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?

In that case do compare costs with multiple pharmacies but also, have you had a look at the shared care agreement yourself? Does it cover the drugs you are taking? Are you still seeing your private consultant?

There is a chance you could get the GP to reconsider/see another one or change practice if you are currently under the care of a private consultant who is overseeing the treatment and it is exactly what the NHS would have offered and is covered by shared care guidance. Did your private consultant sign the document and send to the GP?

No it doesn't?

Op is likely still on that waiting list. She isn't an additional person.

She's the same person she'd be if she'd waited on the list.

I have found tho a lot of services will still make you wait to be seen again, to get the same diagnosis, again. It's a waste of NHS time and money.

What do you propose people actually do? Simply die waiting?

@StormingNorman
Why can’t the NHS interact with private consultants. It’s ridiculous that a GP can disregard the opinion of a specialist who you only see because the GP doesn’t know how to treat you!!!

Actually it's often that the GP'S aren't allowed to prescribe certain medication. I've been trying to get access to some fairly new medication recently. Currently though in the NHS only consultants can prescribe it, so I either have to wait on and an NHS area who keeps telling me they have no funding for this drug or go private. If only the consultant would initiate the prescription (which would come out of their funding) then the GP could issue it. But the GP can't prescribe it as it's a consultant prescribe drug only, even though my GP would happily give it to me if she could.

@MigGril in my experience, the NHS does interact with private consultants and does accept their diagnosis but whether they continue treatment depends on how specialised it is, funding and restrictions (as you are experiencing). They need to feel comfortable prescribing it, monitoring and dealing with any issues that may arise.

I have had one of my DC diagnosed with a common condition privately due to excessive NHS waits for a paediatrician and the GP had absolutely no qualms initiating recommended treatment following a confirmed diagnosis because it is a drug which they commonly give to children.

What do you mean here by baby boomer? Why not go private if he can afford it?

Beat the system? You mean try to get healthy and live a full life?

Disregarding a private opinion. Well, depends. A GP may feel uncomfortable and decline puberty blockers, but be ok with a strong steroid cream etc. Bottom line is, it’s their registration on the line. You can’t force anyone to share care. The specialist can refer you to their own NHS list, or someone else’s. Then you’ll be happy to be under both specialist and NHS care and not pay for treatment.

There's no question about the medication, it is the standard treatment. If I'd been diagnosed 6 months earlier I'd be getting it from the NHS. It's a new area policy and exists only to choke medications. Denying people medication they need to save money.

OP, if you want problem solving you might be better off posting in health with a specific condition/medication. I imagine there are many in your position and if the condition is chronic and debilitating people would have developed life hacks how to navigate the health system.

@prescribingmum the issue I'm having is GP'S can't prescribe these drugs not under NHS guidelines. They maybe able to do in years to come but not currently as they are so new. So unless the consultant will prescribe them, I will have to pay privately for them as my hospital says they have no funding.

That's after a diagnosis and access to a hospital clinic and me failing all other treatment options. Go our wonderful NHS. They are paying for this treatment in other NHS areas, just my luck not mine. Actually it's not just this area but just my luck got stuck in one that isn't currently funding this treatment.

Gosh that is so unfair and frustrating. It makes so sense to me why the "rules" aren't blanket. It shouldn't be a bloody postcode lottery it's ridiculous

But this has nothing to do with shared care as such. More with formulary policies. In any case, if it’s actually standard and according to NICE protocol, I can’t see why this would be an issue. In any case, if you want to rant, rant away, yes, NHS is fucked and not fit for purpose. If you want solutions, see my earlier post. I think you are unlucky with your GP practice/NHS trusts. Many trusts do actually allow consultants to add their private patients to their NHS lists and 5 year wait is rare.

OP, it’s not cost saving. GPs will prescribe medication worth ££ if it’s through the usual channels. It really isn’t cost saving.

Why else would they deny it if it's a standard treatment, same consultant? Why would they make that rule in the icb?

GP's are not allowed to prescribe under Shared Care Agreements from Private Consultant's. This is standard across all ICB's who set the guidelines for this, so is not a case of GPs choosing to not prescribe. It is in their contracts not to accept private SCA's. There are many reasons, but essentially this is to stop GPs being left prescribing medications which need monitoring but the patient stops seeing a private consultant especially when a patient moves areas.

Not all icbs forbid it, so plenty are allowed, and regularly do.

Have you read the thread? Because a one-off paid for consultation where you’re given hope but no follow up is not the same as being prescribed and stabilised for 3-6 months on a medication and then asking the GP to take over, if they feel able to. With monitoring and contact with the private doctor. What happens when you develop side effects? The private doctor won’t see you if you don’t pay. People always look for blame and compo and it will fall on the hapless GP.

I have read the thread, op has clarified that's the case. Have you read the thread?

In my case a number of GPs didn’t know what was wrong and at last count I had seven very similar diagnoses because every time my symptoms changed they added another diagnosis to the list. And I always asked “is this an instead of” but it was always an “as well as”.

That was why I went private (not even private really - Benenden) to get a diagnosis. GPs literally had no idea what was going on and nothing they tried was working.

But I’m now in the same situation as you. The consultant made a diagnosis, recommended a treatment which has literally changed my life and I’ve been told my GP is unlikely to repeat the prescription because it’s too new and too expensive. £230 per month. So my only option will be to pay out of pocket. Which I am fortunate to be able to do, but frankly, why should I?

I don’t know how ICBs work, but at the end of the day GPs are independent practitioners and you can’t force them to treat you the way you want if they’re practising within their limits.

And what about when the consultant is prescribing in line with NICE guidelines for your local trust and it isn’t morally contentious? The reason the GP gives is price. Equally, they have tried and failed to diagnose and treat over a period of years.

I will be asking my GP to refer me to an NHS consultant but what a waste of money for the NHS to pay for an appointment when I’ve already paid for one. And what a waste of a space on a multi-year waiting list.

@StormingNorman what do you mean “too new”? Is it not in the BNF? Does the BNF say specialist only, or have other restrictions? General question, you don’t have to give personal info.

To take the example of melatonin. It’s cheap as chips and available over the counter in many countries in Europe. Yet here it’s highly guarded. I don’t have an answer for this, but the ire is mis-directed IMO.

I'm going to guess this is ADHD meds.
It's always that.

I'm a GP so maybe I can answer this. It's about risk. When we enter SCA, we rely on the specialist being immediately available to deal with results that are abnormal or to help with dose adjustments etc. We are not allowed to prescribe certain medications off our own backs. In the NHS for example, if 1 rheumatologist is on holiday, they have a team that provides them cover.
In private scenarios, we cannot send results to a consultant and expect a response quickly (as often the consultant does NHS work too and isn't available) There's much less likely to be cross cover and the consultant can retire/ leave the country/ drop ded which would leave us with no back up at all and practicing very unsafely.
The patient can also run out of money and decide they're not going to see a secondary care doctor again (again leaving us responsible and really damaging the dr/patient relationship by putting pressure on the GP to prescribe)
So the vast vast majority of GPs decline shared care with private providers as the back up just isn't there and these are usually meds that are beyond our comfort zone (hence why a patient has seen a specialist in the 1st place)
The whole system sucks currently so I get the frustration but it's not a safe way to practice.

*ThirstyMeeples *

I agree. DD works in a pharmacy and the number of normal weight woman who have been prescribed weight loss meds is unreal - they pay£150 per prescription and there is no way a GP would prescribe these, there aren’t monitored. Makes me wonder what pharmacists think about these prescriptions.