AIBU to think the GP just needs to issue the prescription?

[lawandgin]

Not sure if this is an AIBU, but donning my hard hat and posting anyway.

DD is 4 months old and has suffered terrible reflux since she was a newborn. We're all getting through 3+ sets of clothes a day, I'm constantly worried about how much milk she's actually keeping down and it's very stressful all round. For context, she was small for gestational age weighing 5lb 8oz when she was delivered at 38+3. She lost 8% of her birth weight and took over 3 weeks to regain it.

Just over a week ago, we ended up in A&E when she just would not stop screaming. I'm talking 7 hours. The long and short of it was that they thought it was a delayed reaction to her 16 week vaccinations, but the doctor said we needed more support with her reflux and that she likely had CMPA. Knowing that she wouldn't be a priority on the NHS as she's gaining weight and there's a several month long waiting list to see a paediatrician, I paid to see a private paediatrician the two days later. He confirmed he thought she had CMPA and needed dairy free milk and also omeprazole to treat the reflux. We happened to have some dairy free milk left over from a previous trial, so were able to put her straight on that and we saw a huge improvement in some of the other symptoms, but the reflux remains. The doctor prescribed omeprazole privately and wrote to the GP and asked them to continue the prescription.

The pharmacy ordered the omeprazole off the back of the private prescription, but it's £400 for a six week supply. I requested an NHS prescription for the same on Wednesday, chased it twice on Friday (each time being told it would be done that day - their turnaround time is 2 days) and it STILL hasn't been done. The doctors haven't phoned me to explain the delay and neither we nor the pharmacy can understand what they're playing at. I have a sinking feeling they're going to refuse the prescription due to the price and I'm ready to do battle with them on Tuesday as DD needs this medication and we simply can't afford £400 every six weeks. Especially as I'm only on SMP and with bills going through the roof.

So....AIBU to think the GP is out of order for not completing the prescription within their specified time frame and AIBU to think they shouldn't refuse to prescribe it at all (as I am anticipating)? Bonus points for tips on how I might tackle the conversation with them!

I would have thought the issue is the NHS Dr would need to see her to assess whether she needs it, rather than just give out a prescription?

I've had omeprazole on the NHS so I don't think it's cost related.

The 48 hour turnaround on prescriptions is for repeats usually. If the prescription has been recommended by hospital , ie the consultant sends the letter, it’s got to be scanned and read before it is acting upon.
If a prescription is needed to be started within a week of seeing a hospital/ private consultant then the script should be given by the consultant .

Ongoing omeprazole is commonly used in primary care for reflux so that shouldn’t be a problem.

Med sec here (in private practice). Have you checked your GP has received the paediatrician's letter yet? Have you had a copy of that letter (it is now considered best practice for patients to get copies of letters after seeing a doctor.)? If so, drop a copy in to GP. As you only saw private paed consultant about a week ago and most nhs gps do not divulge their email addresses on their websites, the letter would have gone by post (once secretary had typed it). Therefore, unlikely to have arrived yet. GP won't act until they have read consultant's letter.

@FelicityBennett I took the letter in on Wednesday in case they hadn't had it yet and the receptionist said she would put it in front of the gp that day and that it would be 48 hours, so to call them on Friday to check it was ready.

Did you manage to get the prescription for the dairy free formula sorted? My LG had cmpa and reflux was a symptom of that. Once she was on dairy free formula and all the previous dairy was out her system her reflux totally stopped and I could quickly stop her reflux meds! Not quite what you are asking but just thinking she might not need omeprazole for too long and it might not be an issue you need to tackle!
However when we were going through all of the above (took almost 6 months to get there with her!) I would get my OH to do some of the phone calls/visits. Finny how they take a male more seriously than a paranoid mum.

If a GP issues a prescription they are taking responsibility for that prescription - so they need to be happy it's being correctly prescribed etc. So it's not a repeat (where they decided initially it was appropriate to keep prescribing) but a new prescription. They'll need to see the letter from the consultant and read it etc and would still be within their rights to ask you to come for an appointment before they prescribe. It's frustrating but I have a professional role and I wouldn't sign something taking culpability for someone else's decisions without being sure so I can't really expect anyone else to.

@WeAreAllLionesses I picked a consultant who is currently practising in the nhs for this very reason. He's a paediatric gastroenterologist at a local trust.

Does the letter say the paediatrician has prescribed the first 6 weeks?

Sorry x-post with you saying you physically took them the letter!

@mrsjoyfulprizeforraffiawork they have it. I took it in on Wednesday and they've since confirmed twice it's on the system.

@TimboWimbo no, it doesn't.

I've worked GP receptionist job for years so this kind of thing is a common recurrence. You did absolutely the right thing bringing the letter in. I would imagine the GP still has not read the letter. I would ask for GP to ring you back. It's fricking frustrating for you I know but med changes from hospital letters can sometimes take an age to process.

@Augend23 are you a lawyer? 😁 I am, so I do get it. But if you have a letter from a Paediatric gastroenterologist who currently works in the NHS, I think I'd probably prescribe it!

@Dazzledee yes we have the milk and it's made a great difference, but the reflux prevails unfortunately. I'm at my wits end with it after 4 long, distressing months.

Is she unhappy with the reflux? Both of mine have been what I would call happy pukers. A massive laundry issue for us but they haven't been unhappy or bothered by it. It drove me round the bend but it stopped by six months with DD1 so I'm hoping it'll be the same with DD2! I sympathise as I am covered in old milk much of the day and no doubt smell charming.

@Hugasauras yes, she's unhappy with it. It clearly causes her discomfort and affects her sleep too.

Thanks @highdaysandholudays I'm passing on Tuesday so I'll go in again and I'm not planning on leaving without the prescription and/or talking to a GP. Getting an appointment is a nightmare and every day that goes by is another day of DD suffering when there's a medication sitting in the pharmacy which will help!

Yes, agree. As a receptionist you will know only too well how big the prescription and document lists get!! Our receptionists would probably send us a message asking us to look at this as a priority and get it done. We don't know what is a priority and what is not. In Scotland we don't have electronic script transfer so if it misses that days collection that creates a delay too.

Whilst I would prescribe this no question asked I don't prescribe just on the say so of an NHS consultant, I make my own clinical judgement too.

It's not clear whether you've actually seen the GP in the past for the reflux symptoms? If not it's possible they will want to cast an eye over her before prescribing. It doesn't matter if your private doctor works for the NHS or not, that's irrelevant.

Also did the private doctor prescribe suspension? You can use dispersible tablets for paediatric use which are a lot cheaper, you might find the NHS GP prescribes that. So I doubt it's the cost that's the issue.

Hi OP
we went through the same with our baby, it can take a few weeks for the CMPA milk to fully get in their system and for the old milk to flush out. We were in hospital 5 days, and i really had to push for the CMPA milk they were treating her for constipation but i knew what it was as i’d been through it with my first baby.

anyway, we were also given omeprazole, and baby was also being given calpol regularly which seemed to help. In the hospital she was being given omeprazole in medicine format, but they discharged us with it in tablet format which we disolve in water. This wasn’t working for us as we had to disolve 1 tablet in 10mls of water and give 7.5mls, but she was bringing it back up due to the reflux. When i asked the GP if we could have it in medicine format he said no because the medicine is £400 but the tablets are 87p a box. He helped us work a plan out for the tablets, we now disolve in 5mls of water and give 3.75mls so its less liquid going in her but same dose, and it seems to work. Sorry for rambling but just wanted to say if you get the tablets out of the GP they will likely work just as well. Hope that helps.

Your GP is under no obligation to prescribe this item on the NHS whatsoever. If you choose to go privately that includes follow up treatment. Omeprazole isn’t first line and your GP hasn’t requested a consultant opinion. There will be treatment protocols to adhere to. Why do you think that this is your GPs responsibility just because you want to save money?

I would book in for an appointment with the GP on Tuesday and take it from there. They should be able to bring up the letter and review it there and then. (Or tou have itnfor them to see) You shouldn't need to take up an appointment for this BUT given the age of your baby I would not hesitate to do so.

Have you tried gaviscon powders - they're not as effective but can help and are available over the counter in the meantime.

My dd had omeprezole on (nhs) prescription when she was tiny, it's because it is in liquid form as I recall that it's expensive - and kept in the fridge. Tablet form is very cheap but not suitable for (non solid eating) babies.

You’re a lawyer and can afford a private consultation but don’t want to pay for the private meds. Surely you can see why the GP may not be giving you top priority.

I was going to ask what form the prescribed medicine was eg dispersible tablets or suspension - as I know from when DD had omeprezole that it was really difficult to get Doctors to prescribe the suspension as it was expensive and had a short shelf life.

You should not ask for an emergency appointment after a bank holiday weekend for this. You have a prescription, you want an appointment purely to save you money. Generally the first prescription always comes from the person initiating the medication, they have chosen to give you the medication and the responsibility for assessing effectiveness and side effects rests with them. They will later write to your GP to request that they continue it, this is a request and not an order. You really are being very unreasonable