Duty Of Care or Duty Of Punishment?

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danielnorman

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Relationship to Diabetes
Type 2
Hi everyone,

Two days ago I received a request for my diabetic review from my GP. It contains a paragraph which hasn't appeared on any previous review letters. It says:

“It is important to attend your review appointment so we can ensure your condition is properly controlled and managed. If you run out of your repeat prescription and have not had a review, we will not be able to re-authorise your repeat prescription.”

Effectively the second sentence reads to me as “If you do not attend this appointment we will punish you by stopping your continued diabetic medication.”

Is this a standard thing to say now? Have things got so bad in the NHS that if you don't comply with your GP's/Surgery's requests they can stop issuing you with medication that effectively keeps you alive?

Am I over-reacting or do you agree with me that this not what you expect from a doctor who has a duty of care, that threatening a patient is not the best way to get them to attend, and that it is particularly bad to say this to someone who has been diagnosed with anxiety and depression? I am now really worried that if I don't feel like attending this appointment, and maybe the next one (I have bad days and better days), my GP, who I previously thought understood my conditions, will stop me from having the four diabetic medications I need? Would he really do this? I don't know how I would cope as I couldn't afford to pay for them.

Thinking about it over the last couple of days has just got me more and more upset and I don't know what my best course of action is. Has anyone got any advice?

Many thanks.

Danny
 
Yes, that seems standard. It’s annoying but I suppose it’s a blanket letter to cover all sorts of drugs.
 
Oh, and welcome 🙂 Just noticed you’re new here.
 
I think they are trying to encourage people to turn up for their review as this enables them to check that people are actually taking the medications they have been prescribes as many do not but also if people just don't turn up that deprives other people of the appointments when we are all complaining that we can't get face to face appointments.
 
Hi and welcome from me too.

I have just received a similar letter, but I am quite happy to have mine. It is important with any long term condition, that it is being well managed and the medication which is prescribed to treat it are still appropriate and working well. These reviews often involve blood tests etc to monitor your diabetes but also liver and kidney function and cholesterol etc. If for example you had some deterioration in these results that meant that your current medication was not strong enough or perhaps contraindicated due to liver or kidney deterioration, then it would be important to stop that medication and try something else. Just because medication was suitable for you a year ago, doesn't mean it is still suitable. Also new and better medicines come onto the market which might suit you better.

If the doctor or nurse doesn't see you to check things out and you continue to take those medicines they could potentially in some circumstances do you harm, so the medical staff are obliged to check and make sure everything is still relevant.

There are many people here on the forum who really struggle to get appointments with GPs and yet many appointments go wasted because some people don't turn up to them for a variety of reasons. I appreciate that anxiety can make it difficult, as I too suffer from anxiety, but these appointments are for our benefit and to keep us well, so please try to view this letter and appointment in a more positive light, that it is to keep you as well as possible. Medication simply can't be repeated year after year without these reviews, so please do try to make the appointment if you can and if not, then make another appointment as soon afterwards as you are able.
 
Yes I do of course understand that they are trying to encourage people to go to reviews, my point is that encouraging by threatening punishment is never the best way of going about things. They have never mentioned this before so why has it changed, and also they should not send this out as a blanket letter as not everyone fails to take their medication or never goes to review. I always take my meds and I went for a review only four months ago so I am not exactly a person who is not engaging. As for the lack of appointments, this is due to fewer doctors more than anything else. My surgery has seen a 50% drop in the last three years, I have never actually met my current GP face-to-face and only ever get to see a nurse.
 
Yes, its standard. You are quite lucky that your surgery sends a letter. Mine just stops you being able to reorder anything on the app, which, of course, you don't notice will you go to order something!

Luckily, i reorder when i still have quite a bit still in stock.

I got quite unsettled by it when they did it to me first time but now its just mildly annoying. They do the review over the phone at my surgery. It can stop you continuing from taking medicine which is now no longer needed but no one though to take off the list, or tell you you no longer should take

If push came to shove and you were out on insulin you could probably get an emergency prescription.
 
Barbara,
Hi and thanks but I am very aware of the importance of regular reviews. I fully support those and am not against them. Also, I should tell you that if I cannot make an appointment I always cancel it so that someone else can have it (and it is not always the patient at fault - once I cancelled and it wasn't picked up by the system so I got a threatening letter from the surgery saying I risked being taken off their list. They subsequently apologised when I complained). I am not going to accept the charge of being blamed for lack of appointments. We all know that the NHS is short-staffed. That is not my fault.
 
If you have had a review of your diabetes in the last 4 months then there may be a mix up with their records and you should contact them to try to sort it out over the phone.... I know that is sometimes the most challenging bit, just getting through to speak to someone.
I think the letter isn't intended as a threat but to let people know that their medication will be stopped if there isn't an annual review, so that people don't suddenly go to reorder medication and find it is no longer available to order. I know you are not the first person to be upset by these letters but unfortunately the system simply isn't able to do anything other than blanket format letters. It is not personal so please try not to take it as such, but if you have had a recent review then it clearly needs sorting out to prevent wasting your time and theirs.
 
Tdm said:
Yes, its standard. You are quite lucky that your surgery sends a letter. Mine just stops you being able to reorder anything on the app, which, of course, you don't notice will you go to order something!

Luckily, i reorder when i still have quite a bit still in stock.

I got quite unsettled by it when they did it to me first time but now its just mildly annoying. They do the review over the phone at my surgery. It can stop you continuing from taking medicine which is now no longer needed but no one though to take off the list, or tell you you no longer should take

If push came to shove and you were out on insulin you could probably get an emergency prescription.
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Yours will be done via telephone because you are Type 1 and the diabetes clinic reviews and oversees your treatment, but this may not be the case for the OP who is Type 2. You can't exactly do blood tests and check feet etc over the phone.
 
It may not have been intended as a threat but that is how I took it. Where has all the sensitivity, kindness and caring gone?
 
Regarding standard letters, the one I received must have been set up for diabetics given its format. Surely with everything recorded digitally (my nurse looks at her screen far more than at me when I attend) it should be easy to set up letters that have some form of customisation? Isn't this particularly important when it comes to health care?
 
danielnorman said:
It may not have been intended as a threat but that is how I took it. Where has all the sensitivity, kindness and caring gone?
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It probably went out the window when efficiency came in! 🙄 :( I am lucky in that my GP practice still try to maintain old fashioned values whilst embracing modern technology, but I am well aware that not many others are like this.
 
rebrascora said:
Yours will be done via telephone because you are Type 1 and the diabetes clinic reviews and oversees your treatment, but this may not be the case for the OP who is Type 2. You can't exactly do blood tests and check feet etc over the phone.
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My GP surgery does not do a meditation review with me.
I think it still comes up on their system but they approve it without seeing me.
I guess they have workout I have a diabetes review with the endo
 
helli said:
My GP surgery does not do a meditation review with me.
I think it still comes up on their system but they approve it without seeing me.
I guess they have workout I have a diabetes review with the endo
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I only get annual telephone reviews with the consultant these days, so I am happy to have a review at the surgery in between and get my feet checked and tickled etc. Actually, thinking about it, I think I had a GP practice initiated blood test in the autumn... which I used the results of for my consultant appointment a couple of weeks later as there was no point in duplicating, but no actual review with the nurse. Maybe this appointment is the review of that blood test which of course I have had the results from months ago. This new appointment is in my birthday month as well as my "Diaversary" and I know they like to do reviews at this time.
 
danielnorman said:
Yes I do of course understand that they are trying to encourage people to go to reviews, my point is that encouraging by threatening punishment is never the best way of going about things. They have never mentioned this before so why has it changed, and also they should not send this out as a blanket letter as not everyone fails to take their medication or never goes to review. I always take my meds and I went for a review only four months ago so I am not exactly a person who is not engaging. As for the lack of appointments, this is due to fewer doctors more than anything else. My surgery has seen a 50% drop in the last three years, I have never actually met my current GP face-to-face and only ever get to see a nurse.
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You could go to this review and ask if the length between reviews could be lengthened, eg to 6 or 9 months.
 
Hello,

From what I know. This is standard. Yearly revue to make sure all meds on the repeat list are required.
I tend to get something similar by text? My GP almost looks apologetic. I shrug & conform. He’s already had recent details from my endocrinologist.
 
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