Should NHS be more honest about thresholds and treatments?

[Seekingblossom]

Would you find it more helpful to go to the doctor with symptoms and they say “results of your blood tests fit in with these symptoms. However, NHS doesn’t offer treatment but it is available privately”

or

”results of your blood tests are fine”

Obviously this is just one example, but insert for any number of issues including “women’s health”.

How much better would quality of life be/have been for so many people, how many wasted appointments to try to get to the bottom of what’s wrong, fewer secondary health issues affected by initial issue etc?

I don’t know whether it’s an honesty thing, HCW confusing the bar set to access treatment for a health issue with whether there is a health issue, whether scientific evidence has to be ignored in favour of mandates and so on.

How much of the a problem is this?
Anecdote or data?

previously few people would consider private.

ime if you go in and right at the start say I have private medical insurance through my job they do discuss all the options.

@octavia,that’s interesting, thanks.
@TeenToTwentiesusing low ferritin for example, the cut off point for acceptable blood results is lower than NICE guidelines, which themselves are lower than optimal….if you can even get a blood test, rather than be told it’s someone’s lifestyle (kids, job etc) that’s “tiring” for example.

Because of where we live the GP usually asks pretty quickly ‘do you have insurance?’ Not just because of the area but because our local hospital is not one of the best.

😱

Absolutely and not just for blood tests. It's important people are not allowed to believe that the NHS offers gold standard treatment. I always want to be told which treatments exist and which the NHS are able to provide. And as a practitioner I'm tired of saying 'you've improved so I'm discharging you' when the truth is you would have improved a lot more if I'd offered you something better!

The NHS is subject to NICE Guidelines and evidence based medicine....

I had a blood test in January after speaking to a GP about exhaustion, severe hair loss, breathlessness, constant itchy skin, mouth ulcers and cracks in the corners of my mouth. All classic signs of iron deficiency. My ferritin came back at 5 (range 30-336) and the GP marked it as borderline and suggested I eat some spinach 🙄

Fortunately I have private health insurance through work and was able to arrange an iron infusion within a couple of weeks. The haematologist I spoke to laughed and said the NHS is incredibly poor at recognising low ferritin causes some pretty awful symptoms in itself. You don’t need to be suffering from anaemia to feel dreadful. She also said levels that low cannot be treated by diet alone. An infusion is the gold standard but is very rarely given by the NHS.

Seems pretty short sighted to me when I was on the verge of quitting my job because I was barely functioning. How much more would it cost for me to leave the workforce and exist on benefits indefinitely.

As a practitioner, are you limited in what you can say to what nhs can offer?

Sort of agree. If a treatment is not available on the NHS then it is difficult for a practitioner to know what would be available privately. NICE guidance applies but there is also a value for money calculation.
So I had a treatment privately that is in NICE guidelines but hardly exists via NHS as difficult to do well and needs lot training and expensive equipment and is less likely to succeed than the mainstream widely available treatment which is more likely to work. But the mainstream treatment is an operation and I would need 6 months off work. I opted to try the private treatment but I can afford to pay and could travel and don’t want to be off work for that time.
I think it is important that we should know that the NHS provides good overall value for money treatment but it does not provide all options and it often comes at the expense of the patient’s time.

My kid had low iron a few months ago - 4 and the nhs did treat it we got i think 2 months of iron tablets. But… they hadnt wanted to do any bloods at all and had to be made to be another dept (who itself only wanted the bloods to delay other treatment..— which they then refused anyway.
Even with nice it really depends on your gp as they can just fob you off.
There are consequences of doing something and doing nothing.
in our case for dd lack of AB probably has led to hearing issues and then perhaps adhd and asd symptoms..
So there actually isnt evidence that not giving AB for ear infections is ok (notably many of the asd kids around also had ear infections and one had tonsils removed but not til 5.

I can say what we can offer. I can explain the benefits of it, there are always some. If they ask directly about a thing we don't offer, I'm meant to say no we don't offer that. I'm not meant to proactively point out things they could pay for privately.
It is hard because I work privately too so personally I can't be seen to be drumming up customers for myself during my NHS time.

Hmm. My rheumatologist suggested a drug for osteoporosis for which I didn't meet the NHS bar according to Nice guidance. I paid for it. £2.4k. BUPA wouldn't pay for it either.

Interestingly, NICE guidance is that a dorsally displaced radial fracture should not be reduced with gas and air alone.

Conclusion: when NICE guidance costs the NHS money it is ignored; when it doesn't it doesn't have to be ignored. Funny that.

Option 1.

As well as for iron/ferritin, the NHS (in England) threshold / range required for treatment of hypothyroidism is much broader than in Eastern European countries, for example, and you don’t get prescribed levothyroxine here unless you are really struggling with extreme fatigue, hair thinning, weight gain, lethargy, depression, really terrible periods etc etc without any treatment 😢 In Poland you’d be prescribed levothyroxine much sooner / with a much lower TSH (or higher T4) reading than you would be in England. Polish friends were horrified by what the NHS deemed “normal” here, and had some quite serious health struggles until they were able to find a sympathetic GP after many months.

Levothyroxine is free for everyone on the NHS in England regardless of age/income, and entitles you to free prescriptions for ALL medications if you apply for a medical exemption certificate. But that couldn’t possibly be the reason why NHS GPs are so loathe to prescribe it could it…?? 🤔