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!

@DownToTheSeaAgain it is in no way similar and you bloody well know it. This is medical treatment. Do you have DC? Have you ever had an unwell baby? I think you might have had an empathy bypass.

I think you just need to give the busy GP another couple of days to get to it tbh.

@Hellospring22 she doesn't have the medication. Because I don't have £400 to pay for it. I'm only receiving £151 a week SMP!

I tried gaviscon with my little one and it worked however she also suffered with constipation. I gave some lactulose to combat this. It's not ideal to be giving lots of different medications, but if you ever find she is constipated again, and the usual stuff, bicycle legs tummy massages etc don't work, it may be something to consider.

I'm not saying that you shouldn't get treatment. I am saying that you are being unreasonable to expect it free from the NHS when you went private for a diagnosis.

You are unreasonable to imply that in saying this I lack empathy. I have DC. Several. I understand what it is to be worried about them but your U is to want something for free that you're not technically entitled to. I am sure you will get it because most GPs feel pressured to prescribe on the back of private prescriptions but those I know who do get somewhat frustrated by it.

To add - the receptionist has perhaps just given you the standard repeat prescription timescale without thinking. I would imagine something like this would take a little longer, especially for prescribing for a baby. Give the surgery a call Monday morning and ask for an update/appointment.

Good luck, it's horrible seeing them unwell.

The GP may not be able to just prescribe it - as I understand (hospital doctor not GP) they have a set list of what drugs/formulations they can prescribe. Liquid omeprazole is insanely expensive, has a really short shelf life and not all pharmacies will stock it as it's used so rarely - as such generally it's prescribed as either a tablet that's dissolved or a capsule that you can take the contents out of - but if you had a particular need for the liquid (eg the dissolved tablets tend to block feeding tubes) something would be sorted. However the tablets being adult medication won't be licenced for paediatric use - so the GP is either having to prescribe off formulary or prescribe something unlicenced, neither of which they'd be able to do easily without seeing you. Really the private paediatrician should have spoken directly to the GP if they wanted them to provide an ongoing prescription.
I can understand your frustration - having a refluxy miserable puking baby is bloody hard work. Omeprazole reduces stomach acid production so won't actually stop the refluxing, it will just make it less painful and less likely to irritate the oesophagus - often useful to give in combo with feed thickeners like carobel which help the feed to stay in the stomach. As others have mentioned I think, really problematic reflux is an indication for early weaning too.

I think you are being overcharged by your pharmacy for the omeprazole. The liquid is expensive, and they add their own fee on top (which varies from pharmacy to pharmacy) but £400 is way more than a bottle costs. If you have to keep getting private prescriptions, try somewhere else or ask your pharmacy to source from another supplier.
Another option is to get dispersible tablets which are much, much cheaper than liquid and are safe for babies and children - the dose might need to be adjusted to allow for a half or whole tablet dose.
The cost might be why your GP has not prescribed it yet - some health boards only allow liquid under certain conditions e.g. tube fed children etc.

My personal experience has been that my NHS GP has only been willing to provide a prescription for meds I have already started, if prescribed privately. So I have had to pay for the (very expensive) initial private prescription, then could continue on NHS.

Another time, my GP would only prescribe based on the consultant's recommendation when it was officially under a shared care protocol. And this was with my NHS consultant that he had referred me to, not one I had seen privately. I had to wait until this agreement was in place before it was prescribed, which I think was a few more days.

I suspect it is the receptionist giving you incorrect information. In my case, the pharmacy had advised me to get it on the NHS instead of paying privately, but the GP refused until I had paid for and used the private prescription. They explained it as liability rather than cost reasons.

I'd hazard a guess that it's simply that the GP surgery has a high volume of work, especially as it's a Bank Holiday, and they haven't got around to it yet.
There is a national shortage of GPs. Our local surgery is a big group practice but probably has less than 2/3rds of the doctors it had a decade ago, and more patients as other practices in the area have closed due to not being able to get GPs and I don't think our area is particularly unusual. A lot of work is being picked up by practice nurses etc but they can't do everything.
I would think that something like this is a job that would have to be done by a doctor especially as, unless things have changed since one of my children was on omeporazole, it's unlicensed below a certain age. Lots of drugs are prescribed off licence for small children - my son has a fairly complex medical history and lots of drugs he's been on were unlicensed. It doesn't necessarily mean they are unsafe or anything, but it's an additional liability for the prescriber to consider, and I doubt non medical prescribers will do it.
Also this isn't actually a repeat prescription as far as the GPs are concerned. It won't be on whatever IT system they have for medicines management. So it's likely to take longer to process than a standard repeat. And 48 hours is good going for a regular repeat to be honest. We are asked to give 7 days, though they are usually ready in about 4 days except at really busy times.

@DownToTheSeaAgain but she is entitled to it as per NICE guidelines! Making a baby wait for something which is exactly the same under the NHS process is bureaucracy gone mad. And YABU for correcting the spelling of a stressed, sleep deprived mum who is replying to comments between diving into various pharmacies to pick up another prescription that the paediatrician has prescribed while we wait for the gp surgery to sort themselves out. That was just bitchy and you know it.

I tend to agree @Nixbox. Paediatrician has prescribed the dispersable tablets this morning instead. Perhaps I will be able to afford these and pay my energy bills, but I don't know yet as I've tried two pharmacies, neither of which had it.

Book an appointment to see the GP. In my surgery, the receptionist or hca would have phoned to book an appointment so this can be discussed and baby can be treated.

Thanks @sallysparrow157. We have a new (private) prescription for dispersable omeprazole which will hopefully be more affordable and allow us to start the medication while we sort the mess out with the GP. It really shouldn't be this hard.

Thanks @ShouldIbesuspicious we have a new private prescription for dispersable omeprazole. Hopefully she'll take it okay and we can sort out the mess with the GP later. Thats if I can find a pharmacy with it in stock. Not having much luck so far.

@CrunchyCarrot I wasn't aware of this. Can I ask how you know this please?

@lawandgin ah, OP, reflux is so horrible to deal with. My DD was also a tiny one - 5lbs 12oz at 38w and due to her reflux + feeding issues dropped below the 0.4th centile for a while. It was all very stressful. She had reflux which was very much developmental (not CMPA related) and it stopped pretty much exactly at 7months old.

On gaviscon, i see in your updates you said you had tried it and it caused constipation but in an emergency if you run out of or cant get the omeprazole, we found that using about 1/3rd of the prescribed dose had enough of an effect to slow down the reflux, without causing the constipation. We would tip the powder into a teaspoon and just use a little proportion of it. Then put the rest back into the packet. I think the recommended dosage is a huge amount.

Hope you get sorted soon.

@lawandgin the problem is that yes it well be on NICE guidelines but gp and hospital prescriptions have different funding for different items and different prescribing rules. Because of cost and what the drug is and if it has to be monitored etc.
Its all about speciality, the gp is essentially the third wheel in this situation as they are the not the experts but being expected to prescribe even though they have not been involved

For this reason Omeprazole is normally prescribed by a consultant/doctor at a hospital and dispensed at a hospital pharmacy for the first prescription then can be prescribed at a community pharmacy if all is ok and GP is happy to continue.

The problem is because you went private (which you have every right to do) you need to stay private for at least the first prescription then can go back to nhs.

I hope that makes sense i have an covid addled brain atm!

I get your frustration and it is hard. But there is a process for a reason even if feels like stupid reasons.

As a PP mentioned the liquid omeprazole is expensive. All of my DC had this issue and we had to dissolve tablets in water and use a syringe dropper to squirt into the mouth as locally the nhs would not prescribe liquid which I also believe has another issue like a short half life or something.

Oops sorry OP it took me so long to reply because i couldnt think of the right explanation you have already replied a few times.

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

My GP and pharmacy have a 1 week lead time to do prescriptions (more if a bank holiday in there). So 48hrs is not the new normal. I’d follow up on Tuesday with GP. You might have to request phone appointment with the GP to ensure they have time allotted to doing your prescription for you.

I hope your baby feels better soon.

I think you’re totally understandably being a teeny bit unreasonable. Technically, it’s not a repeat prescription and it was only 2 days before a bank holiday. They might have needed to check a medical letter or shared care information which slowed it down a bit. There’s every chance they’ll sort it first thing early next week. Unfortunately, even when the policy is 48 hours turn around, practicalities mean they may not get to it. That said, I appreciate how crap it feels when you’ve got a poorly baby and hope they can sort it out for you early next week asap for your little one.

I did think this. Plus the op is only on smp as a lawyer?

The gp is not under any obligation to prescribe something on the advice of a private, (or nhs ) consultant. They’re legally responsible for any prescription they write. I know you feel like you’ve saved having to have a gp’s appointment by seeing the consultant privately, but it can also be seen as attempting to queue jump.

Regarding the AIBUs, the two day time period is for repeat prescriptions, not new prescriptions, and the second AIBU is 50:50. I can see why you think the gp would be unreasonable to not to prescribe it, but I can also see why the gp may not prescribe it (or at least, not until he assess dc, symptoms, clinical need etc).

I suspect the issue is purely the huge volume of work that the GPS have to do. They may well have intended to do the prescription on Friday but any number of higher priority situations may have occurred. Palliative patients, medical emergencies, a death, admitting someone to hospital etc. I would imagine they will sort it for you early next week.
I am surprised though that you would go privately to get a diagnosis but are not prepared to pay for the treatment. Sort of defeats the object because you would probably have got the same outcome just waiting to see the Gp but would have saved you some money.