Why do you have to beg doctors sometimes to do tests? Or is my experience unusual?

[ReenaGee]

I am under neurology for right sided weakness, and hyperreflexia. Ruled out MS and spinal issues with MRI and NCS. Appt time to see neurologist for follow up is 45 weeks (argh). Neuro letter even stated I needed bloods. So won't see neuro until then. Tried my GP and asked to consider deficiencies and ask for blood tests. They sent the footfall form back and said no, neurologist has to order it. I booked appointment again stating anxiety over symptoms to get an appointment and they then, told me I have health anxiety and wouldn't order bloods. This was a few weeks after first appt and symptoms the same. A few weeks later booked another appt, weakness the same and can't think properly. Again, told likely fnd or HA and to get counselling. Booked a private blood test as getting fed up, cost me over £100. B12 and folate through the floor (like really through the floor). I take B12 daily so will need injections as clearly can't absorb it. GP ordered their own tests so they have NHS ones which showed the same. I don't understand why I had to beg in my final appointment. Is it normal to refuse to do anything when under another specialty, even routine stuff like bloods?

That's absolutely ridiculous and it's a massive issue in GP surgeries and causes terrible consequences. You shouldn't have to, but can you call your consultant's secretary and ask them to write again requesting the bloods are done?

In a lot of cases the billing goes back to the service that ordered it. As does interpreting the results, and managing the follow-up.

So there are valid professional and budgetary reasons for things to be requested and managed by the service that needs them.

GPs are no longer funded to do bloods ordered by a hospital specialist. They need to be done at the hospital. It sounds like they are each passing the buck. Now you know you have deficiencies, your GP should be doing something about it.

It is a political issue that unfortunately you have been caught in the middle of. Some hospital consultants use GPs as their community house officers and want them to do various work for them for free. This has caused a push back from GPs - if the consultant wants bloods, the consultant should request them and importantly deal with the abnormal results that follow. It is rubbish for the patient stuck in the middle. But if GPs spend all day doing unfunded work then they will go out of business.

It's bonkers because you can't just call the neurologist to ask them to order bloods (I've tried!)

Thanks for explaining this. It makes sense.

When I needed bloods for a neurology investigation they wrote and told my GP to do them and they did. Sorry to hear this has changed.

My child is under various medical teams and they request the bloods at the time of his clinic appointment and give me the form. Which is what your neurologist should do. Plus also, can you imagine if everyone that decided they needed bloods got them it would cost a bloody fortune.

Honestly I didn't even care who did them I just didn't want to be £100 out of pocket!

Surely everyone they decide needs bloods should get them? Or do you mean from GP?

The neuro secretary should be able to
follow up it neuro have actually said they need them.

(Vs that they will need them once you get to the top of the review pile).

Oh I mean from the GP, not from consultants. But if the medical team have decided you need bloods they should sort it out, not pass it off to the GP, it’s not very fair and the funding is different as someone else said.

I meant, the general public just deciding they need bloods, it’s always said on here, demand a blood test. Well, no….

Oh yeah of course. I was just following what the neuro letter said. His secretary said I have to wait for appointment. If I had, I could have ended up with permanent neuropathy.

I’m sorry this has happened to you op. Something similar happened to me and I’m now permanently disabled due to it.

the lack of communication between hospitals and gp are dreadful

It's terrible op! The communication is so bad between the services. When my folate was extremely low I had all sorts of weird symptoms, felt so much better when the level got back up to normal so fingers crossed it'll be the same for you.

I'm a hospital consultant. If your neurologist thinks you need blood tests, then they should organise them i.e. send you a form and follow up the results. That's what I do, and that's what is supposed to happen.

The neurologist is not someone special.

As I was reading the beginning of your post I was thinking b12 deficiency.

I’m glad they’ve identified it.

Just to make you aware, if you’re not already, many GPs don’t stick to the NICE guidelines. You need injections every other day until symptoms disappear. I have heard of several instances where the GP
does EOD injections for 2 weeks and then send you on your merry way, with a view to inject once every 12w.

Good luck. It’s completely exhausting having to battle for adequate care.

There’s been recent push back from GPs about doing blood tests ordered by specialists. Specialists are supposed to order the tests themselves. This is less than practical for me as a community psychiatrist who does not operate out of a hospital where a blood test could be done but those are the rules. GPs have been carrying out ‘work to rule’ type industrial action recently and have stopped doing anything above and beyond their contract. I now have to ask confused frail elderly people to attend an unfamiliar clinic a long way from home if they need bloods or an ECG. So much for devolving medicine into the community…

Hi I have just read this thread and how you have right sided weakness, I have right sided weakness for the past 3 years as a seizure, I have been passed from pillar to post, I have seen neurologist twice and been discharged now. I am currently under rheumatology as I also have joint pain and swelling going on but they aren't proving much help 😔.

Can anyone explain about B12 for me and what should the level be and what issues it can cause if too low

Many thanks

Sorry I don't know enough to advise you. Can't imagine it causes seizures or joint swelling though. Hope you get to the bottom of it!

That’s not exactly what the NICE guidelines say.

It depends on the reason for the deficiency,

@ReenaGee unfortunately many hospital consultants push their work back to GPs. If a hospital doctor requests blood tests, then they should be doing and reviewing those bloods.

Technically GPs aren’t contracted to do most secondary care work. We often do it anyway to benefit the patient, but really the consultant should be requesting the bloods, directing you to hospital phlebotomy services, and reviewing the results.

But if you didn’t the GP practice would be £100 out of pocket instead. I know it’s frustrating but it’s a funding issue rather than a lazy GP issue

It's all about funding. My GP surgery loses £5 / £6 for every test. They do c. 15,000 a year.

This is correct . Also a hospital consultant. This was cheeky of your neurologist . They needed to arrange for you to have the bloods by requesting them so that you can make an appointment at the phlebotomy clinic. The test comes out of the secondary care budget.

Sometimes if a patient lives a long way from the hospital I will write a letter to the patient and GP, saying that I have requested the bloods and could the practice nurse take them. That way the GP funds the blood taking appointment but my service pays for the test to be processed and I am responsible for managing the result.

It’s about time and expertise not just about money .