GP denying Bipolar diagnosis

[BethTwinkie]

I’ve been awaiting an nhs appointment to diagnose possible bipolar. My partner and I decided to pay private after an episode of mania at home to try and give me some support.
I had this private assessment and they confirmed bipolar type 2.
They sent their assessment and recommendations through to my gp. My gp said they cannot and will not accept the private diagnosis and will not recommend to continue the Lamotrigine which the private psychiatrist has started me on.
In order to get another prescription from the private psychiatrist I must pay £250, my gp has said they will expedite my nhs referral but there is no time scale!
I’m just at a loss here - surely by me going private it’s one less person on the waiting list?! I thought I was doing the nhs a favour by going private and also my mental health needed an answer as to why I am how I am.
Can a gp over rule a psychiatrist? I have a formal assessment from them? I’m so scared they’re going to stop my medication, treatment and just try and pass it off as depression.

It's frustrating, but I don't think the GP has to do what the private psych says. If you go private, you kinda have to suck up paying for the private prescription. I know of cases where a GP has prescribed what a private consultant has advised, but it's not a definite thing. I hope the expediting helps and you get an NHS diagnosis soon.

My sister had both kids diagnosed with ADHD privately, she now pays over £300 per month for their prescriptions. If you start private you have to stay private. I suppose you’re just paying to jump the queue otherwise.

surely by me going private it’s one less person on the waiting list?! I thought I was doing the nhs a favour

It's the drugs that will be an ongoing cost not the diagnosis so it's not doing them a favour. It's adding a cost that wouldn't be happening yet via their own system. You'd be doing them a favour by funding your own meds. Not that you have to do them any favours ofc, but just explaining - it's not like you've had a private operation that's taken someone off a waiting list.

You can ask for shared care but I don’t think they have to agree

Sounds normal….if you go private then you have to continue with private prescriptions…..gp quite within their rights to refuse

vary rare that they agree to shared care

It’s absolutely not always the case that once you start private you have to stay private. It varies between GPs, private providers and possibly locations. I work in the private sector and have an under-18 client on my caseload who was diagnosed with bipolar disorder jointly by myself and a consultant psychiatrist, and her medication is prescribed by the GP (on the advice of the psych). It might be worth seeing if you can switch GP.

I've always had to have my meds prescribed by a (private) psychiatrist. My GP knows what medication I'm on but don't want to/aren't able to prescribe them.

Lamp trig one for bipolar in my area requires a shared care protocol. I will enter into this with NHS psych but not private psych and I'd say 99% of other GPS would be the same.
We get penalised if it's a drug that requires shared care and they aren't under a specialist.
It's too easy for a patient to stop seeing/paying for private psych and we are left prescribing.
I always explain this to patients that by all means go private but the NHS can't always prescribe the meds on the NHS unless they are under an NHS clinic

I ( think) part of the issue, is that after very few sessions, one in many cases, they will give you a diagnosis of Autism, ADHD, Bipolar, etc and start right down the medication route, which not all GP,s may agree with, or be properly educated about. Unfortunately as others have said, if it's prescribed privately, the NHS GP is under no obligation to keep prescribing it, although some do. Can you maybe speak to a different GP in the practise?

Sorry, cut off! Also, they aren't then monitoring the effects, and the dose, because you're under private care, so can't adjust the medication, as they aren't in touch with the prescriber. It's either private or full public, aktough with the wait lists I understand why that's frustrating

I guess I didn’t realise what a mine field going private for the diagnosis was going to be. I really thought I was doing the nhs a favour!
the gp expedited me to my local nhs team who commended me for seeking help privately and said they thought I should continue on with the treatment even though I had said to them that I couldn’t afford to carry on attending.
I just feel like one person is telling me to go one place and someone else is saying to go speak to someone else. I just need a really good doctor to sit down and look at everything properly and have a good long chat with me and for us together to come up with a plan moving forwards!

@BethTwinkie - absolutely, and it's one of the biggest failings I see with the system. The system can't keep up, so advise you to go private. You go private, but that cost isn't sustainable. You go back to an NHS practitioner who now won't treat/ prescribe the medications, because you have a private diagnosis and plan...... despite being advised to do so.

The person who signs the script is legally responsible for it.

So no - I wouldn’t sign a script when you have paid for a diagnosis from ‘anybody’ because that’s about as much as some of these private services are.

Do you mean you’ve now seen the nhs team and they have assessed and recommended the same medication?
In that case they can prescribe it and it’s nothing for the gp to do.

or is it the usual: psych suggest this med but when the prescribing risk comes back to them….oh wait….that’a not suitable/wasn’t a psychiatrist you saw/don’t have prescribing rights etc

there are many people out there happy to suggest a gp prescribes X medication but completely unable to do so themselves!!!!

Think it was more a case of zooplankton thinking they could just transfer care to nhs…..as OP says she was initially prescribed by private psychiatrist…..OP not being able to afford to stay private due to ongoing cost of prescriptions

If she got her assessment with a registered psychiatrist she should speak with her GP about 'shared care'.

It means the GP will prescribe but any changes of medication will require the psychiatrist and once a year a psychiatrist review but otherwise all free on nhs

GPs in our area will not do this…..something to do with commissioning

@Kitkat1523

vary rare that they agree to shared care

Not in my health authority it's not

It's standard

If people are using an nhs approved private provider then all regulatory processes are followed and they are already checked and approved so shared care is very standard.

Most of the practitioners are also working in the nhs

@Kitkat1523
Again so unfair that it's different in different authorities or practices.

I'm so grateful at how flexible our practice is.

NHS mental health agreed with the private psychiatrist and said I should continue with medication and then rereferrd me back to my gp but gp has said they aren’t happy accepting the private psych assessment for some reason?

In OP you say: my gp has said they will expedite my nhs referral but there is no time scale - so when you say the NHS mental health team agreed etc., that's not the same as saying you've gone through the NHS process to get diagnosis etc, so the team you mention here isn't one that can overrule a GP. Not telling you, just trying to clarify as it sounded like you were still waiting for NHS process to start, so no one in that system can agree with the psych in any official/influential capacity?

i went to go and see the nhs team a few weeks ago and they did a sort of assessment - half an hour and read questions from a laminated sheet? Then they wrote to me saying they think I should carry on taking the meds as I am
now even though I explained to them I couldn’t afford to keep paying. Now the doctor has said they are going to re expedite me back to the nhs mental health team so that’s where I meant there’s no time scale. I have about 10 days left of medication from my original privately funded prescription

Ah okay, that does seem like the GP's decision until you've had the full assessment. Hope you can keep getting the private meds until then, unless one of these other options - shared care or different GP pays off.