Conversation with a "slightly" clueless GP...but not a complete dead loss...correction was a dead loss!

[Peely66]

Interesting one this morning. Booked a telephone appt with a GP ( you never get the same one these days do you?) I had a brief discussion about blood pressure and he advised sticking with the dose of ace-inhibitor I'm on at the moment.

Then we moved onto the subject of the Libre system. He had never heard of it! He started telling me about the criteria for it. I said I didn't necessarily want him to prescribe it at the moment. What I wanted to know was could I have a referral to the diabetes team so I could talk to someone trained in this system so that we could look at the data and make adjustments. He went away to have a chat with someone. When he returned (after some time I might add) he said that he had spoken to the pharmacy and it was available on prescription but it was just another way of measuring your glucose and if I spoke to the Health Care Assistant they could help with changing insulin adjustment. I didn't need to see someone who was trained in using the system. I told him that in the past every Health Care Assistant I've ever spoken to has said I need to speak to a Dr as they cannot advise on dosage adjustment. It was slightly frustrating but the upshot was, as he said he could prescribe it, I said "Well. Go on then". So he did.

 

[MarkGeordie]

I thought funding had to be applied for? I had to jump through hoops before my DSN asked the consultant to apply and prescribe.

 

[Robin]

I thought funding had to be applied for? I had to jump through hoops before my DSN asked the consultant to apply and prescribe.

I had to jump through hoops and get a referral to a consultant for mine too, and I won’t get transferred to the Libre 2 til I have my next hospital clinic telephone appointment next month. But I have heard of others on here who have managed to get their GPs to prescribe it, or to swap them over from the Libre to the Libre 2.

 

[rebrascora]

Oh wow! Yes that is odd! Great result though!
As I understood it, the GP couldn't prescribe it without authorization from the consultant. Have you got Libre 1 or 2?
Do use the training and webinars etc on the Abbott website to learn how to use it effectively as it is easy to react too quickly to readings whoich are usually 15-20mins behind your BG with it being interstitial fluid, so you can get into a YoYo situation if you correct too soon. It is a fantastic bit of kit though and I am sure it will help you enormously.

 

[Peely66]

Update...he's just rung me back to say he can't prescribe it!!! GRRRRR.

All I want is a bit of input from someone who knows more than me and I'm happy to fund myself for a bit. In 5 years of living here I've had no input to help me. TBH he didn't know what he was doing if he'd never even heard of it!

 

[rebrascora]

Oh Bummer! Thought it was too good to be true! You need to get a referral to a diabetes clinic. Keep trying! Maybe an appointment with another GP or perhaps an email outlining the problems you are having managing your levels will get the point across better if you have an online reporting system at your surgery. I find it a great way to tell the doctor everything I need to when I am not under any pressure or interrupted/distracted by something they say/ask.

Have you had an educational course like DAFNE (Dose Adjustment For Normal Eating)? Just thinking that could be a backdoor way to get you under a clinic or at least get some input from a DSN.
I am sure you have a right to be referred to the Diabetes clinic for support as a Type 1. I wonder if ringing your nearest clinic helpline might be another avenue. Night time hypos tend to be a "red flag" issue so if you are having those then you should be getting an emergency referral.
What was your most recent HbA1c like?

 

[MarkGeordie]

I had to jump through hoops and get a referral to a consultant for mine too, and I won’t get transferred to the Libre 2 til I have my next hospital clinic telephone appointment next month. But I have heard of others on here who have managed to get their GPs to prescribe it, or to swap them over from the Libre to the Libre 2.

I got mine changed from 1 to 2 by the GP but only with a letter from the DSN.

 

[PattiEvans]

According to NICE guidelines you are entitled to structured education. See https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#education-and-information-2 which can only be delivered by a proper diabetes clinic. So he should not be denying you a referral.

 

[Robin]

I got mine changed from 1 to 2 by the GP but only with a letter from the DSN.

Well, yes, administratively the GP will issue my prescription for the Libre 2, but only after she’s had a letter from the hospital clinic telling her to.

 

[Peely66]

Oh Bummer! Thought it was too good to be true! You need to get a referral to a diabetes clinic. Keep trying! Maybe an appointment with another GP or perhaps an email outlining the problems you are having managing your levels will get the point across better if you have an online reporting system at your surgery. I find it a great way to tell the doctor everything I need to when I am not under any pressure or interrupted/distracted by something they say/ask.

Have you had an educational course like DAFNE (Dose Adjustment For Normal Eating)? Just thinking that could be a backdoor way to get you under a clinic or at least get some input from a DSN.
I am sure you have a right to be referred to the Diabetes clinic for support as a Type 1. I wonder if ringing your nearest clinic helpline might be another avenue. Night time hypos tend to be a "red flag" issue so if you are having those then you should be getting an emergency referral.
What was your most recent HbA1c like?

It was 58.

I know this could be better and since I think I've started developing some niggling little problems which I'm joining the dots up and thinking could be autonomic neuropathy I've been motivated to improve control.

I've done DAFNE but 17 years ago. I started doing the BERTIE course as a refresher.

I was just really surprised that the GP had never heard of it and didn't seem very willing to help me to improve my control. I told him it was 58 and he just said it should be 48.

TBH the last 5 years have presented me with so many big life changing events in a short period of time, bereavements, moving house, changing job all in the space of a few months I think I've been feeling a bit burnt out and in need of some input.

 

[Bruce Stephens]

I was just really surprised that the GP had never heard of it and didn't seem very willing to help me to improve my control. I told him it was 58 and he just said it should be 48.

GPs just aren't that great with T1. Should be able to refer you to your local hospital team, though. (One of the local DSNs spends a day a month at my GP surgery to make that kind of thing easier (though they also visit the local hospital which is ~10 minutes away on foot so I'm not entirely sure why they do that).)

 

[trophywench]

.... difference in price for the GP practice?

If anyone purporting to be medically qualified told me my HbA1c ought to be 48 - I'd laugh in their face and tell them they'd just told me in no uncertain terms how very little they knew about Type 1 diabetes - and explains exactly why I need to see someone who knew more about it than them.

 

[everydayupsanddowns]

How frustrating for you @Peely66

Hope you can keep nagging for a hospital referral to see a consultant/DSN who at least OUGHT to be a bit more familiar with Libre.

The DTN videos that I’ve linked before, and the Abbott ones (mentioned above) are pretty useful. Nothing like having a good one-to-one conversation though!

To be fair to the GP @trophywench, the NICE guidance for adults is to ‘support people with T1 to aim for 48 or lower’ (with caveats) - which isn’t the same as ‘should be‘, and of course A1c targets should be individually agreed... but that’s prolly where it came from.

 

[Peely66]

Update on this thread...the next installment...
I went into my Pharmacy today to pick up a prescription and, just on the off chance, I asked if they sold Libre sensors. I had an idea that if they bulk purchased I might be able to buy them a couple of quid cheaper...maybe. Anyway that bit is by the by.
I started speaking to a dispensing pharmacist whose jaw hit the floor when she heard that I had no DSN and had been refused the Libre. Now this was one feisty lady who I wouldn't want to get in the way of. She said to leave it with her she was going to get me a DSN and the Libre prescribed! I have absolutely no idea how much clout she has or how realistic this is but,I suspect, someone is going to get a right earful from her and, who knows, I might get the Libre and, maybe just maybe a referral to a DSN.
What ever the outcome it's nice to have someone fighting on my side finally. Fingers crossed.

 

[trophywench]

Brill - bet she does have success - the main pharmacist at our pharmacy has a number of close relations employed as consultants at our hospital and even though I don't currently need any opthalmology appointments I bet 'our' pharmacist could find out from his bro or sister who in the line of work I needed, was approachable and worth contacting. I really like it when he does my 'drugs review' instead of sundry A N Others who haven't the slightest idea about me or what floats my boat. Decent pharmacists actually do, truly, network and often know shedloads of other HCPs!

 

[Ljc]

That sounds like one feisty pharmacist, I would love to be a fly in the wall when she is having a little word in someone’s shell like at the practice.
But it may well be that she will bypass your go practice and contact a DSN directly .

No way should you be denied access to the teal experts.
I really hope you get the news soon that you are being referred.

 

[PattiEvans]

Good luck!

 

[Docb]

Brill - bet she does have success - the main pharmacist at our pharmacy has a number of close relations employed as consultants at our hospital and even though I don't currently need any opthalmology appointments I bet 'our' pharmacist could find out from his bro or sister who in the line of work I needed, was approachable and worth contacting. I really like it when he does my 'drugs review' instead of sundry A N Others who haven't the slightest idea about me or what floats my boat. Decent pharmacists actually do, truly, network and often know shedloads of other HCPs!

Agree with that. My niece is a pharmacist and it is the sort of thing she would do. Good luck @Peely66!

 

[SB2015]

I hope that works out @Peely66
Good to have someone fighting your corner.