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!

It’s possible there could be a reaction to something else possibly the thickener (carobel (mine couldn’t have it, it made them worse.) We had to keep them upright after every feed for a minimum of 20 mins until around 6/7 months. Fed slowly and winded often (literally every ounce to begin with) even though they were not happy having it taken away it actually helped massively. It does get better. You will find what works for her and you.

Hi OP, my ex 24 weeker (807g at birth) struggled terribly with reflux until she was around 14 weeks corrected. She still has the occasional issue. Anyway, omeprozole was prescribed by the neonate consultants at hospital. Post discharge, my GP admitted she was reluctant to prescribe as she would "get into trouble" due to the cost and did I want to see how things went given babies "typically grow out" of the reflux by 2-3 months... given the reflux episodes would trigger desats, my answer to that was a rather firm no. Definitely follow up with the survey. No harm in asking for an update. Hope you get the medication soon.

It's awful. There's a Facebook group called babies with reflux and silent reflux which was a great source of comfort and advice for me .

@Rooberoobe we still wind every oz and without the carobel she'll projectile the whole bottle (including all over the back of the car the night before last when we'd stopped to feed her on the way home as she was screaming for a bottle and i stupidly didn't want to wait 3 minutes for the carobel to thicken). I'm using one scoop in a 5oz bottle so as to avoid making it too thick. We've literally tried all the non-medication options and the basic medication options too.

Thank you @lamaze1 - that must have been really scary.

I'll check it out, thank you @Michellebops

That's not fair, she should be given the same urgency as she was if she couldn't afford to pay privately.

My toddlers health problems have been ignored for 10 months, I took her to A&E the other week where the A&E doctor told me to "go back to the private consultant" rather than help me and I then had to take her to a different A&E as she was so poorly. Being seen privately doesn't been you shouldn't have normal access to NHS care.

If the letter says they have prescribed omeprazole for x weeks we wouldn’t issue the next prescription till you have been reviewed as it may not have worked.

Going back to your original posting, if the pharmacy have ordered the omeprazole liquid "special" and it is sat in the pharmacy, it will be running down to its expiry. If you gave them the script initially they will expect you to pay for it.
If the Consultant has said he's given a 6/52 script the GP would expect a review or to assess before issuing an script after that time, and before accepting clinical responsibility.

If the letter says we prescribed x drug at x dose for x weeks the gp won't do that again because it's already been done. Also if the pharmacy has ordered it in specially you will have to pay for it

This is it- explains why GP is not expected to simply issue the prescription

GPs are independent prescribers, they do not simply issue a prescription on the say so of another clinician, even if that other clinician works in a big shiny building/on Harley street

It comes down to clinical judgement & in the case, review of the patient to see if the ompeprazole has actually made a difference

I this situation I really don't think the prescription request is "urgent", the patient has been assessed by a clinician and prescribed medication

The fact it's a private prescription does not then make it an urgent request for your practice to deal with

Hope your baby improves with this medication, it's tough with a little one experiencing those symptoms

Ahh but @vegang I'm a lawyer, so I MUST earn ££££, right? As it happens, I really don't and I'm on SMP and have been since I went on mat leave. You do get used to people's assumptions, but it's still bloody tiring. Hope your LO is feeling better?

@RainingYetAgain they've not specified that and most pharmacies work on a sale or return basis with their suppliers. Admittedly it will depend if the suspension has been prepared or not, I'm not sure how it works with omeprazole. Does the pharmacy order the constituent parts and then prepare the suspension once they have a need for it? Or does the suspension come ready prepared?

@TurquoiseDress I agree with you but op won't be paying for it because she has no money so it feels like it's an emergency to her. Unfortunately to your gp they know you have a private prescription and your financial situation is of no concern to them.

I've gotta say your mat leave package sounds awful though.

@lawandgin it depends entirely on the pharmacist and their skills. They may have ordered it in in the dosage you need or they may have made it specially for you.

Well, if the doctor you are referring to is a GP then that's a huge big NO

The vast majority of GPs are snowed under looking after the patients on their surgery list, not somehow looking after 'private patients' elsewhere

@RainingYetAgain they've actually offered to prepare half the amount for half the cost, so I assume they just have the constituent parts waiting to be prepared. I still don't have an extra £200, but it's better than £400. At least they won't be out of pocket if we stick with the cheaper mups version (if I can get it).

Tell me about it @fannyfan. I am looking for a new job for my return!

£400 sounds extortionate. Did you shop around to see if any other pharmacies could do it cheaper? There’s not a standard price for private prescriptions - they all put different margins on.

@TurquoiseDress funny how @mumda was so quick to judge bit hasn't returned to share their thoughts? I doubt the paediatrician would have been working an NHS clinic on a Sunday. The nurse we saw yesterday is also an NHS nurse but working privately on a Sunday, I assume, as he'd like a little bit more cash in his pocket. Should we not have seen him as we were stealing him from the NHS, @mumda?

Also, can’t see why you’re paying it alone. Dp should also be contributing. I presume 100% of his money doesn’t go on mortgage and bills.

The GP is under obligation to prescribe a medication that a local Consultant (whom the GP will know of professionally) has said there is a clear clinical need for. If the GP has a problem with this they need to grow a pair, phone the Consultant, and state their issue. Being passive aggressive by ignoring the prescription,and making a 4 month old baby suffer, is pathetic.

@Riverlee no. This pharmacy is just down the road and much easier to get to with baby whilst DH is working. They also work directly with our gp and our prescriptions are sent there automatically. Perhaps naively, I didn't think we'd have this much trouble getting a prescription from the GP so didn't make the significant extra effort to shop around. Clearly if I did this again I would do some things differently, but naturally I still think ianbu 😁 and hope to have it sorted one way or another in the next couple of days. I suspect I'll end up paying privately for the mups (dispersable) preparation and speaking to the gp this coming week.

@Riverlee this isn't a conversion about our personal finances, it's about whether it is reasonable to deny or delay receipt of medication a baby needs and which she is entitled to under NICE guidelines. What her parents do for living, earn, or their financial arrangements are not relevant. She's a child who is entitled to NHS treatment for a condition which is causing her (and us) to suffer. I'm not asking for anything she wouldn't already be entitled to, had we waited 4+ months to see (potentially the same) consultant on the NHS.

To answer PP’s previous questions about why what’s available from area to area is different is due to differing CCG’s.

Not all areas have the same pt population, some will have loads of elderly, some will have lots of people with substance misuse issues etc. CCGs can receive funding to tailor services for what the local population needs.

Omeprazole may be recommended by NICE but it depends on what your local formulary and pathways dictate as to what your GP can do. A shared care agreement is also an actual letter filled in by the initiating consultant, then presented to the GP who chooses to continue (most often they do) - it won’t just be in place if that makes any sort of sense.

I hope you can get something sorted soon.