To ask if you've ever successfully challenged a GP refusal to prescribe under a shared care agreement

[OptimismvsRealism]

Debilitating illness - NHS consultant waiting list 5 years - used up significant savings and went to a private doctor who set up a plan - GP says no it's got to come from the NHS and no they won't take your diagnosis and adopt it you go back to day 1 on a 5 year waiting list. The same private consultant btw works on the NHS team that would make the diagnosis.

Cost of the medication to NHS is actually not that much but cost to an ordinary individual on private prescription isn't within realms of possibility.

Is there any alternative?

Oh and the aibu, aibu to despair that the NHS seems to actively want people to suffer?

The private consultant of one of my relatives wrote to his GP and insisted meds be prescribed on NHS. The consultant was pretty annoyed with the misdiagnosis by the GP and the string of pointless/wrong meds prescribed for well over a year.

If the consultant works for the nhs too the diagnosis will be recognised but that is different to sharing care. GPS don't have to do that for nhs consultants let alone private ones.

Most people wouldn't need to go private, if the speed of service was acceptable on the nhs. (Of course some go private anyway through choice). But most of us go private in desperation, for speed, to be seen and helped. We wait and wait on the NHS, get nowhere and then in desperation go private.

If the Doctor Who we see privately is honourable and recognised and does both private and NHS work why can you then not be put back on an NHS waiting list?

The irony is that if they have already diagnosed you privately they know that something is actually wrong. Ie they've diagnosed you. It's confirmed!

and they should be wanting you to get back into the NHS to be diagnosed on the NHS to be treated on the NHS and not to have to continue to keep going privately (unless you want to of course!)

because they've already recognised that something is actually wrong with you by giving you the diagnosis in the first place.

when you think about it, the whole system is absolutely mad!

If you want to choose to or can afford to carry on going privately great. but many people would actually want, having initially been treated maybe privately, to get back into the NHS and have all their care done in the NHS, if it was at all possible .

I appreciate in certain circumstances it is not possible to have a shared care plan. but in some, surely it could, and in many it would be advantageous.

One has to question why it's not been done more.

@ColdinNovember GPs have an obligation to provide NHS General Practice care.

This does not include prescribing anything a consultant (NHS or private) says.

For conditions outside of normal GP prescribing a GP may agree to prescribe inside a Shared Care Agreement. But they do not have to.

My GP has always been clear that she will prescribe what a private consultant suggests as long as it is within normal prescribing practice - eg she will prescribe HRT if you have seen a private specialist but not if the specialist has recommended things outside standard NHS guidelines.

Why is Shared Care not done more? My experience having written two of them is because it takes an enormous amount of time and effort to write the bloody things. Time which in private practice you wouldn't be paid for. I did mine on NHS time but honestly you could not pay me enough to make me write another.

Who are these doctors, who are private? But then their diagnosis aren't recognised? Is it a proper doctor who's been to med school? Or is it some quack / some weirdo who's suggesting you have dandelion and burdock and rub it into your big toenail to solve your problems? (I'm teasing).

If it is a proper Doctor, Who only does private, why would their diagnosis not be taken into account or accepted?

if you've got a private diagnosis with this doctor and then went to see the NHS back specialist / ADHD / ASD specialist etc, surely the nhs doctor would know this other private doctor (they do generally all know eachother).
and hopefully respect their opinion.

if you phone up the NHS and say I saw Dr Jones privately and he's diagnosed me with a bad back / ADHD / ASD etc. surely if they are a decent doctor, the NHS doctor Would, acknowledge their private doctor diagnosis, and take it on board and would want to see you sooner because it's already been established that you do have a medical condition.

How could a nhs doctor not recognise a fellow doctors diagnosis?

There absolutely are private doctors who are completely off piste and doing their own thing.

There are also private doctors who use the opportunity of being private to do stuff that isn't allowed on the NHS - this can be a really good or a really bad thing

And there are private doctors doing exactly what they would do on the NHS only quicker, with a longer appointment and a nicer office

However when a consultant asks a GP to prescribe something, the GP is taking the whole responsibility for the prescription and saying 'but Dr X told me to' is not an adequate defence in court.

I think as mentioned above many people posting don’t actually know what shared care is.

It is an agreement to prescribe and monitor medication with supervision from a specialist and usually specialist reviews at agreed intervals.
It applies to medications which are not started by GPs and where regular monitoring is needed (e.g. blood tests, weight,BP) and if any of the monitoring is outside of agreed parameters they specialist takes back over.

If you decide to stop paying your specialist, you lose private healthcare insurance, the company goes bust, the private specialist leaves then the GP then has to stop prescribing which in itself can have issues with withdrawal and be upsetting if stable and is helping. It might not be apparent also that the private provider has stopped ‘sharing’ the patient immediately and it’s only when something has happened to need to contact them that it becomes apparent.

It is not a case of not recognising the diagnosis. GPs are not questioning the diagnosis here but the clue is in the SHARED of shared care. It means the care of the patients condition is shared between the GP and consultant so while the GP is taking responsibility for issuing prescriptions, the specialist is monitoring the treatment and adjusting doses where necessary.

If an individual has a single appointment with a private consultant who diagnoses and proposes a treatment plan, who do you propose will monitor the treatment if it is something specialist and outside the GP’s usual area of practice? The patient can’t/wont go to the private consultant due to cost then the GP is lumbered with something they do not feel they know enough about. Then what happens when the patient does not tolerate treatment? Or has severe side effects? The GP doesn’t have experience in dealing with it, the private consultant won’t see the patient without them paying and they’re not on NHS books.

The guidance is there for a good reason and people need to remember that shared care is just that - SHARED.

TBF there are some pretty random private doctors out there who behave in ways that wouldn’t be tolerated in the NHS (even though they do nhs work too there is far less oversight).

and has been explained, it is not the diagnosis per se that would be in question, but if the OP can only manage one appointment with the private doc then it by definition NOT shared care and falls outwith the standard shared care agreements.

the private doc should know this and not build up his patients hopes without clear official policies with local GPs (which would be incredibly unlikely to be agreed). If he feels so strongly about her case, then he could upgrade the urgency of her pending referral…

GPs don’t have to accept shared care - whether with NHS consultant or private. Many do. Many (almost all) will do for some conditions but not for others. Depends on complexity of the conditions and monitoring requirements. For example, GPs are very reluctant to take on shared care for ADs for under 16s, but have no issue taking over meds from a dermatologist etc.

you can try your luck with another GP - it really does depend on the practice, not all CCGs have policies on shared care. Some do.

why would you go to Day 1 on the waiting list though? I assume you’ e been on it for a while. A diagnosis shouldn’t throw you back to the beginning.

Or her...

Why would you have to go back to day 1 of a 5 year waiting list? I presume you were already on that list for a while? So why would that knock you back to the beginning again? I don't understand that bit.

I have a shared care agreement - my GP did need their hand holding through the process 🙄 but it was approved! There are lots of helpful documents online (google search) that can help them understand what is actually happening. They aren’t taking over any of your care, just allowing you to get your prescription for NHS price. However, unfortunately they can decline, as it’s their choice. I would move GP surgerys and try elsewhere!! I have no idea why GPs are so hesitant around things they don’t know about, probably because they are so waterboarded with everyday work, they can’t find the mentality to look into something new!

Not sure why the eye roll

If they are signing the prescription then legally they are taking responsibility which is about as ‘taking over’ as is possible.

The policy has only just changed (post my diagnosis).

I guess my next thought is that this is incurable and my quality of life is very poor as a result. I appreciate there's probably no solution on the NHS and because we won't ever reform the NHS because it is the national religion I have no prospect of ever being well. I would consider euthanasia. Obviously that's not available in the UK but it is in Switzerland. So now I'm thinking how do I beef up my medical records to make a good case for that. If I'm on a neverending NHS waiting list will they refuse me? And, very much separately but, actually if I'm on a neverending waiting list is travel insurance impossible because I'm waiting for a referral?

Honestly this era is more nightmarish than I had expected.

Posters before me have already explained all of the potential reasons for your GP declining to prescribe. I would just add that the decision is also not always even down to the GP. There are many drugs which simply cannot be prescribed in primary care via the NHS in each area. What’s available in one area (under one Integrated Care Board) may not be available 5 miles down the road under the next ICB.

There’s a tendency to assume a GP just can’t be bothered to prescribe or is annoyed that you’ve seen a private Consultant. Neither of these are true.

OP how much is the prescription privately?

You're not being unreasonable but you can't force them unfortunately. Depending on what it is sometimes they don't feel "comfortable" prescribing stuff (translates to, I'm not getting paid enough to prescribe this controlled drug I don't know very much about)

You could try and change GPS?

I understand it's a policy across the entire health board area now. Wondering about moving. But also thinking what's the fucking point. All this effort to make myself well enough to get up in the morning to work to pay taxes for another 30 years. Why fucking bother.

It is if they're prescribing under the specialists direction. That's exactly what it means. The specialist remains responsible for the care. Check ups etc.

The ignorance and entitlement on this comment is astounding, hopefully a wind up but the way many people act probably not.

They can prescribe under shared care with a private provider but they don't have to.

Honestly, it sounds like you thought you could beat the system because you could afford the private consultation. This used to happen a lot, especially with operations. They paid for the private diagnosis then jumped the queue. It's either/or, not both.