GP trying to take over

[Lizzie]

Hi

Has anyone else experienced their GP trying to take over their diabetes care when they would prefer to be cared for by the hospital?

At the hospital diabetes centre I can get my HBA1C done as well as a battery of other tests, I can see a DSN, consultant or dietitian, catch up with my DAFNE reunions, and many other things. The eye department on the ground floor checks my vision.

The GP does not have any of these facilities. Yet they want to redo my HBA1C and also discuss my diabetes with me. Why would they want to do this when I already have both these things from the hospital?

I understand having prescription reviews as the GP deals with my prescription and would want to make sure the amounts and drugs prescribed are still OK. But not this duplication of care I already get at the clinic. In fact the GP HBA1C is not even done at the surgery but at the hospital, except not the diabetes centre but a general blood testing department where you have to wait hours to be seen.

It seems patently ridiculous to me to duplicate this, especially since the hospital sends the GP a detailed breakdown of exactly what my test results are and what has been discussed with the consultant. If they need more information can't they just phone the hospital?

Has anyone else experienced this and what have they done about it? I don't want to be held to ransom and refused my prescription but I really don't want to waste my time or theirs with extra appointments and tests which I do not need. I certainly don't want my care transferred over to a non-expert non-specialist GP whose surgery has a fraction of the facilities available to me at the hospital. And any division or duplication seems stupid - if they cannot provide the same level of care and expertise as the hospital clinic, I don't see the point.

 

[Northerner]

I wonder if it's one of those cost things? They try to get people to be seen at the surgery otherwise they'd have to 'commission' the service from the clinic for each person who refuses. Your GP has to issue your prescriptions according to your consultants wishes as far as I know.

 

[AlisonM]

I get the bloods and prescriptions via the surgery but the results and all the rest are done through the clinic. I wouldn't want to let Dr Idiot loose on my diabetic care again, the mere thought makes me shudder.

 

[Cleo]

Funny you should mention this Lizzie - I get that as well - to be honest I just ignore them !. They cant not issue my prescriptions when I ask for them, so I try not to worry about them.

I think its absolutely ridiculous as the hosp / diab clinic has MUCH better resources and as you said, the blood tests arent even done at the surgery! Complete duplication and a waste of resources.....

Having said that though I do need to go tomorrow morning for some travel vaccines so I hope I dont get told off 🙂. If they do mention it I'll just say that I am being followed at my hospital and that my consultant is my primary point of contact as they are the specialists in the area.....(not the GPs)

 

[Annette]

I get regular appointments sent through from my GP for the Diabetic clinic they run, despite my having been transferred to the hospital within weeks of moving into the area, and also despite my being on a pump that none of the doctors know anything about (they freely admit this).
I just ring up, tell the practice manager that I'm being seen at the hospital, she says 'yes but you need to get your eyes done' I say 'I have them done at the hospital' she says 'what about your blood tests?' I say 'I get them done at the hospital', she says 'oh, well you dont need to come here then, I'll cancel your appointment and make a note on your file'. It happens (almost verbatim) every year. They've never said I have to go, they just automatically send out an appointment to everyone on the books who is diabetic, regardless of anything, it seems!

 

[everydayupsanddowns]

I signed myself off at the hospital some years ago ager a year or two of 'double appointment fun'.

However when I had some pointy questions to ask about swapping and changing insulins to solve a problem I was experiencing I was referred back to the hospital clinic, which is where I have stayed.

The arrangement I've come to is that I go to the hospital every 12 months and to the GP every 12 months and that these appointments are approx offset by 6 months.

I did get an 'overdue' reminder just recently but only had to call to explain and they were fine with it.

Surgeries seem to have 'standard' expectations of appointment frequency, based largely on T2s it would seem - my 'overdue' was for a nurse appointment and urine sample 🙄. Of course, it is in the surgery's interest to make sure your care/checks are up to date because they get QoF payments based on various criteria, but it actually doesn't matter *where* you have the tests done, only that you have them at least annually.

I'm more than happy for my GP to do the toe tickle/weight/BP etc and our area has a mobile eye screening unit (which goes round surgeries). For more pithy control questions I go to the pump clinic at the hospital.

 

[Northerner]

Is it definitely the case that they want you to be seen by a GP at the surgery? I ask this because when I was originally told that I could be seen at the surgery (when I was at the hospital clinic) I assumed they meant by the GP and nurse who really only deal with Type 2s and declined. However, my clinic at the hospital closed so I had to go to my GP for a referral to a new consultant-led clinic. She again said I could be seen at the surgery, but what I had realised originally was that it was a proper clinic with DSN that visited different surgeries on different days. I agreed and actually it's a much better set up because I get seen by one of the best in the city, plus access to DSNs, and it's only a 5 minute walk away not a traipse across town 🙂

 

[Flutterby]

My GP works as part of the hospital clinic team anyway so I just see him. If I wanted to though I am sure I could request to see the hospital team and I can ring the DSN if I need to anytime so I'm pretty well covered I feel.

 

[redrevis]

I've been seen under the hospital team since my diagnosis nearly 3 years ago. So far I've only had 1 letter from a GP at my surgery (not the GP I'm actually registered with though) saying that he wanted me to go in for blood tests etc. I called and said that there was no need as I'd already had these done under my hospital team. He tried to insist I had them done but I basically refused as it was a waste of my time, plus the fact I hate having blood tests done anyway, so for them to try and request more that weren't even needed, I wasn't having any of it. Since then I've not heard a peep from my GP surgery again regarding anything diabetes related at all. They don't even review my prescriptions, or should I say, they haven't done to date.

 

[Pumper_Sue]

Hi Lizzie,
it's not the case of the GP trying to take over. It's called money.
The government will only pay for your extra costs to the surgery if X amount of boxes are ticked. The boxes that have to be ticked are all diabetes related, HbA1c etc.

 

[Homedaze]

I am still seen at the Diabetic Clinic attached to the hospital. I was told by my GP's staff that I have to be seen by the diabetic clinic at the surgery once a year even though I attend the Hospital Clinic. I was asked to make an appointment but so far have not.

On the DVLA form to renew my license I had to declare when I was last seen by the Consultant and when by my GP.

 

[Pumper_Sue]

On the DVLA form to renew my license I had to declare when I was last seen by the Consultant and when by my GP.

It actually say's

If you do not see
your GP about your diabetes this question does not
apply so please answer ?N/A?.

Even though I have type 1 and use a pump, I do not have a consultant, thus my GP only is named on the form 🙂

 

[Lauras87]

When I got lost in the hospital system when I left young adult clinic, I ended up in the diabetic clinic at my gp surgery for 3 years

I went once, they told me taking 54 units of glargine is too much, I should only take 20 units.
Novo shouldn't be taken at 2 units to 10 grams, I should reduce my novo.

And had I considered that I'm T2 not T1 due to my hba1c's

I switched off after 5 minutes & just nodded.

I get its about money etc but I can email or text my consultant at anytime & there is 4 DSN's at hospital & the support is decent.
I'd be lucky to get an appointment with my gp if I had chopped my arm off but they still want me in their clinic

 

[Tina63]

I agree it's all about GPs claiming money for fulfilling various checks on you. Our GP receives a follow up letter after EVERY clinic appointment, we have the copy letters here. However, he regularly wants my son to have blood tests too and given that he is seen at clinic every 8 weeks or so with HbA1c done EVERY time, that is just plain stupid really, but he is a pedantic sort who likes to prove he is doing everything right, despite the cost. He does my son's foot checks too, despite them being done at hospital, urine checks, BP tested and even set up an appointment for his eyes mid-way between 2 annual reviews at hospital where it is always done, but being new to it, we just went along with it. I would certainly phone and cancel that now if it came through again (would be due in next month or so if it does come - but retinopathy screening was done with the annual review last December).

In the early days I was blissfully unaware of GPs receiving 'bonuses' for things like this, I actually assumed a GP would actively shy away from having someone with something like diabetes on their books due to costs, but it seems it can be quite lucrative! So someone like me who rarely sees the GP is actually a pain to have on their books I guess!

 

[Caroline]

My diabetic care has always been with my idiot doctor so I don't know any different. He is very bad at passing on results and unless I take someone else with me and push he wont.

our GPs get paid to look after us and as I understand it get extra for certain long term conditions like diabetes.

 

[everydayupsanddowns]

Hi Lizzie,
it's not the case of the GP trying to take over. It's called money.
The government will only pay for your extra costs to the surgery if X amount of boxes are ticked. The boxes that have to be ticked are all diabetes related, HbA1c etc.

Is it definitely the case that they want you to be seen by a GP at the surgery? I ask this because when I was originally told that I could be seen at the surgery (when I was at the hospital clinic) I assumed they meant by the GP and nurse who really only deal with Type 2s and declined. However, my clinic at the hospital closed so I had to go to my GP for a referral to a new consultant-led clinic. She again said I could be seen at the surgery, but what I had realised originally was that it was a proper clinic with DSN that visited different surgeries on different days. I agreed and actually it's a much better set up because I get seen by one of the best in the city, plus access to DSNs, and it's only a 5 minute walk away not a traipse across town 🙂

But... as long as those checks are done and the information is shared/notes kept up to date, my understanding is that they don't have to be done *again* by the surgery.

There certainly seems to be a move to 'decentralise' us difficult diabetic lot. There are so many of us that clog up the secondary (hospital) care system that there is a move to spread a lot of that burden across primary (GP surgery) care.

Personally I think it is only right for GP surgeries to get allocated extra money for us. We are major users of healthcare budgets, particularly presciptions - so a surgery with a lot of D's will need extra income/support in order to finance all those extra items we need.

We are the bane of a GP surgery budget!

I'm not sure what happens where a surgery has a special 'diabetic' nurse/clinic (there seems to be a very vague/inconsistent version of how much training this might involve too). I don't know if the surgery gets extra support/cash for the number of people who attend their D clinic, but if so this could be part of the picture.

Personally I'd far rather just politely decline any duplicate appointments once in a while than read about people who completely fall through the net, with no care/checks/follow up for their D at all!

 

[AlisonM]

My surgery claims to have a diabetic nurse, but when I asked, it turned out she hadn't yet finished her training as a DSN, and won't do for at least another year as she has to do the training part time and fit it around her surgery work.

If I were a straightforward (hah!) T1 or T2, I might be more accommodating, but given the struggles I've had with the meds they insist on, I won't be using her services any time soon. LADA is routinely treated up here as T2, but I'm clear proof that doesn't really work too well.

Plus, Dr Idiot doesn't believe LADA is real, so why on earth would I trust her to treat me?

 

[Lizzie]

Wow ? such a lot of helpful replies! Thank you all for your help.

Northerner ? it is hard to say exactly what they want, the receptionists are not the best. When I explained I had received a letter asking me to make an appointment, the receptionist made one with a GP.

Pumper Sue ? but I already have my HBA1C checked, by the hospital. And the hospital always sends a detailed breakdown of everything tested and said in the clinic, back to the GP. But even if they did not do that, all the GP has to do is pick up the phone ? ordering a battery of duplicate tests seems a complete waste of money to me.

Everydayupsanddowns- I think there is a distinction to be drawn between the prescription side of things, and associated costs with that, which of course the GP should get adequate funding for, and the rest of our care which might be at a hospital clinic and if so, as long as good lines of communication are kept open between the clinic and surgery I don?t see the need for the GP to have any involvement in or funding for this, unless of course the patient wishes them to.

 

[MargB]

I am T2 so hospital appointment has never been mentioned. I get the practice nurse who knows everything (not).