Here we go again!

[BlitzenandMikey]

Went to see GP today, armed with my letter from oncologist, stating he will support my request for HRT if that is the route I wish to go down. No, GP says he wants to consult the practice partners first as he isn't comfortable prescribing! Practice want to speak to oncologist to clarify which HRT to prescribe. Why is this becoming a battle?? I will write to oncology myself and request the prescription to present to the GP I think!!!!!!!

Seriously, get a new GP. What a tit.

so sorry to hear this.
What a palava.

The best way might be for the oncologist to provide a supply for 3-6 months and see if your GP agrees to a repeat request from you.

It’s because if your GP prescribes it then it will come out of their prescribing budget - hence needs to discuss with oncologist in the hope s/he will prescribe and GP, as an independent small business contracted to NHS as they all are, can swerve the cost and the hospital have to pay.
More interested in money than you getting your medication promptly and I agree with PP - a tit.

It's not necessarily all about money.
If the GP provides the prescription HE is legally liable for the safety of the drug even though it's been recommended by a consultant.
This is all about WHO manages care.

If the consultant writes the script, he is responsible for follow-ups and there has (legally) to be a review of all HRT use at least once a year.

The GP could ask the OP to sign a disclaimer, but common sense says that if an oncologist is ok with it, a GP should be, but some are very cautious and know they could (I think) worst case- be sued by the patient.

How does it come out of the practice budget is the OP pays a prescription charge? the type of HRT is cheap- it will be almost completely be covered by the NHS prescription fee.

JinglingHellsBells has it.

The GP is responsible to check what they are prescribing is suitable. If they give you HRT and you get a recurrence of your cancer or a blood clot (presumably the reasons they are unhappy) and they have prescribed against usual guidelines, they could have repercussions. I'm sure people sue for less.

GPs are well trained independent practitioners, they are not secretaries of consultants who just do what someone else tells them.

GPs are well trained independent practitioners, they are not secretaries of consultants who just do what someone else tells them

Independent perhaps but also arsey at times! and not qualified to make judgements outside of their experience as a GP.

The OP has gone back to her oncologist to ask for an opinion. GPs are being cautious but also perhaps not using common sense. If a cancer specialist says it's ok , are they a tad arrogant to think they know better?

OP if you keep having a problem find a private consultant who is happy to work alongside your oncologist.

A very long time ago I had cancer treatment which gave me an early menopause. It was a non hormone sensitive cancer ...not any of the “female” cancers. The terrible menopause symptoms and the ongoing disagreement between the hospital consultants and my GP about prescribing HRT ( I was 41) was way worse than the cancer experience itself. Later when I changed GP (I really don’t know why I left it so long) my new one said, “it’s fine...women of your age are still having periods and you should have the oestrogen for your bone health” etc. This was what my cancer specialists had been saying all along.
Maybe speak to a more sympathetic GP, or see a private meno specialist?

Prescribing budgets. CCGs are responsible for setting a prescribing budget against each GP practice within their organisation.
www.nhsbsa.nhs.uk › prescribing-...
Prescribing budgets | NHSBSA

The prescription fee the patient pays, although it feels expensive when you have to pay it, is a tiny proportion of what the drugs actually cost.

@MrsDrudge

The prescription fee the patient pays, although it feels expensive when you have to pay it, is a tiny proportion of what the drugs actually cost.

Drugs have very different costs.

I pay for my HRT because it's from a private consultant. I pay just over the NHS prescription cost. This includes the dispensing fee and the pharmacy mark up.

For example, the wholesale cost of the gel is around £4.50. The mark up means I pay around £9.

Some drugs are extremely cheap. Some antibiotics for instance are a few pence .

Some drugs though- like expensive creams for dermatology- can be £30-£100 a tube.

HRT costs are here

www.menopausematters.co.uk/treatafter.php

GPs are not part of the NHS, but independent contractors who sell their services to the NHS, and are given a budget from CCG (NHS) for their prescribing. They get to keep any savings they make. Perhaps this is easier to understand
www.gponline.com/exclusive-pressure-rises-cost-gp-prescribing/article/1227489
However this is hijacking the OPs thread and for this reason I don’t intend continuing the discussion.

Change your GP OP.

MrsDrudge That is interesting. Thank you.

OP... I feel your frustration. Why is HRT such a bloody hassle? So many people I know have to fight to get what they need.

But you can't just change your gp mrsdrudge otherwise they are getting away with just creaming off the 'best' (cheapest) patients. I would go back and make more fuss op, from what I've seen of the NHS the squeaky wheel gets the oil.

It's got nothing to do with COST! (In this case.)

The GP is worried about prescribing to the OP because she had breast cancer.

In the prescribing guidelines for HRT it says do not give to women with a history of BC BUT the NICE guidelines make it clear that this is something where GPs have to bow to the superior knowledge of consultants (gynaes and oncologists.)

In this case the OP is being a prick and seems to think his colleagues know better than an oncologist. and it needs discussion with them.

OP= GP!

I was given to understand that in the case of hormone sensitive cancers for women with really severe menopausal symptoms, it’s about balancing risk.

Yes it is which is why she has seen her oncologist and he gave the OK.

GPs do not have to do what consultants say, but it's an arrogant one who thinks they know better.

Thank you for your input everyone.

Feeling exceptionally angry today, since reflecting on the conversation with the GP on Friday. He said "It is only quality of life which is affected and if I didn't take HRT, there would be no further implications" WTF! What if I came to him with suicidal thoughts?? Anti depressants? Why are they making their own decisions about MY treatment and body?

Next, i need to email the oncologist and request the prescription or at least request that he be specific in what I can have. I have an appt. booked again on the 11th June, to see another more senior and experienced GP. In that time i hope they also manage to communicate with oncology, so they are clear in their minds how to proceed.

This all started in January and the suffering continues. Yes I have tried herbal, red clover, sage and It just doesn't work for me,; hence wanting to at least TRIAL some HRT to see if the symptoms improve.

Yes Jingling, the arrogance is quite something. The GP had not even read the letter I was waving in front of him; so I made him listen whilst I read it out.

'It is only quality of life which is affected'

Yep... that's pretty much what he (GP) said to me too. I feel your anger.

I remember saying to my GP at the time .” .... so I’ve come through cancer for what.... for this....?” It brought her up short. Good luck OP. You sound more empowered. 💐

You know what Rosen, I don’t usually bring up the cancer, but if I encounter this arrogance, unwillingness , “ have to talk to partners” stuff, one more time, then yes, I may well say the same as you,

@thenightsky, how dare they imply quality of life doesn’t matter 😡😡😡

I'm actually furious on your behalf having read this. I would complain to the practice manager. I think the gp was blustering because he hadn't read the letter. Does this particular doctor not treat diabetics because they're overweight or prescribe antidepressants to patients in awful life circumstances? He sounds utterly incompetent. Alternatively is there someone in your practice interested in Hrt and female issues?

Teta, you are right,; said GP had not read the letter. Ive asked them to contact oncology for advice re prescription. I am also going to contact him myself too. When i return to the surgery in two weeks, I hope to pick up a HRT prescription from someone!

There’s been a recent article on Kirsty Lang going back onto Hrt after Breast Cancer in the Daily Mail ( sorry!). It’s pretty interesting about the possible drug interactions. I also think you may need more specialist advice than a gp’s. Could you ask your consultant to refer you to a gynaecologist with an interest in treating menopausal conditions ?

Yes that may be the way forward. I am desperate now though and just want to start taking something to relieve the symptoms. I did read that article with interest and I appreciate it may not be black and white. But oncologist has said in his letter that he will support me taking oral oestrogen plus progesterone, in his letter. So why didn't that GP acknowledge and prescribe?