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 common misconception that NHS Consultants are doing private work when they should be in the NHS hospital! No they are not! It doesn’t work like that. They have to fulfill all their contracted hours for the NHS. What they do in their own time is no one else’s business.

That makes sense @Floraflower3. Still doesn't make it right and I struggle to see how something which is clearly needed and recommended at a national level could be denied at local level, whether that's because of budgets or politics.

@lawandgin These days it's really unusual for a pharmacy to make suspensions Most know how to do it, but for various reasons, often insurance related or related to lack of correct facilities or conditions in a high street pharmacy, "specials" such as omeprazole are obtained from a company set up to make non standard items . The DH had a look at these a while ago to try to ensure value for money.
They are definately not sale or return. The short expiry date and the specific dose eg related to baby's weight, make them unusable elsewhere.

That’s not true. The doctors are not beholden to consultants - gps make their own clinical decisions as to who, what when they write prescriptions for. They may not agree with the consultants recommended course of action, or have expertise in that area to prescribe that medication.

Thanks for the heads up @RainingYetAgain - good to know I have another potentially difficult conversion to have tomorrow. FFS!

Right so if they disagreed with the Consultant’s diagnosis then as I said they need to contact them and state why. If they have an issue with a certain prescription they also need to contact the Consultant and state why. That’s called being professional, ignoring the patient and doing sweet FA is being unprofessional, and could result in not only a complaint from the patient but a professional complaint from the Consultant too. No point in causing a storm when an adult intelligent conversation would do.

What doesn’t seem right about ensuring services, medicines and local pathways offered are the most suitable and cost effective for the local population?

Omeprazole will probably be on there but Will need to be prescribed as per your local pathway whatever that is. I tried looking for a local paediatric formulary to no avail.

NICE makes lots of recommendations but they can’t be implemented everywhere for everyone due to cost.

As someone who had a baby with awful reflux I feel for you but you are being a bit too pushy.
firstly the good news is that babies with reflux will improve dramatically with age usually between 3 and 6 months.
It is really important to make changes in a stepwise fashion so that you can see what is actually working.
so dietary modification for two weeks, you could try gaviscon duo balanced out with a laxative then omeprazole as a last resort. Have you got the cot propped up with books and/or a wedge, avoiding car journeys , bouncers etc

I think we should try and give the GP some benefit of the doubt that they are probably rammed with work.

I know this will be very distressing for OP and her baby and this will be a high priority for OP but in the context of everything that goes on in surgery I can well believe they haven’t had the time to look through the letter yet.

@Floraflower3 it doesn't seem right that a baby would be left suffering when there is a medication that would help her, just because of where we live and the local population make up. I doubt people would think it was okay if there was a significant difference in the cancer pathway just because they happened to live in an area with a lower overall incidence of cancer.

But that conversation will take time to happen. Both consultant and GP are busy and can’t just drop everything for one case.

@olympicsrock please read the full thread. We've tried everything medical and non-medical and to date, nothing has worked.

Yes busy or not they have to do right by the patients, I get it if the GP is planning to make that phone call and just hasn’t done it yet. But just ignoring and doing nothing is unprofessional and will come back to bite them on the arse.
Also the Consultant on that phone call is just likely to state that they don’t request prescriptions unless they are clinically needed.

Ah yes of course, you must be loaded!

My parents had to help out with £ to get my DD diagnosed after GP ignored me for months and now the GP assumes I'm loaded and can afford to keep going back to get her treated which I can't.

The only reason she ended up in A&E was because she was so poorly after they'd been dragging their feet about helping her, now they're taking it seriously and have done urgent referrals to a paediatrician and specialist department.

Hope your baby is OK, reflux is horrible. The GP was happy to prescribe my DD omeprazole when she was newborn but wanted her to try Gaviscon for a few weeks first

Oh god you have my utmost sympathy OP - I was in your shoes with DD, and I understand the difficulties you are having with your baby. Reflux crying, the vomiting etc are all dreadful and I’m afraid to say did push me into PND.

all I can suggest is that you keep on at the GP - be the squeaky wheel - we used The same medication and it helped massively, I can’t say that it was habit forming although we did step the dose back carefully once she was up and walking, took us a few months to ‘wean’ her off the drug (I can never remember how it is spelt!).

as for bobbing between private and NHS - as a family we have done this in the past in London and it wasn’t an issue - it’s been a few years since we did this and things may have changed.

(also I can back up the OP’s claims re not being loaded as a lawyer - both myself and OH were fairly junior lawyers when DD was born and I can confirm the pay is crap, I’ve mentioned before that in the first year of OHs practice he didn’t earn enough in fees to pay income tax, but had been out at court every day - such is the life of the junior criminal bar)

I don't know weather this has been mentioned but my baby had the exact same problems he wouldn't take the omezoprol but once he was on prescription formula he didn't get constipated with gaviscon so it could be worth trying again with that he's two now and still sometimes needs the gaviscon x

The GP might be under the impression your baby has 6 weeks of medication, as prescribed by the consultant.
It's sensible for the Gp to wait 6 weeks to do a medical review.
Can't see how it's the GPS problem that you went privately but didn't get the prescription filled due to cost .

Unfortunately I agree with this. Try sending your husband. I was ignored and knocked from pillar to post trying to get the CMPA formula prescription from my. I toom a slightly different tact and asked to be referred to by Dr ( I am an academic with a PhD not a medical doctor) but it made them stop messing me about. I find it so irritating and stupid that they can be so dismissive of "overbearing' mothers. Ironically I teach in a medic school and this is something that is addressed with med students, the importance of the instincts of the primary carers are highlighted but apparently forgotten when they go into clinic. Sorry for rant.

OP I also agree with dazzledee that it is likely with time on the presecption formula the reflux may treat itself. My sons reflux and excema were completely gone once we got his allergies under control and if he has an exposure now these alongside mucous nappies will be the first sign. Hopefully he gets better soon.

Thanks @FrenchFancie 💗 I'm so sick of people assuming we're loaded and choosing to completely ignore the fact DD is a CHILD who is entitled to NHS treatment, which she desperately needs. I'm fighting so hard to stay on the right side of PND but every day is a struggle. She's just puked all over the floor, despite her last feed being over 2 hours ago. This happens multiple times a day and makes it really hard to get out and about, which I think we can all agree is really important to combat the loneliness (and sometimes monotony) of mat leave.

@Coffeaddict sorry you had this experience, I can't believe this is still happening in 2022. May have to try sending DH even though it will infuriate me if he gets the result, but so be it if it gets DD what she needs.

@Laurapb88 she was on prescription formula and gaviscon. Even a half dose had her ridiculously constipated to the point of rectal bleeding.

Omeprazole comes as a powder that the pharmacy makes up themselves, it’s only manufactured by one company and the trade cost to the pharmacy is £101 for the 10mg strength per 75ml and £196 for the 20mg and then whatever the pharmacy charges for their fee on top.
I work in pharmacy and we have quite a few patients on omeprazole so we always keep it in stock but I can see why some pharmacies wouldn’t, it’s expensive to have just sitting on the shelf just in case.

@whowhatwerewhy you think it's sensible for a gp to ignore the fact a parent has contacted the surgery 3 times to request medication which the parent has specified the child does not have because she can't afford to buy it. Is that really what you're saying? Fuck me.

@Changingmynameyetagain that's super helpful, thank you. She's been prescribed 10mg so £400 is absolutely ridiculous.

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.

I don't know why you'd think this is anything other than the bank holiday causing the delay. They thought it'd be done on Friday, but as we all know Fridays can run away with us, esp before a bank holiday, so when you check in with them on Tuesday and there's every chance it will be sorted. Understandably you're strung out and stressed about your LO suffering, but so far it's barely been delayed at all by NHS standards, the receptionist and pharmacist are being helpful, and you do have a way to get it if all else failed so it's not life and death like some meds. Frustrating that these things always seem to convene around a bank hol, but fixating on their 'two day turnaround' rule/aspiration isn't going to help your MH, worrying about ulterior motives, when there's nothing you can do until tomorrow. Hang in there and soon it will be sorted.