5mg folic acid and frustration

[j0hnskot]

Heya, we recently received the wonderful news that we are expecting our first baby!
We went through the process and got assigned a midwife and had the first appointment where she prescribed us 5mg of folic acid.
This is were the "nightmare" started. We were told to go to the GP to get it prescribed. When we asked the GP, they told us that the midwife has to prescribe it .
We are now stuck in a loop when on side is pointing us to the other and we have no idea where to go from here.

Do you have any advice to help us figure this out? For the time being, I found an online shop that sells 5mg of folic acid but to be honest, I'm not confident it's not going to be some sort of dodgy vitamins. The store seems to have multiple positive reviews.
I'm not sure I'm allowed to share links here so please let me know if I can.

So SURELY the midwives would know the answer isn't to point women at the GP then.

It's because some GPs were prescribing it until they suddenly weren't, then a small number continued to.

In an ideal world the midwives would be able to prescribe folic acid and aspirin for women, I'm sure trusts will be looking in to this

I'm guessing this is where the problem is then. GPs won't prescribe, midwives can't prescribe but none of the two give clear explanations of what will happen next. I'm hoping the hospital will resolve this and that this just a one off. If there is such confusion for just a bottle of vitamins, I'm scared to think what will happen with something more urgent.

Midwives work closely with a whole team of doctors who are able to prescribe...Obstetricians.
GPs are not funded to provide antenatal care and while they have been doing it anyway for patient ease/out of kindness/for historic reasons it means no one has changed practice and it continues to be directed at them incorrectly. The process needs sorting out by those that are funded to and do provide antenatal care. It's not disimilar to midwives writing to, I don't know a Cardiology doctor who happens to be seeing the patient to ask if they can prescribe their antenatal meds. Times this by a lot and it's a significant amount of work and budget. If GPs aren't contracted for it they usually aren't indemnified for it either.
Staff could be trained up to prescribe, pharmacists utilised correctly, folic acid added to list of meds that midwives can prescribe. Issue still remains best to take for first 12 weeks so if pregnant and have risk factors requiring higher dose need to be aware of need and have access to meds prior to first booking appointment.

I've been on 5mg since April. I was told by the midwife to contact my GP for a prescription. My circumstances are different, as this all happened while we were losing our baby to a complete fluke severe neural tube defect, so I doubt my GP was going to fight me on it after what we had been through (it was our 3rd consecutive loss).

There should be someone associated with your care who should have the ability to prescribe medication. I would contact your midwife and tell them what's happening.

But given you are supposed to be on it from 3 months before TTC, you don't have a midwife at that point - that's not antenatal care. Who prescribes it then?

I was also prescribed 5mg while TTC but have only just now got some, 8 weeks pregnant.

I've been taking normal strength folic acid as well as Pregnacare vitamins.

Is it now safe for me to take 5mg alongside Pregnacare which also has folic acid in?

when ringing my GP about the prescription she didn't really seem to know much about why the previous doctor prescribed it and when I mentioned my weight just said 'oh ok'

My Midwife had to request for the GP to prescribe it for me.

Unfortunately this is incorrect. This is very topical. The GP service is a subcontracted service, it is paid for by set contracts issued from the healthboard. Historically the hospital service has bounced patients to the GP and the GPs did it … because there was a patient in the middle whose fault it was not. Unfortunately the primary care sector receives 9% of funding and has been starved of uplifts. So they are pushing back on things they used to do ‘for free’ for the health service ( a lot of things… ). What should happen in reality is that your midwife service should be set up to be able to provide you this script. What happens is that hospital management cut this corner and give midwives the advice to ‘just go to the gp’ .. these type of admin requests are an avalanche to your GP surgery. They should be being done when you are seen. the system has been taken advantage of.

The GPS have now agreed to take the BMA guidance to push back on things that are not their job. Sadly you will be caught in the middle h till the system wises up and either finds fps to do extra work or provide a prescriber in the midwifery office.

it is not uncommon for your GP to receive emails from nurse led services saying … ‘erm we did a blood test… because we wanted to … but I don’t know what the result means .. can you deal with it as it’s flagged as abnormal’ . It’s a practice that needs to change and why you can get a gp appointment.

you can take lots of the 400mcg dose until this is resolved. In reality the midwives need to find a prescriber to issue these scripts from their own department.

Indications for the higher dose include an increased BMi and certain pregnancy conditions. other pregnancies can take the over the counter dose.

I would argue if you fall into the small group that require 5mg then you do require antenatal care to assess and prescribe folic acid.

It is ‘just vitamins’ but the core theme is the same across everything.

The hospital puts ‘gp to follow up’ ‘gp to chase’… or even worse ‘gp to refer to…’ and ask your gp to refer to a hospital specialist int he same building as the hospital worker.

it is something your gp has had to tolerate getting worse for years but given the crisis in primary care. They are starting to do just do their job role for their own safety.

individual departments need to accept their responsibility. The actual guidance on responsibility is very clear via the gmc

e.g if you do boots or order tests - it’s your responsibility to deal with the results. You’d be amazed how often this is not the case and your gp is expected to pick up the result having not seen you for months

What a pain in the neck. I was meant to be on the higher dose of folic acid with my youngest but nobody told me until it was too late so I just had the normal dose. Thankfully baby was fine.

My GP prescribed it for me for TTC. If I had needed it as a new prescription post conception, then it would sit with the midwife team.

Really, rather than just another repeat with your GP?

That's not what my GP have done and I'm very glad about that, reading this thread!

No if it's on repeat it's with my GP. I meant if I had only had it suggested after I found out I was pregnant 🙂

I took it for 6 months (3 months before trying) due to family history, had first lot prescribed by GP and then just ended up buying it myself from iHerb was identical to what I had been prescribed

So we ended up going through our insurance (have some private GP sessions).
Within a few minutes, we got a prescription. The private GP said that since this is a private prescription, we will be paying the full cost of the Folic Acid pack.
Took the prescription to Boots, got the pack within 20 minutes and then asked to pay.
The cost? £9.90.
The contribution we pay for anything via our normal GP? The same, if not more (can't remember if they increased their prices recently).
So effectively 0 impact on the GP's budget.
I get that (by reading comments from both sides) it's not the GP's fault and they don't want to pay out their own pocket for stuff they shouldn't, but somewhere in there we have to show some humanity.
I have to blame both sides.
My wife was crying for days, scared at what might follow from this disorganised mess. She was strongly considering not continuing with the pregnancy. All that stress and psychological pressure, in a period of her life when she should be avoiding this, for 0 impact on anyone's budget.

I'm hoping this thread will prepare at least one upcoming mother.
My wish for 2025 is for this mess to be resolved ASAP so no more parents have to go through this, so early in the journey.

Also as a prescriber the GP has clinical responsibility for that prescription. Folic acid isn't a problem in my mind but we used to get frequent requests from midwives to prescribe things but if something goes wrong then it is the GP who will get the blame. I am a year retired now but I think midwives should have prescribing rights or their consultants should do it.

@j0hnskot I understand your predicament. And I hope all goes well for you. Regarding cost. It's not the cost of the drug that is the problem it is the GP time that costs. When I was working a year ago I would have just done your prescription but I think there is a bigger backlash against this now. It's political and it's wrong that the patient suffers but something has to shift the mindset somewhere

Scotland gets 7% of NHS budget it was 11% several years ago.