Private prescriptions and gps

[LilyTheMink]

I went to see a psychiatrist at the Nuffield group as I want to try some medication that's not frontline for depression- called vortioxetine.

This was over £300 for appt. The psychiatrist wrote to my gp to ask him to prescribe starting dose of 10mg so luckily I didn't have to pay for private prescription.

I had discussed with psychiatrist that the dose might have to be tweaked to get benefit and now I would like to try 20mg.

It's looking like I have to have another £300 appt to get my dose inreased, as GP (receptionist) said he won't be able to do it.

Does this sound right - anyone in the know to tell me if I can avoid paying again?

GPs are responsible for what they prescribe so I think them wanting confirmation before putting their name to something is understandable

If you're on an unusual medication, I presume the GP has little experience of it, so I would expect them to insist on guidance before they would adjust it.

This is normal. Our GP wouldn't prescribe the private psychiatrist's medication at all as it was off label, we'd have had to pay for private prescription at £175 a month (just for the medication). I can see why as they are familiar with it but have to take responsibility.
We got an NHS psychiatrist to prescribe it in the end, but after trying 4 or 5 other drugs first. The GP will then reissue it, as it is under instruction of the NHS psychiatrist. However, in our case it turns out it didn't actually work for DH anyway!
But we got his diagnosis, after a certain GP laughed in his face when asked for a psych referral. So it was worth the £300.

Some medications are not licensed for GPs to prescribe without first being prescribed by a Consultant (including prescribing a higher dose) . No idea if this particular drug is one of those, but it's quite possible.

You can email or phone his secretary and ask him to contact your doctor re changing the dosage.

I've just googled, and the cost of a 28 day supply at 10mg is just under £30. It might be worth finding out the cost of the private prescription (remember there will be a dispensing charge as well).

That might be cheaper than another full consultation, if the private doctor is happy to prescribe based on the telephone conversation

You may be able to contact the consultant, either directly by email or via his secretary, and let him know you need the higher dose. He should then be able to write to your GP and change the prescription. I don't think you should have to pay 300 for another consultation for this. (First consultations are, in any case, usually more expensive than follow-ups, so if you do have to see him again, it may cost less this time.) But I doubt another consult would be needed for this.

I would not expect your NHS gp to change the medication recommended by of your private one.

phone or contact private psych and ask them. If you might not need a face to face appt so they should charge less.

@2bazookas

I would not expect your NHS gp to change the medication recommended by of your private one.

phone or contact private psych and ask them. If you might not need a face to face appt so they should charge less.

Already been offered a tel appt, but it is the same cost.

@Cantfindausernamethatsnottaken

You can email or phone his secretary and ask him to contact your doctor re changing the dosage.

I called her and she didn't think so. Altho she said she'd ask him, she has booked a tel appt..

Once you’re on a stable dose, rather than still tweaking to get there, your GP may be able to prescribe, or if there is a shared care agreement (that both psych and GP agree to).

@LadyWithLapdog

Once you’re on a stable dose, rather than still tweaking to get there, your GP may be able to prescribe, or if there is a shared care agreement (that both psych and GP agree to).

Yes I think that's what will happen. Bit frustrating to have to she'll out more tho. NICE guidelines do say adult dose can be between 5 and 20mg. I'll ask psychiatrist at next appt if Mt GP can tweak dose from now on.

The GP may not want to if they’re not familiar with it. It’s placing the responsibility on them, if you have side effects or whatever. That’s why you’re paying ££ for the consultant to explain and discuss the treatment.

I mean about changing the dose. They may take over once you’re on the right dose for you.

Your GP is under no obligation to continue prescriptions from another doctor. That includes NHS consultants although usually they have asked for their opinion. That’s not the case if you’ve decided to go private. They will, however, generally continue medications if it’s something that they would have given you on the NHS. Do you meet the NICE criteria? I doubt a GP would have experience with this drug, they wouldn’t usually tweek doses for treatment resistant major depressive episodes either, that would need to be mental health team. So either your private consultant or ask to be referred to an NHS team

Came on to say the same as @BungleandGeorge. A letter written to the gp written by a consultant, whether private or nhs, is advice/recommendation., not a commandment. The gp is under no obligation to write a prescription if they don’t feel it’s suitable, relevant or know about the drug.

Agree with posters above.

My GP wouldn't even prescribe what the NHS consultant had prescribed (and she'd seen the hospital discharge letter) so I could get it locally until I'd been stable on the meds for 3 months and a shared care agreement was in place with the NHS hospital team.

Immunosuppressant meds not ADs but the principle is the same, it's about who exactly is responsible for care, monitoring.

Speak to the consultant's secretary, if tweaking dose was discussed in your original consult, the cons may just up your dose without another appointment.