“Get to from the pharmacy” message from GP

[itsgettingweird]

I’m not sure if IABU or not?

I have a chronic incurable rare neurological condition. I take a medication that causes constipation as a side effect.

When first started the medication I struggled and the GP prescribed a macro gel and said if it doesn’t resolve they would need to investigate further.

On the whole it resolved and I have needed laxitives a few times but I’ve just got OTC stuff for occasional use.

I’ve recently had to up my medication a lot and suffering chronic constipation again and so did an e consult asking for another prescription.

Message came back “you can buy it from the pharmacy”.

The reason I’m not sure IABU or not is I know that and support it for occasional use but this is a chronic problem caused by a medication I need and will need long term. I pre pay prescriptions because of the cost and the OTC cost for the macrogels is higher than a one off prescription cost even for generic branded products.

Before I go back and challenge this I thought I’d garner the thoughts and opinion pf a wider audience.

So my question is “AIBU to expect a prescription for a medication I need long term for the side effects of a medication I need for a chronic health condition?”

Doctors have a mistake if prescriptions that they are allowed to prescribe by the local NHS trust. Perhaps what you asked for is one they are not allowed to prescribe?

It’s exactly what they prescribed me before! Prescribed for the exactly the same reason I asked for this prescription.

As far as I can tell that is one of the pre-set messages that the AI who has replaced our GP comes out with in turn.
It seems to be set so if you mention pharmacy it's more likely to choose that response.
"I've been to all the local pharmacies and none of them have the prescription in stock or can get it to order."
"Try the pharmacy".

Either that or the doctor's exams needs to include a basic comprehension test, because that should be coverable at about age 6 work.

This is what I got in response. Only just realised it’s strigol so they haven’t even spelt it correctly. Which does beg the question that they even read it!

As a GP I would prescribe this and have it on a repeat for when you need it so you can manage your chronic condition. If someone had constipation as a one off I would advise go to the chemist to discuss a treatment.
In my opinion the price of over the counter medication is so high it makes it unaffordable to many - £15 for a thrush treatment £14 for 7 tablets for heartburn and the cost of some of the more popular laxatives - this makes people opt for health centre appointments as the get free prescriptions or prepayments.

Thanks @Pixie2015 it’s good to get the opinion of a GP.

Im on verapimil for chronic cluster headaches and as of tonight’s ecg am now dose of 980mg a day and as you can imagine its really affecting my bowels!

i do actually think a system whereby necessary repeat drugs only are under prepayment would be a reasonable compromise - I’d be more than happy to pay a prescription cost for antibiotics etc if I ever needed them but I cannot find £20 a month for 60 macrogel sachets for a problem caused by a necessary medication for a chronic neurological problem.

On the flip side my dd has hereditary spastic paraplegia and gets 3 months worth of baclofen at a time whereas I would have considered his would be monthly and he should pay prepayment certificate (so pay more than he is - especially as he gets PIP!)

My sumatriptan injections aren’t on repeat but I get them through acute request as often as I need (which can be a lot as they come in packs of 2!)

Health boards have lists of otc drugs they no longer will issue prescriptions for, it may be on your local list - they have tightened up on this recently so it may have been different in the past. Other drugs are still at doctors discretion

That’s interesting. Quite worrying that it’s done by drug rather than need for said drug imo.

I wouldn’t need macrogel if I didn’t need the other medication for a condition I have no control over.

OP have you tried another way to manage the constipation. I'm on drugs for migraine that cause chronic constipation (known side effect), I could ask the GP for something but decided to try and manage it myself. I take a high dose magnisum supplement over 600mg daily, its recommended for migraine as well so should be helping that to. I don't know if it's proven to help cluster headaches, but it probably would harm to try it I'd it doesn't clash with your meds. It does totally solve my constipation issue and I notice if I don't take it.

Although I agree that ideally you should be able to get your medication on prescription.

I cannot take magnesium nor calcium carbonate (gavacon) because of the verapamil. There’s so many many OTC medications I cannot take because of it.

I’ve tried everything and have a good diet but unfortunately I have little appetite due to the cluster headaches which I don’t think always helps. I do have my 5 a day though even if that’s all I eat in a day

@itsgettingweird hugs op it's horrid isn't it. I have chronic migraine and have found it difficult to manage over the years. If you have had to increase your preventative medication it maybe time to try something else. I have found that preventative medication weara off over time and have had to switch meds a number of times.

I’ve had laxatives prescribed alongside opiate based meds as a matter of course (short term following surgery). If there’s a known reason for it I agree it should be prescribed.

Thinking outside the box. Fybogel can be bought at the pharmacy but may be easier and cheaper for you to eat flax and chia seeds as these work the same by drawing water into the bowel. Magnesium is also quite a good laxative if you use magnesium citrate. Again, very cheap.

That seems harsh. I'm prescribed laxatives alongside opiates. It should be standard surely?

I guess it's a postcode lottery if your area are stopping funding for prescriptions of things that you can get OTC? If you pay for your script it's true it could be cheaper to buy it.

You should contact practice manager. You only need them because of the other medicine you're prescribed. So it feels like it's their responsibility to give you them? But that's only if you're on a free script. Else it could actually save money.

I think it is fair to ask. Just say you are happy to buy it for occasional use, but as your upped medication is causing permanent side-effects, would it be possible to have this on prescription?

They might say no, but it's worth a try.

FWIW, strong coffee and Vitamin D spray are good laxatives. And eating little at night but drinking at least 2l of water by day.

Yep, plus lots of fibre. I'm on medication that would make me chronically constipated (very uncomfortable) so I have to eat a load of fibre and drinks loads of water. Also, it's very healthy in general so a win-win!

Your GP isn’t wrong, you can get many remedies for constipation from the pharmacy without a prescription (also the supermarket has a few options on the shelf). You should only need to see a GP for constipation when you have tried everything the Pharmacist can offer and they don’t work or you can’t have them due to allergies or other medication. You are taking a GP appointment that could go to someone else that has no other option but to see a GP.

Is your issue that you have to pay in the Pharmacy?

Have you read and understood OP’s situation?

Thank you for saying this

The amount of medication I’ve been prescribed and then been told to ‘just buy over the counter’ is voluminous.

Apparently there are OTC meds for severe arthritis, chronic synovitis, psoriasis, infected flexural skin, IBD, uveitis, pernicious anemia … who knew? Apparently some Aveeno and syrup of figs will sort out the lot. Oh, and not eating cheese

OP, your plan sounds good. You just have to persevere and keep asking!

Often the OTC cost is less than a prescription cost. Same reason doctors tell people to buy paracetamol rather than getting it on prescription

OP is fully aware of this. In her situation it is not the case.

Why, when OP has a pre payment certificate? OP has paid for prescriptions presumably to cover cost of things like this

The preventative medicine wasn’t at the highest dose I should have been in. I had to stop increasing for a few weeks as it affects BP and also Xmas because I had to have an ecg every tablet increase and I could only increase it every 2 weeks!

Thing with chronic cluster headaches is medication often only makes them
manageable - which they generally are now

I don’t need to see a GP. I asked for another prescription for what they prescribed before (over the phone).

I have a chronic health condition and the medication causes the constipation and I have a prepayment certificate.

Occasional use - yes £5/10 here and there is affordable.

The amount id have to buy is £20 a month.

I think either everything should be free, or there needs to be a real discussion about a partly private system. For your situation OP, if you're struggling with costs, do whatever you need to do if you're entitled to it.
A friend had to go for a tooth extraction over a crown due to cost (she said it was about £80 versus £300) while another person got all their dentistry free.
Similar situations can arise with prescriptions.
In Scotland, I'm sure it was all free? Happy to be corrected.