To think this isn't ok (NHS)?

[Sapphire387]

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?

A nurse practitioner has to follow guidelines and cant go out of the guidance.

Whereas a qualified doctor can bend the rules and generally has more experience. As long as they can defend their decision they are ok.

Unfortunately the lack of doctors and due to costs, meant you saw a nurse practitioner rather than a doctor who can practice outside the guidance. Because that's what the guidelines are- only guidance.

Same with 111. They have to follow their protocol.

That's why they ask you yes and no questions so they can risk strategy you. And ask random questions tgat have nothing to do with what's wrong with you.

Whereas a qualified clinician would just say- what's wrong, or how can I help? Again costs and lack of doctors.

@Blossomtoes except increasing the chance of resistance in someone with repeated uti?

Its costs.

It's cheaper to do it this way than have everyone see the appropriately qualified people first time.

The NP would have sorted out enough patients to make it more cost efficient to employ an NP than a doctor.

It’s probably on her PGD. They don’t have the same free rein as doctors, they have to follow a set of specific instructions.
I get that it’s frustrating though

She had access to the patient records and agreed that the antibiotics were necessary. She just refused to prescribe them. Anyway, hopefully the GP will agree to prescribe an extra just in case course for this kind of eventuality and the problem won’t arise again.

This is ridiculous, no wonder there is am increase in debilitating embedded/chronic utis. It is not safe to leave utis untreated.

The nurse followed the correct procedure.

If she had prescribed an antibiotic and the child had suffered a delayed reaction to the drug she could have compromised her Nursing Registration.
Protocols are there to safeguard patients.

There is also evidence to suggest that repeated courses of antibiotics can give rise to resistance to the drug.

@Blossomtoes
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.
The safety aspect doesn't come with the giving of antibiotics, it comes with potentially missing something more serious like pyelonephritis. Just chucking drugs at people who request them would be failing in their duty of care.

@Sapphire387 I had recurrent UTIs and was put on a prophylactic dose of Nitrofurantoin. This helped my immune system recover from recurrent infection and I then managed to stay symptom free for many many years. Recurrent UTIs are worrying, painful and exhausting - I really would advise at the next paed appt you ask about this as a preventative measure or you ask for anti bs prescription so you can get them when needed.

Hope your DD gets what she needs and soon recovers.

Thank you very much. This is helpful to know. I'm glad it helped you and definitely something for us to consider.

@Sapphire387 Sorry to re-start the thread after quite a long time but just wondering how your daughter is doing now? Our daughter has been suffering from something similar over the last few months and may go down the route of prophylactic antibiotics.

I had a similar experience!
Went to walk in center because we couldn't get an appointment for our daughter (was awaiting operations on ears nose and throat and told to get antibiotics at the earliest opportunity).
But in our case it was so bad the doctor at the walk in center wanted our daughter admitted to hospital because of the severity of the infection and the hospital refused because my daughter was already in the system and already had an hospital appointment booked for three weeks time!
The walk in centre doctor prescribed the antibiotics but insisted we got to a & e and refuse to leave until she was seen.
Bless her she was proper arguing with the hospital and wrote us a letter for accident and emergency.
She also put a formal complaint in on our behalf due to her utter disgust with how our daughter was being abused by being made to wait for treatment due to their policy!