GP refused my prescription for insulin!

[Babysaurus]

Margie, the ridiculous thing is that they have already been sent letters from the DSN which is why I am now allowed 10 strips a day rather than 4 - personally, this is still not good enough really as I often use far more (I do a lot of exercise and this can make my levels drop off suddenly, and its not like I can raise them high enough to start with as I am pregnant.) Its also nice not to be on the edge of running out at the end of each month. ON Sunday I was unexpectedly high, not sure why, and so was testing every hour and giving extra insulin till it came down. If this happens again it would mean I 'use up' more than I am meant to for that day - truly bonkers, it really is! Especially as pregnancy is so unpredictable at times that it takes a lot of hard work to keep on top of it!

Sue - I'm with you! Lets hope I can convince the surgery of this too! I was already fuming about the rationing of strips so also plan to address this when I see them. The more I think about it the more I resent the fact that I have been told I can only have a certain amount and have to buy the rest. This isn't good enough either! I will point out that, hopefully, after the baby is born and things get back to normal I won't need to put in a prescription AT ALL for a while if I have enough in and hopefully things would level out a bit. I can't bear not having any back up at all at home either.

 

[Catwoman76]

Never mind loggin off. I want to come over there and have a word with your GP !!!😡

Excellent advice from everyone. It could be one hell of an embarrasing case for the surgery if the GP doesn't crawl under a stone and hide.

Speechless.

Rob

I have just read this, totally unacceptable, no wonder you are SO angry and rightly so, OMG it's neglect. Please let us know how things go and I hope you and baby are well 🙂 Sheena

 

[Abi]

Witholding insulin from a pregnant insulin dependant diabetic= potential death sentence for you and the baby.
Complain
Now

 

[Northerner]

...Sue - I'm with you! Lets hope I can convince the surgery of this too! I was already fuming about the rationing of strips so also plan to address this when I see them. The more I think about it the more I resent the fact that I have been told I can only have a certain amount and have to buy the rest. This isn't good enough either! I will point out that, hopefully, after the baby is born and things get back to normal I won't need to put in a prescription AT ALL for a while if I have enough in and hopefully things would level out a bit. I can't bear not having any back up at all at home either.

NO WAY should you have to buy your own strips! I wonder how many people with other problems they issue inadequate supplies of medication to and then say they should make up the necessary shortfall out of their own pocket? I'm appalled. If they want to make savings then they should at least be making them where they have the full facts and where the consequences are not so potentially dangerous. You should not have to fear running out before the next prescription can be put in, it is a totally unnecessary extra stress they are placing on you. I know test strips seem expensive, but they are not in the scheme of things - they cost the NHS about 30p each which is a tiny amount of money to pay for the vital information they provide. Grrrr!!! 😡

 

[Babysaurus]

Bit of an update.
I called the surgery yesterday with the idea of going to speak to the Practice Manager after my midwife appt. Unfortunately he doesn't work on Wednesdays apparently so instead I found myself, as they asked for details, explaining to the receptionist why I wanted to speak to him. She then, it was a hard work tbh, started talking about how the Practice Manager could not alter my prescriptions (I did say several times that I knew this, but wanted to complain but she seemed to go selectively deaf) and there was no point trying to see them, instead I needed to see a GP. So, I now have another appointment with the GP to discuss 'my increasing requirements.'

The receptionist also said that the original GP had done nothing wrong, she had simply questioned the amount but then plans to issue the prescription which ought to be with the chemist today - hmmm... make of that what you will (they usually take two days at the most, and I put in the original request on Thursday morning.) Regardless if that really was the case, the prescription was delayed, nobody called me to let me know and I would have been left with no insulin and have to have taken myself to hospital should my pump have run out (which was pretty likely as at 5.30pm on Tuesday I only had about 30 units left.)

When they call on Tuesday, it's a phone appointment, I am also going to insist that there are NO limits on what I need for the time being. I will also explain why I don't want to have to run out completely before I can put in another prescription request as this too seemed to be no big deal to the GP. If the GP, yet again, does not appear to have a full understanding of why I am asking for the amounts I may be asking for, I will insist on speaking to someone else and I shall also, if neccessary, report them.

Yes, I am on a bit of a roll! BTW I am not normally so, but this has really wound me up!

Lastly, my lovely DSN who I saw yesterday at the ante natal at the hospital said she had written to the GP and explained so there ought to be no issue, but if there I need to to get them to call her. She said the GP's often don't like it when they increase the prescriptions required for patients as they have to foot the bill.

Extra lastly, I ended the day feeling very pleased with myself as my latest HBA1C came back - it's 5.1! Now try achieving that on four blood tests and limited insulin a day 😉

 

[margie]

Glad to hear you will get a prescription. When you speak to the GP ask if they have read the letter from your DSN (maybe call the DSN and check when it was dated so that you know they are reading the right letter). If they haven't suggest they read it before continuing the conversation as it should explain why you are asking for more.

 

[Northerner]

Well done on the HbA1c! 🙂

As for the receptionist, I don't think it's her place to block you from communicating with the Practice Manager. I would get in touch with PALS because this should not be wriggled out of by saying that the prescription was always going to be filled - there is much more to this than that. I don't know how things work in medical practise, but in financial services if a company receive X number of official complaints in a given time period then they will be investigated by the Financial Services Authority (or whoever has replaced them!), so they have to take them very seriously.

Pals contact details are at: http://www.pals.nhs.uk/cmsContentView.aspx?Itemid=944

Imagine if you had been the type of person who feared the authority of the GP and simply accepted their restrictions, or didn't have the knowledge to know how dangerous it might be to stop testing and reduce your insulin? The whole situation needs clarifying so that no such 'misunderstanding' occurs for you or anyone else in the future. Good luck! 🙂

 

[Robster65]

Really well done for standing your ground in the face of adversity (or the receptionist as they're otherwise known🙄). 🙂

It sounds like things may have been said and it could well have been a brush off tactic to get you speak to the more senior GP so they can spin a cover story. Pure speculation but interesting that the receptionist didn't quite get the gist and wouldn't let you speak to the manager. Cynical? Me? 🙄

Good luck with the phone call. And huge congrats on that HbA1c!!

Rob

 

[cherrypie]

The receptionist does not have the authority to block your request to see the Practice Manager. The fact that they were not on duty should have been followed up by telling when you would be able to see them. Receptionists seem to think they are in charge about everything even though they do not have any medical knowledge other than what they have gleaned during their employment.
I need an emergency appointment this week and was asked by the receptionist to explain the emergency. I told her in no uncertain terms that I was not prepared to discuss my medical needs with her.
She seemed taken aback but then said that if I liked to wait about 10 minutes she would be able to fit me in. You have to play them at their own game. I would say that they are not all like that though.
One got verbally aggressive with me one day and started shouting. I suggested to her, in a very calm manner, that I was not deaf and asked her if it was a requisite of her employment to be rude to people. She always seems very busy when I approach the desk now and someone else takes over.

 

[Babysaurus]

When I wrote my original update I was a bit concerned I was going to come across as overly cynical and suspicious but it seems as if I am not the only one who has a slightly cynical nature when it comes to these things. Phew!

No, the receptionist does not have the authority to block requests and I do now regret telling her what it was regarding in the first place. I find it is a hard balance to get to the bottom of what you what in a precise manner but not come across as unneccessarily (to them) arsey while doing it. I now wish I had simply gone in today when, I presume, the manager was working but I can't undo that now.

I guess we shall just have to see how things pan out following the conversation on Tuesday really. I shall, of course, keep you all posted!

Thanks again for the moral support and help x

 

[Northerner]

Have you read my poem about receptionists?

http://www.diabetessupport.co.uk/boards/showthread.php?t=1376

😉

 

[imtrying]

Hope you get this all sorted out, and quickly. I can't believe (for whatever reason) that they have refused or delayed you getting the drug that keeps you alive 😱

Regardless of the reason, it needs looking into by the surgery to ensure it never happens again.

Good luck!

 

[PhoebeC]

Hope you get this all sorted out, and quickly. I can't believe (for whatever reason) that they have refused or delayed you getting the drug that keeps you alive 😱

Regardless of the reason, it needs looking into by the surgery to ensure it never happens again.

Good luck!

And its not only you its your baby too.

I really hope this is sorted out soon.

xx

 

[Ellie Jones]

I think before you going rushing in complaining and throwing allocation around you really need to think about 'what' your complaint actually is otherwise I feel that you will be slapped straight in the face with an unfounded complaint.

Your surgery and GP, haven't broken any 'duty of care' or fallen foul of SOP's of prescribing. They have followed the proper procedure surrounding this throughout...

Your GP did contact you concerning your repeat prescription request in accordance with SOP, and I very much expect that when your last repeat was refused that you had used up the allocated amount before review or reauthorisation, again SOP followed.

If you had phoned the surgery to order your repeat prescription then you would have been told straight away that it was being refused until you seen your GP.. But this was delayed due to you ordering via your chemist. Now did the surgery fail in a duty of care not informing you directly?

Well it could be argued that you were aware of a problem with your prescriptions requests, you hadn't satisfied your GP's query by phone, and it's possible that the letter from your DSN hadn't arrived yet! And reality here is that she can request on your behalf with a request such as 'plenty' but she can't instruct only an consultant can do that..

If you used vague phrases, 'I'm pregnant', 'I exercise a lot' it's could be said, you hadn't provided the GP with enough information nor had you offered to show your GP information/data to back up your word.. Also what did you do before your GP phone call to get your repeat prescription to be amended to reflect your new needs, assumption is that repeat prescriptions are issued to cover 28 days.. So did you just order more frequently. Until they complained!

To be a devil advocate here... A pregnant women doesn't normally spend hours down the gym or go on a 5 mile run... So you need to clarify what exercise you do, how you use your test strips within this regime and your daily routine... Which means showing your doctor your data from your pump and glucose monitoring, talking them through it and reason why...

Don't forget even though our medical team are oblige to issue us our medication to our individual needs, we also have the obligation to prove that we are using it effectively or why we require more than the customary amount prescribed.

As for the Practice Manger.

They are Admin personal, not medical personal so don't normally have contact with patients, they can't over turn the medical opinion of the doctor. All they can do is investigate a patients complaint to see if the there is any foundation within the complaint. If a complaint is considered founded, they then act as a go between between GP, patient to rectify the matter in hand.

Normally the practice manager will deal with a patients complaint either when the patient has followed the grievance procedure, and the patient has failed to get redress at each level, levels being, GP, Duty Manager. When involving the practice manager a written formal complaint and/or a request for a meeting. They don't normally tackle complaints that haven't followed this route unless the complaint comes from outside of the practice such as the Health Authority or PAL's...

So the receptionist rebuff of your verbal request to speak to the practice manager is acceptable action as she did refer you to the start of the procedure by talking to the GP about your concerns...

So your complaint isn't that they failed in their obligation or duty of care, that put you and your baby welfare in danger. As it could be argued that you didn't bring the attention of your changing needs before they complained.

Your complaint is based around diabolical 'bedside manners' and how they handled the situation as a whole, making you feel stressed, worried etc...

 

[Pumper_Sue]

Ellie, the complaint is about not providing insulin not test strips this time.
GP was saying OP was using to much so no prescription was issued.

What would your reaction be if you found no insulin prescription had been issued?

 

[Robster65]

And no one from the surgery contacted her before or after the event to clarify or check she had enough.

If the chemist had played by the rules, she would have run out and would have had to go to A&E for backup. Not how any PCT would want their GPs to act I wouldn't have thought. All of this following the GP stating that she doesn't need more than a certain amount of insulin per day and no more than 4 tests.

No part of it can be defended by claiming they were following procedures. There was no attempt at duty of care. I presume the practice manager is the first line of complaint.🙂

Rob

 

[Ellie Jones]

Sue

If you read my post, you will see that I'm giving her information so when she makes a complaint she complains about the right thing namely the handling of the situation not whether the doctor acted illegally without consideration of duty of care which left her without insulin...

If you are going to start 'blaming' people you've got to consider what blame you yourself have within how the situation panned out..

The doctor and the surgery carried out their duties complying with the various rules, regulations and legislation that govern the issuing of a repeat prescription.

But did BS uphold her obligation of informing her GP of changes in need of medication that effected her repeat prescription

Err no she did not, her insulin requirements increased significantly but instead of requesting a consultation with her GP to review her increased needs so that her repeat prescription could be adjusted accordantly, she chose to increase the frequency of her requests for a repeat prescription.

Another responsibility of the patient, is that when we've used the allocated repeat request that either we have our medication reviewed or reauthorised, which is something know of actually do, just assume our surgery will do it automatically..

So there is a possibility that she didn't check whether she had the clearance to request a repeat..

So in fact both sides were in the wrong...


As to what I feel about if I'd had a prescription refused, wouldn't know never been in the position and doubt that I would end up there, due to ensuring that I make my GP aware of any changes to what I need without them having to second guess or chase me around etc..

 

[Northerner]

As to what I feel about if I'd had a prescription refused, wouldn't know never been in the position and doubt that I would end up there, due to ensuring that I make my GP aware of any changes to what I need without them having to second guess or chase me around etc..

I have never discussed my insulin requirements with my GP, she understands that it is the Consultant and DSN who approve the medication I require for my diabetes. Babysaurus' GP is forcing an unsafe situation without adequate knowledge of the needs of a pregnant diabetic. Even I know that pregnancy imposes huge changes on a person's requirements. It may be OK to question the supplies being requested, but not to withhold them without adequate warning or explanation supported by clear evidence.

Even if this turns out to be a result of an administrative problem, it is not the patient's responsibility to determine the root cause, but to make the practice aware that there is a problem and for them to sort it out. Not everyone who attends a surgery has the wherewithal to analyse why things happen, as I have said before - and those people may be left feeling they have to stick to the reductions imposed.

 

[Cate]

Wow Ellie, I've never used up my GP's time consulting her about how much insulin I need! Do you really do that? How often do you need an appointment for it? (Genuinely curious btw!) Also, how can you tell, as for me my requirements change based on day/weather/time of the month etc.

My GP knows that my diabetes care is done through the hospital, and that I will request repeat prescriptions as and when I need them - for insulin, test strips, etc. Also, at my surgery there is no ability to request prescriptions via telephone. It has to be either in person, in writing (NOT email), or through a chemist. For me, that makes doing it through the chemist (who will take a repeat requests over the phone... 🙄 ) is by far the most convenient method.

 

[Ellie Jones]

I wouldn't call discussing your insulin needs with your GP as a waste of time, if you need your repeat prescription changed to reflect a increased need that out strips your normal usage, a repeat prescription is supposed to be a minim of 28 days supply. There's a lot of surgeries who will not entertain issuing a repeat prescription until 21 days have passed since the last request.

If I'm correct BS would have been put on a standard 2 vials of insulin per month, now she's using 300 units in 2 days or just over which would mean she's looking at 5 vials a month.. A big difference.

So with this in mind, who blames a GP with yes limited understanding of the needs of a diabetic which wouldn't be helped as most of the diabetic patients will be on 2 or 3 vials per month, and probably go 6 weeks plus before putting in a request (I have 2 vials on my repeat, and order every 3 months or so)

So was the GP trying to restrict BS insulin or was in fact the doctor trying to get her into the consulting room to see medical proof or should I say her pump data/bg data to confirm what BS is saying over the phone, where the GP has no indication other than tone of voice used to determine is what she says is correct. The GP needs to see body language and some evidence to establish what's going on..

As yes pregnant women during part of their pregnancy will suffer from increased insulin resistance so require more insulin, but it's not that often that there's a dramatic increase that requires major alteration of frequency of repeat request or adjustments to the prescription.

And the quickest way for the GP to get his/her patient into the consulting room is to refuse the repeat prescription, if they need it they be swift..

Sometimes we have to educate our GP to what our needs are..