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!

'A 2 minute phone call in 3 days between 2 surgeries (they are linked as part of a group and we can go to and request prescriptions from either) and over 15-odd doctors really shouldn't be this difficult.'

There you go again. You are making assumptions about other people's work load (they have home visits and a considerable amount of paperwork, bloods results, and general queries to fit in between surgeries not just your letter/ script to process) and the order in which they need to prioritise it.
The best way to deal with it would be to go in and say you have had a terrible weekend with upset baby and would be really grateful if they could flag it to the GP so that DD doesn't have to wait longer. Surgeries are bombarded with calls post bank holiday so they will be really busy. I hope you get what you need.

@whowhatwerewhy because I called them! And they told me they were sorry it hadn't been done and would definitely be done that day?! Am I missing something or are you being deliberately obtuse?

@orangemelon I get the point. You think they must be far too busy dealing with other things, despite them telling me they would sort it on Friday - twice. I on the other hand, think it's reasonable to assume someone could have found 2 minutes in 3 days to make a call to explain the hold up, or that they couldn't issue the script for whatever reason. That's fine, we just have a difference of opinion. Let's leave it there shall we? Hopefully all will be resolved one way or another today.

You are saying no one is communicating with you , you have spoken to them twice.
It was bank holiday so the only thing to do is be patient and wait until the surgery opens or pay for your private perception to be filled .
As it's been pointed out yours is not the only case that they have to review.

You’re not really listening. In primary care you really don’t have just a few minutes to sort out a new script. Because they’re are tens of similar requests plus own sceptres generated plus bloods plus actual patients.
I appreciate its horrible when your child is unwell but you’re not being fair and blaming your GP inappropriately

as I said before the NHS standard contract allows your GP a week to sort a new script t from outpatients , not 48 hours. If it is needed within 48 hours it must be provided by secondary care.
so your consultant behaved appropriately by giving a script , your GP still has several days to act ( as is working days) . You don’t want to pay which is fair enough but you then cannot demand that the accepted timescale is expedited because of this.

You’ve been given the wrong advice by your GP surgery and that’s not your fault. I appreciate that’s frustrating. You’re still insisting you should have been phoned / told when plenty of people on here have explained why it’s been delayed - it’s as per the contract.
My GP surgery are fantastic on the odd occasion I have made a mistake and run out of meds and they rush the prescription. I’m always extremely polite and they go above and beyond. I’m sure if you phone today and plead your case, they will try. But I really wouldn’t go in with an attitude, no matter if you feel you’re right or not. I really hope you can get the medication today for your baby’s sake. It sounds horrible but the GP isn’t wrong. It’s just very bad timing with a bank holiday weekend too.

I haven't read the whole thread but just to say I went through this exact same thing. 7/ 8 months of being fobbed off by the gp about reflux. Multiple dairy/soy exclusions from my diet( he was exclusively breastfed and wouldn't take a bottle) to no effect. My son at the time would vomit 50 times a day at least. Eventually did what you did and went private to an allergy consultant who diagnosed multiple allergies. They said he needed to be on omeprazole and our gp did prescribe it without seeing him but would only do so on direct instruction from the consultant by letter. It worked a treat almost instantly but gave him HORRIFIC diarrhoea. So we had to slowly go through the route if multiple food exclusions from both his and my diet until we figured out the right combo.

I empathise with you completely about how you feel like your constantly fighting and not getting anywhere.

Anyway what I actually wanted to say two things:

1. You will figure it out and soon it will feel a distant memory. Hang in there.

2 the very very best support I got came from a private dietiatian (recommendation from the allergy consultant). For £150ish I would highly recommend even a one off appointment. A one off appointment gave me so much more info and support than any time with the nhs dietitians. If you would like their name then please do pm me.

And I realise that your issue is with the gp, so apologies if anything I have said is unwelcome or unhelpful. I just wanted to let you know I've been there and know exactly how it feels to be fighting against the system. Hope you get the prescription soon. (And sorry for all the spelling mistakes!)

I think a lot of people here are posting from a rational and unemotive point of view - which - although might seem correct technically doesn't take into account the actual emotional side of suffering daily with a baby who has severe reflux. My middle child had absolutely awful reflux, and CMPA it was so bad that her stomach was distended to a ridiculous amount that nappies 2 sizes weren't comfortable and she would scream, she was in agony for the majority of the time, and when she wasn't screaming she was constipated/ gassy, vomiting just terrible to see her in that way. This was 5-6 years ago, and we took her to a and e in the end - after the gp prescribed gaviscon and dairy free milk - these helped to an extent but the tummy largeness etc still persisted. She was still only a few weeks old so I think based on that and I guess just general availability whilst we were in the hospital a paediatric consultant saw us and prescribed ranatadine - which I know is discontinued now but was an absolute life saver, within days she was so much better and I'm so thankful that we had the quick turnaround. I know hand on heart if for whatever reason it would have taken much longer to get an appointment with a paediatrician I would have somehow managed whether that have been borrowing or using money I just didn't have to see somebody private if that meant speeding up the general diagnoses to prevent my child being in such constant pain. I'm just confused because ideally yeah it's shit to pay private and then jump through and get the prescription on the NHS but at the same time - especially atm - that could be the only choice you have between having a baby that's in pain or isn't? Surely that's the overriding factor here? If appointments were available then it would have been fine but unfortunately there wasn't and it would have meant waiting weeks with a baby in pain? How is this ok? Also more often then not you get referred to a consultant who works private aswell as nhs so it could be had you waited you would have ended up seeing this specialist anyway?! You have just quickened the process by paying.

Anyway I hope there is some progress today, hopefully it's just a case of busy backlog due to bank holiday and you get the full prescription and your baby feels alot happier soon. And you get sleep soon! I know how hard it is without it , almost like torture so be sure to rest yourself! Xx

The problem you have is that the receptionist has no idea whether there is going to be a delay and for what reason, so she’s going to give you the assurance she will chase it and it ought to be done, but the clinician is either too busy or getting advice as to whether they are able to prescribe it (all reasons already given)

plus letters tend to go through a process of being scanned, sent to a team who ‘code’ it and then sent to the registered GP or clinical pharmacist who look at the content and decide whether to take liability for the actions it’s requesting (and they do not have to). So if your registered GP is on holiday and the covering doctor is busy doing their own caseload, urgent work, it might technically be waiting to be assessed, or they might be asking ‘is this appropriate’.

consultants have licence to prescribe 2nd line ++ meds that GP’s don’t but technically, consultants should not just pass care straight back to GP’s they should initiate medication, monitor then pass on the shared care agreement, and it’s also true that if the consultant letter says ‘I’ve given 6 weeks meds to mum’ then Gp thinks you have 6 weeks medication and then need to pick up the separate message you don’t want to pay for it and need the Gp to initiate. The letter needs to specifically instruct the GP to take over the care of the patient

This absolutely does happen. Different areas will have different cancer pathways and different treatment available. NICE is also only recommendations usually, sometimes guidelines, and arent binding. Not all teams will have the ability to follow them. There are several teams locally who dont have the resources to give the NICE recommended treatment and theres nothing to say they have to

1. The dr hasnt said that he wont prescribe. Are you certain of when they got the letter? The private dr has to type it, then send (often via post for some reason!), then it makes it to the receptionist who puts on a huge pile of similar requests for that dat/ that havent been done. The drs slowly make their way through the list, some will require no action, some a skim read and others in dept read with medical notes up, some the patient needs to be phoned, others urgent actions like booking in tests. This takes a considerable amount of time, rarely is it as simple as just reading a letter

2. Just because its a nhs consulatant working privately doesnt mean he will prescribe like an nhs consultant. Often in order to get the most effective treatment there is a pathway to medications to stop people being prescribed expensive or overly powerful meds with big side effects, when a simple med will do (eg if you are in pain we will start with paracetamol, which will work for 70%, then work our way up to the expensive and habit forming painkillers that are only needed for the 5%. We cant start with Oramorph without trying others first)

In my team for example in order to be prescribed Treatment A, youd need to have tried Treatment B at several different doses (for a period of weeks at each increment), Treatment C and then some background tests to check its needed. Our consultant who works privately as well as nhs, can privately prescribe Treatment A without going through those steps however cant prescribe it to an nhs patient without. If a patient came with a private prescription for treatment A without already being on it, or having gone through the steps then we couldnt honor it. 7

We also get letters from private consultants (even nhs working ones!) who prescribe things not available from the nhs, that we dont even have locally, not liscensed for the purpose they are prescribing, or where they dont meet the local criteria for it (like age, weight, co-morbidities etc, presentation).

A massive issue is that private consultants will issue a prescription as a one off, and leave 100% of the follow up care to someone else. If its a one off, then they have no plans on monitoring how its working, managing any side effects, monitoring the dosage or when to stop it and what comes next. That is all passed back to a GP who may not feel comfortable or know the drug well enough to know what to look out for, and what physical paramaters are normal . With young children for example some of these descions can only made by the local consultant and your child isnt under them yet

Take your case, you have this script. What happens if your baby has side effects? or if you find its not working? will you be expecting the GP to up it or change it? or give advice? If you decide its not the right medication will you be expecting another suggestion? Your private consultant isnt taking any of the responsiblity for that. It might be that usually babies of your age are usually only given this with oversight of an nhs consultant as your gp doesnt have the right expertise but you arent under the consultant. It might be that your GP has no responsiblity for any of this usually for nhs patients as its all done by the consultant team

Locally we have medications where the trust pathway says we can only give it to patients with a certain diagnosis who fit a certain criteria healthwise, The medication is licenced by the nhs for a slightly broader catagory. Private consultants can prescribe outside that if they are willing to accept the risk, however it doesnt mean that the next doctor will accept that risk or come to the same conclusion even if its a private to private transfer but even more likely if its a one off private review with no ongoing responsbility eg if they arent planning on reviewing it, or in any way monitoring it. If that responsibility of a medication that a GP wouldnt usually prescribe in these circumstances, and all the follow up is passed to a GP then are within their rights (and sometimes the only responsible thing) to decline

I agree about the rational and unemotive. I think many people though can empathise with how exhausting and frighting it is when you have a poorly baby.
The thing is, in order to get this resolved asap, the OP needs to approach the doctor in a very rational way. They’re human beings in a caring profession. Nobody wants to see a little baby suffer and be unwell. I just think OP needs to go into the GP surgery remembering that you catch more flies with honey and hopefully they’ll resolve it as a priority. 🙂

This is a very emotive topic. I refer to @Mudblast post. Yes it is tricky. But there is little excuse in this particular case. Its been handled badly. Yes private consultant may issue prescription. But it then comes back to GP.
Has GP also sent chasing letter recently to Paed/ Consultant on the nhs? There may be a waiting time, but i bet OP would be seen quicker if GP chased, especially if they tell them that diagnosis has already been done privately by one of their own nhs doctors. Ask for that OP. Because if you deliberately chose a Consultant who works prviately and nhs, it may well be him you see. I'd phone his private secretary and ask him to chase your case on the Nhs aswell.

And what Mudblast says re the Gp gets left with the aftermath. Yes, that's true. But I'm afraid that's true in many senses. Once you are dismissed, all cases go back to the Gp. Once you are referred for cancer, or any other op, or HRT clinic, it then goes back to Gp to manage the dosage. And if they are out of their depth then they need to take advice, or get clarification from the consultant, privatel or nhs. Or chase for another appointment, on the nhs.

I do appreciate what Mudblast says. But yes, its up to Gp's to deal with the aftermath of many many conditions. Including if you have a sick, screaming baby, which if any of you have had ( I did) it breaks you down quickly. Don't underestimate that.

Update OP? Have you got Gp Receptionist to resolve it?

It's disappointing that the receptionist gave you the wrong information. Of course that's frustrating. Several posters have tried to explain that 2 days is unrealistic in this instance and that many GPs surgeries are ridiculously busy and understaffed.
I hope you get the prescription but, as someone else said, you catch more flies with honey so I hope that is the way that you manage things from now onwards.

@Oblomov22 the receptionist gave the wrong information when they said 2 days so that raised OP's expectations. It's disappointing that it wasn't done on Friday and upsetting looking after a baby in pain. However, there is nothing to suggest that it won't be dealt with today (the BH is unfortunate).
@Mudblast was explaining that private referral/ prescribing can sometimes complicate things significantly for the GP and sometimes medications are suggested that a GP would not prescribe on the NHS so may be declined. I think that's unlikely in this case as we certainly prescribe omeprazole.
I haven't seen the OP say that she has been referred on the NHS. From the OP, she seems to have assumed that the waiting list would be long so chose to go privately herself. In my experience, the baby would have been assessed very quickly although that may obviously be slightly different in other areas.

I hope that things have been resolved now OP

Was just re-reading your original post...from the private letter it probably reads that your baby already has 6 week supply of medication thanks to private consultation

I think You'd need to speak with a GP about this afresh explain that you do not have the medication/cannot afford it even though it has been prescribed for your baby

At our practice it's minimum 48 hours for repeat prescriptions to be issued- these are regular medications that a person takes eg for blood pressure, cholesterol etc

In your case it's not a repeat script, I'd say that reception has maybe got it wrong saying it'd be dealt with in that time frame, without you having a conversation with a GP

If it's not sorted today/no further forward, I'd call your practice to book a telephone/face to face appointment to explain events & the bottom line is you're requesting a prescription for omeprazole

@Mudblast has it spot on

Mudblast is clearly a GP who has commented on what a GP has to put up with. As Joe public I already knew what she told us. But what is it that you expect the public to do?

Plus this isn't some complicated scenario with a plethora of solutions. We're talking about omeprazole here! Hardly a really complicated drug.

And OP has provided the letter. It should've been scanned by now. And a GP should've rung OP today, by now. And then OP could've calmly explained her situation.

That should've been done. By now.

Any update from the OP?

Am curious to know the outcome!

To close off this thread...we have this afternoon acquired the omeprazole. Not the suspension, but the mups. I asked the receptionist if this had been issued in place of the suspension due to cost and she said yes, but if we have problems with the mups to go back. I am more than happy with this outcome. There's little point giving a supply of a very expensive medication until we know how DD gets on with it (or not). There certainly wasn't any rudeness or argument. A further annoyance was that I had a text to say a prescription had been issued and I was intending to go out and get it this morning but the car is fucked so had to wait until later to walk down there...then I got a phone call very late this afternoon explaining it wasn't the suspension and that it hadn't gone to our normal pharmacy. Glad I didn't go out this morning! Luckily DH was able to rescue said car enough to get to the pharmacy and back at very short notice before it closed.

Obviously I'm pleased we have a prescription, but I still think it could have been handled better by the surgery. However the overwhelming response was that iwbu about that, so I'll bear that in mind, should we ever be in this situation again!

Good.
At least you got it.

Glad it’s sorted. Seems like a reasonable outcome

I hope I’ve misunderstood that you had given the pharmacy the private prescription and got them to order the suspension as they’ll be £££ down if you don’t complete your transaction. No you can’t return specials…

@BungleandGeorge then the pharmacy should have told me the price before they ordered it.