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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Original poster

To think this isn't ok (NHS)?

37 replies

Sapphire387 · 01/04/2023 16:54

DH took DSD to the walk-in today. She gets recurrent low-level bladder infections and is under the care of the paediatrician for some longer-term bowel issues that might be pressuring the bladder. GP normally prescribes antibiotics as and when the infections occur. DH tries to get it nipped in the bud ASAP when it occurs - we noticed the issue last night so he took her this morning.

She has her usual symptoms - her urine smells and she has a little bit of leakage now and again. She is well otherwise - they checked all that stuff. No fever, no pain, etc.

The nurse practitioner acknowledged the infection and refused to prescribe antibiotics without sending her to A&E. She said she knew what she needed but wouldn't prescribe without speaking to a paediatrician because she is already under their care.

AIBU to think this is a waste of time and resources? DH said well can't you just prescribe now for over the weekend (as the GP normally prescribes), and I'll call the GP and/or hospital on Monday to follow up for her longer-term treatment plan? Apparently not, they won't prescribe.

There are no concerns around DSD being seriously ill, all her observations are normal etc. It is neither an accident nor an emergency.

He says he'd rather wait until Monday than take a 'not very ill' child down to the hospital emergency department for a simple prescription and have to wait twelve hours or however long it is these days.

AIBU to think no wonder the pressure on A&E is so huge when the 'lower levels' of healthcare are failing in this way?

OP posts:
strawberryjeans · 01/04/2023 16:56

That’s crazy

Blort · 01/04/2023 16:57

Yanbu thats absolutely bonkers. Can you wait there and asknfor a second opinion?

MarshaMelrose · 01/04/2023 16:57

Is it because they're trying to minimise the use of antibiotics?

Original poster
Sapphire387 · 01/04/2023 16:59

MarshaMelrose · 01/04/2023 16:57

Is it because they're trying to minimise the use of antibiotics?

I don't know... but they acknowledged she should have them. We're currently dosing her with large amounts of water and some d-mannose powder. Of course if she gets any pain or starts feeling unwell we will take her somewhere else to be seen. It's just so tedious and unnecessary in my view to be going through this.

OP posts:
maddening · 01/04/2023 17:01

I would call 111 and ask for the ooo gp rather than a&e - that way you at least have an appointment

Blossomtoes · 01/04/2023 17:04

Maybe your GP would prescribe you a “just in case” course now? It’s crazy that the walk in wouldn’t prescribe.

Theluggage15 · 01/04/2023 17:06

When my daughter was small she had recurring urine infections. Paediatrician said she’d grow out of it but was very important to give antibiotics as soon as infection started. She had a repeat prescription at the doctors so I could just phone up as symptoms were so clear. This sounds a lot of palaver that you’re being made to go through.

MarshaMelrose · 01/04/2023 17:08

Sapphire387 · 01/04/2023 16:59

I don't know... but they acknowledged she should have them. We're currently dosing her with large amounts of water and some d-mannose powder. Of course if she gets any pain or starts feeling unwell we will take her somewhere else to be seen. It's just so tedious and unnecessary in my view to be going through this.

Show quote history

I do understand. My mum had a uti on a Saturday and her esidential home rang 111. She got 7 days of ABs. The home were amazed she got such a long course. They said it's easier to get on a weekend than during the week. Could you try 111?

AnotherVice · 01/04/2023 17:10

The nurse practitioner probably has very specific and limited prescribing abilities and can only give them out for simple, non-recurrent UTIs, which this isn't.

Moraxella · 01/04/2023 17:11

She’s being cautious as your child is under a paed for a long term issue. Prob doesn’t want to deviate from their management plan. Might not have access to previous culture and sensitivities.

Original poster
Sapphire387 · 01/04/2023 17:11

Blossomtoes · 01/04/2023 17:04

Maybe your GP would prescribe you a “just in case” course now? It’s crazy that the walk in wouldn’t prescribe.

This is actually a really good idea, thank you. Hadn't thought of that at all. I will mention to DH to ask them on Monday.

(And before anyone says it, I know antibiotics can be over-used but we're really trying to get to the bottom of the underlying issues and we do clearly recognise the signs ourselves when she has another infection!).

I'm just sad for her - it goes on and on, she's nearly nine and it's 'embarrassing' for her in front of other kids etc. I really hope we get this sorted properly soon.

OP posts:
Blossomtoes · 01/04/2023 17:16

Hope you get to the bottom of it soon. It must be miserable for her.

StressedToTheMaxxx · 01/04/2023 17:24

Moraxella · 01/04/2023 17:11

She’s being cautious as your child is under a paed for a long term issue. Prob doesn’t want to deviate from their management plan. Might not have access to previous culture and sensitivities.

This will be it, nothing more to add really.

Thepeopleversuswork · 01/04/2023 17:27

It does seem absurd and is an example of the kind of utterly pointless bureaucracy in which the NHS specialises.

As you say it’s inevitable that she will eventually be prescribed antibiotics and they aren’t dangerous drugs. I can’t see any logic for it.

TeenLifeMum · 01/04/2023 17:30

Nurse prescribers have a level of autonomy and risk they can take. Junior doctors have similar but then a registrar or consultant can take additional risk. So without a fever the nurse hasn’t met the criteria needed to prescribe antibiotics.

Yes it feels a bit mad but it’s about patient safety on a wider scale.

TeenLifeMum · 01/04/2023 17:31

Call 111 and explain, they can get you a gp phone call and they should be able to prescribe.

Lastnamedidntstick · 01/04/2023 17:32

Moraxella · 01/04/2023 17:11

She’s being cautious as your child is under a paed for a long term issue. Prob doesn’t want to deviate from their management plan. Might not have access to previous culture and sensitivities.

Agreed.

probably doesn’t want to prescribe an inappropriate or ineffective ab when paeds are already investigating.

rather than a waste of time it’s probably more effective to do this and get the treatment right first time.

Shopper727 · 01/04/2023 17:37

She could phone the paeds ward and speak to whoever is on for the weekend who could review her notes and advise accordingly though I mean if I don’t know (as a nurse) I ask someone who might….if they don’t know at least you’ve tried and then next course of action is a&e but there should be some way of phoning ahead to give them a heads up, she’s seen your dsd and advised you to go to them for x reason as I am sure they will check the system for notes from paeds and likely get someone to see her, you could cut out a&e if only the nurse could call them to ask - they might see her directly on the ward or ask her to prescribe x antibiotics and note on her file this has happened for her next paed apt.

Original poster
Sapphire387 · 01/04/2023 17:37

Those of you saying they might not know which one to prescribe... I do take your point but they pulled up her record and could see what she'd last had (in January).

I guess next time we'll avoid this particular walk-in and call 111 and try to get an OOO GP appointment instead if need be, as others have suggested - thank you.

111 call handler keeps saying they won't go against clinical advice to go to A&E - i do understand why they would feel nervous. They have offered a call back from a doctor at some point though, so fingers crossed.

OP posts:
JussathoB · 01/04/2023 17:59

In a nutshell this example shows the way the nhs seems to be constantly tying itself in knots and making everything extremely long winded and inefficient. The systems which are trying to do things very carefully and properly are very slow, use excessive resources and are becoming so complicated that half the time they can’t actually be followed successfully. Never mind the poor patient getting worse or being in pain.
Things have to work on a practical basis.

MarshaMelrose · 01/04/2023 18:04

JussathoB · 01/04/2023 17:59

In a nutshell this example shows the way the nhs seems to be constantly tying itself in knots and making everything extremely long winded and inefficient. The systems which are trying to do things very carefully and properly are very slow, use excessive resources and are becoming so complicated that half the time they can’t actually be followed successfully. Never mind the poor patient getting worse or being in pain.
Things have to work on a practical basis.

I said something similar on another thread. It's the admin in the nhs that causes everything to be so slow. It's just so cumbersome and inefficient.

Not saying that's the problem here, though.

Blossomtoes · 01/04/2023 18:22

TeenLifeMum · 01/04/2023 17:30

Nurse prescribers have a level of autonomy and risk they can take. Junior doctors have similar but then a registrar or consultant can take additional risk. So without a fever the nurse hasn’t met the criteria needed to prescribe antibiotics.

Yes it feels a bit mad but it’s about patient safety on a wider scale.

I can’t see the patient safety aspect. An unnecessary course of antibiotics would hardly be dangerous, there isn’t a risk, they weren’t asking for industrial quantities of morphine.

TeenLifeMum · 01/04/2023 18:25

@Blossomtoes unnecessary course of antibiotics has a huge safety issue. Multiply by millions of time a year and we’re now in a position that many infections are antibiotic resistance. We could all be wiped out by infections that years previously we could treat. Therefore, prescribing antibiotics is controlled and set criteria. Nurse prescribers must follow the guidance.

eatdrinkandbemerry · 01/04/2023 18:28

My daughter gets lots of severe ear infections (so bad her eardrums oooze perforate and green gunge flows down her neck!
The last time we took her to the walk in centre the doctor wanted her admitted to hospital as it was so bad,she was literally arguing with the hospital because she is already in the system for her ears they wouldn't admit her they would send her the next available appointment that was 14 days away!
The doctor told me to take her straight to a and e and refuse to leave until she was admitted to a ward and placed on an antibiotic drip.
We followed this advice and she spent 7 days in hospital.
Honestly it's a shitshow and absolutely disgusting that they would leave an 8 year old to suffer.

myoldmansatrendydustman · 01/04/2023 18:29

OP,
There is a protocol in healthcare.
The nurse cannot treat someone who is already under the care of a specialist.