific part of their body.

I suppose its understandable that they see it as an annoying but relatively trivial issue. However, it's really not in the same league when the condition is chronic and covers 90% of your body and a bad flare up can leave you with infections and even hospitalised.

I'm all for the NHS saving money but I do think there needs to be an understanding that chronic sufferers often take years to find out what works for their skin. Changing that is not a trivial thing and as you highlighted does not result in cost savings.

I's also say that my experience with GP's on this has been pretty poor. Again understandable as a General Practitioner, they are used to dealing with/prescribing for the vast majority of cases which are mild/moderate. Its only with a specialist Dermatologist that I've ever really made any progress.

brownelephant - i know eczema isn’t just dry skin, my niece has been hospitalised with her eczema on many occasions since 3 months old and is now 5.

I don’t need you to patronise me thanks. i was just giving the OP another option whilst she hopefully sorts out getting it prescribed again by her GP.

2rebecca and others with similar attitude - this is not a case of want but need - the op needs these products to manage her eczema effectively, even at all, as using other products has resulted in the condition deteriorating. I too believe you have no experience of eczema which can be very extensive, painful and debilitating. Can increase the risk of serious infection which can have all kinds of ramifications - including YES being LIFE THREATENING. My gran and my cousin were both hospitalised several times with very nasty infections due to their severe eczema. I've "only" been hospitalised once.

Regarding "just pay for it" - you can clearly easily afford £40pcm extra out of your income NOT everyone can. Many people (yes even working people) are struggling JUST to cover basics like rent and food - and that's also WHY the nhs was created in the first place! In addition "just pay for it" doesn't work for prescription only products! What's your magical solution there?!

"If it was that bad you'd pay the money" - seriously? And people that don't HAVE the money?? Does it appear by bloody magic?

2nd thread this week where I'm shocked by the ignorance of those that have clearly never struggled financially.

Also - they're missing the point - it's a FALSE economy so it's not even saving the nhs money which is the excuse they're giving. Yet more proof that they're TRYING to wreck the nhs imo.

I've recently had text this week telling me that it's no longer intended that patients go to GP for uti's but instead to pharmacists who will now be allowed to prescribe antibiotics. This is REALLY worrying. Good as pharmacists are (and I'm a huge fan) they are not Drs. I can't see how in boots you can provide a sample for testing to ensure it IS a bacterial infection, they can't (I hope) view your full medical records which may flag uti's or certain uti's as being indicative of other conditions or worsening of conditions, if people aren't seeing the same pharmacist or even going in the same chemist each time there's no continuity of care and repeated uti's in one patient aren't going to be obvious or raise cause for concern... AWFUL idea! I'm also concerned this will lead to a new rise in unnecessary use of antibiotics.

I've also had the nonsense pp have spoken of regarding asthma medication from both Gp's and pharmacists. Again MANY years of trial and error to reach a regime that works for me and DOESN'T lead to me ending up in hospital (which is MUCH more expensive).

"Changes in the formula of deodorants, washing powder, make up, creams can have massive impacts" yes this drives me nuts, I know after MANY years of trial and error which products I can use, VERY annoying (stomach sinks) when I see the words "new improved formula" ffs leave it alone!

Our CCG works as somebody said upthread, they will get agreement from the dermatologists first that no new patients will be started on it, instruct surgeries to change everybody to the cost-effective ones then deal, individually, with those who have problems (as opposed to those who just want a brand)
Our surgery also has a pharmacist who runs clinics and will see patients to assess if there is genuine need to switch back and who will sort that and any follow-up needed. I'm sure our surgery would have switched you back before you went through a lot of this

Not disputing your case at all OP but, being devil's advocate, is it right that the NHS is spending millions extra for a product which shows no added benefit in clinical trials and which is advertised by Jennifer Aniston?

YANBU. Same thing happened to my mum with psoriasis, and I ended up buying it for her for several years. Then she moved to another NHS area (PCT? forget what they're called) and got it prescribed again.

Same thing has happened to me recently with my blood glucose testing strips. My consultant has written to the GP to say I need different strips, but the GP surgery is ignoring my repeated requests.

I sympathise OP - I am really lucky as I have a great GP who supported me when our CCG said that the extended release anti depressants I was taking showed no difference in efficacy over the normal ones. That is true for the anti depressant itself but not for the nausea that is a side effect I suffer from quite badly. After 2 weeks of chucking the ADs back up again my GP marked my notes up that there was a good reason for overriding the restriction on prescribing and gave me back my old medication. It may be that my case is different in that the original prescription was from a consultant but if you have already seen dermatology I would have expected your GP to represcribe Aveeno once a couple of other medications hadn't worked for you.

I have a skin condition too so I would condemn the comments about an expensive moisturiser. (You might try tying a handful of oats in a square of muslin and putting it under the bath tap whilst you are waiting to get the bath oil reinstated given that Aveeno is oat based.)

Perhaps Jennifer Anniston, who is an actual person, understands better than you @IvorHughJarrs

I feel for everyone on this thread.
I am now on methotrexate (with monthly blood tests).
My GP has stopped doublebase, and I am on something generic.

Hoping this doesn't make things worse.