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!

Also a bit confused as to why the private doctor had to prescribe 6 weeks worth. Can you ask them to do 1 weeks supply or 1 bottle in the meantime whilst the gp does the ongoing prescription? Might be cheaper

I think as said above you are being unreasonable but can understand your position.
the NHS standard contract between primary and secondary care says that secondary care ( in your case private care) are responsible for any prescription that is needed within 7 days , ie they do not expect primary care to have the resources to prescribe urgently for secondary care.
the 48 hour turnaround as said multiple times above will be for repeat medication and not for a new prescription for a patient the GP hasn’t seen . As also said above they do not have to prescribe but I suspect they simply haven’t seen this yet rather than are refusing to prescribe.

I’m currently working my way through a hundred odd documents that , due to sickness , no one has had a chance to do.

Thinking back on this all of my children’s NHS consultant requested meds went to the GP in a letter to that end. A request that the GP continue to prescribe (after getting a hospital pharmacy prescription to start it off). I guess the GP then had to be happy and satisfied with the consultant request in order to do so as the legal responsibility is with the prescribing GP? Omeprazole is used off-license for babies from what I recall.

Yes @Lennybenny. Would you like to see my payslip?

I haven’t read the whole thread so sorry if it’s already answered.

For those who know the system is it possible due to GP commissioning that the GP is reluctant to fulfil the prescription and this hit their area budget and they would rather allocate funds elsewhere so are trying to play ping pong with the hospital to cover it?

This is my concern @Scepticalwotsits

@Hobbitfeet32 we wouldn't have got the same result. Most GPs won't prescribe omeprazole for babies without the say so of a consultant paediatrician.

That's actually helpful, thank you @FelicityBennett. If this is the problem and they'd phoned to tell me that, I may not have been in any better position, but at least I'd know.

@lawandgin I respectably disagree that most gps won’t prescribe it without a consultant.
What about getting a shorter cheaper prescription whilst you wait for the gp to do the prescription. Is that an option?

Guess that's why my earlier post was ignored. Medication issued initially by consultant, from then on issued under shared care by GP. Buy the medication. If my child was suffering that's what I'd do and worry about financing later.

I think you’re being a bit unreasonable but I can understand why. Both my DD’s had reflux, one had ranitidine until 14 months and the other had omeprazole until 18 months. Both under NHS paediatricians, no other allergies and now both healthy.

My GP would never prescribe the omeprazole without seeing the paediatrician first, it does vary by area though because I’ve friends in different parts of the country who had it prescribed by the GP with no issues.

We had both liquid and dispersible tablets, the pharmacy actually swapped us to liquid themselves so not sure how much more expensive it is. Both worked fine, the liquid maybe slightly better than the tablets but whatever you can get will likely help.

Yes, agree you need to milk and maybe the omeprazole to start with, b it once settled on the dairy free milk I would try to avoid the medication, especially for longer than 6 weeks.

I think you are being v unreasonable. It is not just simply writing the prescription - you are asking the GP to write a prescription for a patient that they haven’t even assessed. Yes your daughter has been seen by a consultant and written a letter, but by issuing the prescription your GP takes full responsibility for that (not the consultant). With regards to the 48 hour time frame you mentioned, I assume only applies for repeat prescription requests (which this is not). You also have a current valid prescription and are not running out of medication, therefore this is not a priority.

In addition, generally liquid omeprazole is not supplied on the NHS as is it significantly more expensive and alternatives should be tried first line - I imagine your GP would like to explore and discuss these alternative options with you either over the phone or in person before ‘simply issuing the prescription’

also just because the consultant has recommended it, does not mean that it is correct - all healthcare professionals make mistakes including consultants.

@Hobbitfeet32 yes this is an option and what I'm now trying. @PortalooSunset I didn't intentionally ignore your earlier post. I'm on my way to my 4th pharmacy of the day and I've phone another 10+. But are you seriously suggesting I get into debt to get necessary medication? If so, yabu

@MynameisJune where are you based? I am Surrey/Greater London border and this is what I'm hearing. Why does it vary, it's infuriating!

@Wildrosee RTFT. We have tried first line without success. If GP wanted to see baby to exercise their own clinical judgement, why haven't they called me to tell me this instead of the receptionists repeatedly telling me it's coming? Also, I'd LOVE to know how everyone knows the 48 hour policy is only for repeats! I was very clear this was a new prescription and they didn't advise otherwise. 3 receptionists have all advised 48 hours.

@worriedniece I don't plan to have her on omeprazole any longer than necessary and have specifically asked for a slightly lower dose to start with.

Thank you @GuidingSpirit. I don't think anyone can really understand the stress of a small baby plus reflux plus cmpa. It's awful.

Rather than panic just take a deep breath - give the GP the benefit of the doubt and give it another 2 working days. It’s FAR more likely they are a little behind on their paperwork than are deliberately denying your baby treatment due to ‘budget concerns’ - I’m sure they’re more than capable of telling you how to manage a dispersive tablet. I get that you’re stressed but please for your own sake just wait a few days before entering panic mode!

@lawandgin I’m in Lincolnshire, I’ve no idea why it varies so much. I will say that we were very lucky both times with seeing a paediatrician. With DD1 we were sent to the local childrens ward on New Year’s Eve when she was 3 weeks old and struggling. The prescribed straight away and the hospital pharmacy filled the script that day. With DD2 we had to swap from ranitidine to omeprazole after ranitidine was taken off the market, the nurse practitioner told us the wait for a paeds referral was 18 weeks wait and that by then DD2 would be 6 months and likely ‘over it’. I insisted anyway based on experience with DD1, the appointment came through bless than 2 weeks after the referral was sent.

The NHS are amazing in many, many ways but things like this I find incredibly hard to see why it has to be so difficult.

I don’t doubt the GP will prescribe it under the shared care guidance of a consultant, however YABU to expect it to be dealt with immediately.

The 48 hours you were given by the receptionist is unlikely and they shouldn’t have told you that. We aim to turn around hospital written medication adjustments within a week as they are responsible for the first weeks prescribing supply.

Also the GP will be legally responsible for the prescription so may want to review the baby first (unlikely) but will certainly be bound by local prescribing authority restrictions so the prescription may need some adjustment.

Do you think a long wait for doctor is down to the doctors also doing private work for people who don't want to wait?

I had a baby with CMPA and reflux. Reflux is often a symptom of something else in their case the CMPA. On the first line milk given they still had awful reflux and I was given omeprazole but reflux was only mildly better. Managed to get them changed to an amino acid based milk and needed no omeprazole. What I’m trying to say is if your baby isn’t on an amino acid based milk Id push for that first.

@DownToTheSeaAgain fortunately for the OP'S dd and a lot of us, you've been misinformed. It is indeed possible to mix and match bw NHS and private healthcare, including for autism. What you can't do is get a private consultant to prescribe something that's not available on the NHS and then expect the NHS to pick up the tab. But the OP isn't doing that.

I'm so sorry to hear this. Our GP rolled her eyes at us on the first snd subsequent visits. By the time CMPA was diagnosed, my son was really unwell. We got a different "zoprazole" then switched to ranitidine as it was getting better with Neocate.