GP's DSN Appointment

[MikeyBikey]

I was surprised to get a call from the GP practice to arrange a diabetic review with their DSN. I pointed out that I had had a face to face with my consultant two months ago, and vascular, opthalmology and podiatry since. The response was they were the prescribers and an appointment duly made!

Has anyone else had this? It is over three years since I last saw a GP DSN (at my previous practice) but since the start of the pandemic I have had three telephone and the face to face with my consultant or her colleague. My concern was the last DSN seemed to think anyone with a BMW over 21 needed to lose weight and nobody took animal insulin anymore!

 

[Robin]

I was surprised to get a call from the GP practice to arrange a diabetic review with their DSN. I pointed out that I had had a face to face with my consultant two months ago, and vascular, opthalmology and podiatry since. The response was they were the prescribers and an appointment duly made!

Has anyone else had this? It is over three years since I last saw a GP DSN (at my previous practice) but since the start of the pandemic I have had three telephone and the face to face with my consultant or her colleague. My concern was the last DSN seemed to think anyone with a BMW over 21 needed to lose weight and nobody took animal insulin anymore!

I get the same, I have a review with the nurse at the surgery once a year, so they can tick boxes and get a payment for it. Last time, she had to tick a box to say that 'Smoking cessation advice had been offered' even though I’ve never smoked in my life! And when I admitted to drinking 3 glasses of wine a week, she had to go through a whole questionnaire that asked me things like, 'Do you drink every day?' I don’t know how anyone thinks three glasses could be split over a week.
At least now, our surgry have streamlined it so the nurse can do the Medication review, I used to have to see a GP separately for that once a year, an appointment that used to last 30seconds, with my GP ticking one box and saying, good, now I can get on with some other work before the next patient is due,

 

[Pumper_Sue]

I was surprised to get a call from the GP practice to arrange a diabetic review with their DSN. I pointed out that I had had a face to face with my consultant two months ago, and vascular, opthalmology and podiatry since. The response was they were the prescribers and an appointment duly made!

Has anyone else had this? It is over three years since I last saw a GP DSN (at my previous practice) but since the start of the pandemic I have had three telephone and the face to face with my consultant or her colleague. My concern was the last DSN seemed to think anyone with a BMW over 21 needed to lose weight and nobody took animal insulin anymore!

It's your right to decline the the review, the only reason they insist is because they get paid £100 per review. So if you don't want the review then put it in writing. They can not stop your meds as your life depends on the insulin and you are under a consultant anyway.
I do not have GP practice reviews and there is no threat of withdrawing my insulin either.

 

[Lucyr]

Last time I had one the nurse said “you don’t need to come to these you know you can just decline if you want, we only invite you as we get paid for doing them, but they don’t benefit you as we wouldn’t change anything without the hospital saying so”

 

[Robin]

I didn’t attend mine when I was getting the same checks at the hospital, then I got discharged back to my surgery, so it was the only time I had my feet, BP, etc checked, and got my annual bloods done. Now I’m back with the hopsital again, but I only get a 6 monthly phone call to check up on the Libre, so I still attend the GP surgery for foot checks and my annual bloods.

 

[nonethewiser]

Get text reminder every year without fail, this despite telling them time & time again don't need to be seen by DN at gp surgery as get seen by hospital clinic.

Now just ignore them altogether, only get bloods done there to be sent off to hospital which diabetes clinic have access to, sure all consultations in hospital clinic are copied to to gp surgery anyway so they are well informed on diabetes matters.

 

[Pumper_Sue]

I didn’t attend mine when I was getting the same checks at the hospital, then I got discharged back to my surgery, so it was the only time I had my feet, BP, etc checked, and got my annual bloods done. Now I’m back with the hopsital again, but I only get a 6 monthly phone call to check up on the Libre, so I still attend the GP surgery for foot checks and my annual bloods.

In 57 years of type1 diabetes I have never had a foot check.

 

[everydayupsanddowns]

I get these too. I try to make them 6 months apart with my pump clinic - but they do tend to drift together!

 

[MikeyBikey]

In 57 years of type1 diabetes I have never had a foot check.

That's simply appalling! I know that in the sixties/seventies/eighties foot checks only seemed to happen if the person had walking difficulties. Eye checks were quite random as well and I was probably over 15 years in when I had my first one. My foot checks only became regular after I suffered a crush injury in the mid-nineties losing the toenail in the process. It grew back and has been problematical since. The DSN said my pulses were fine a few months before the podiatrist diagnosed PAD with a reduced ABPI!

 

[JohnWhi]

I have something of the sort once a year ("Review of Long-Term Condition") with a nurse from my GP surgery, but they do not describe themselves as DSN. In fact, I was firmly told last time that I could not discuss diabetes or prescriptions. Fortunately, I have a really excellent consultant at the pump clinic. Last time she asked me to talk about pump therapy to a trainee GP, so things might be moving forward.

 

[Flower]

I had to have one a few months back to get insulin prescribed again. I usually say not thanks to the review as I go to a pump clinic for bloods etc but this time round the surgery were insistent that I had to have a review. I did and it was a quick appointment where we agreed I still need insulin and all the other stuff I take.

 

[MikeyBikey]

Thank you for your replies. I now understand what is going on.!

I will go through with it this time and take a view on DSN's knowledge base and that of diabetes lead GP the following week.

Once I received a visit from a community DSN. Her opening gambit was "Now I understand you wish to switch from from animal insulin". I replied "No, who told you that? Moses or a vegan"? She was gone in under five minutes deciding to leave as is.

 

[Drummer]

I've been told that I have had an annual health check every year from the age if 40 - but I keep a diary, and I haven't.

 

[gll]

In 57 years of type1 diabetes I have never had a foot check.

I was getting concerned I haven't had one yet 8 months in

I did and it was a quick appointment where we agreed I still need insulin and all the other stuff I take.

because insulin is optional for T1 right? 🙄

 

[helli]

I had to have one a few months back to get insulin prescribed again. I usually say not thanks to the review as I go to a pump clinic for bloods etc but this time round the surgery were insistent that I had to have a review. I did and it was a quick appointment where we agreed I still need insulin and all the other stuff I take.

I had my first GP-based DSN review earlier this year - they usually invite me within a month of my hospital diabetes clinic review so I decline but with covid my hospital appointments had been delayed.
She asked how many units of basal insulin I use in my pump and whether I had ever had a hypo!
No toe tickling and the only blood test was HBA1C. I had to ask her for the result.

 

[Robin]

She asked how many units of basal insulin I use in my pump and whether I had ever had a hypo!

My new one asked me if I shook my Levemir pen well to mix up the suspension!😱 I told her no, because it’s not a mixed insulin, and she quickly changed the subject. I don’t think it was a trick question.
My previous one always asked 'you never have hypo, do you?' and always looked horrified when I said yes.

 

[helli]

My previous one always asked 'you never have hypo, do you?' and always looked horrified when I said yes.

I told her that anyone with Type 1 who denied ever having a hypo was either lying or ran their levels ver high.

 

[trophywench]

I told her that anyone with Type 1 who denied ever having a hypo was either lying or ran their levels ver high.

and I sincerely trust none of those people ever drive a vehicle on the public road, since if you've never had a hypo, how the hell would you recognise the symptoms of one? And if you have no hypo awareness, it's illegal to hold a driving licence ......

 

[SB2015]

I am happy to have my bloods done at the surgery and they do the full set of tests (I used the DUK 15 health essentials as a check when some were being missed out) . I also get the foot tickle, BP, weight, … done, and have that all done before my consultant appointment, as he can access the results. The Practice nurse then asks loads of questions about my pump as she is interested.

Practice happy as they can tick a box
It saves me a trip to the hospital to get bloods done
I have all my results before I see consultant so have an informed discussion

 

[eggyg]

I got my annual review yesterday, over the phone. I was in the surgery two weeks earlier getting bloods taken, had my feet tickled and BP taken.

She told me my HbA1c, 50, she said that was good, I said it’s not as good as 48 which it was only six months ago. Asked how much Levemir I injected, I explained it varied with the weather etc. How much bolus did I take, I explained my ratios differed, again, weather dependant, what my start point was, blah , blah blah. She then told me my cholesterol was high and had I ever considered statins. I asked what my HDL was, she stumbled a bit then, but admitted it was good. I told her I’ve always had high cholesterol and I suspect I’m predisposed to it. I also mentioned I couldn’t take statins as I’m on a fibrate for my liver and never the Twain should meet. BP quite high, I’m to pick up a seven day monitor on Monday, again I told her it’s probably white coat syndrome but have said I’ll do it. What a pain though. She then conceded, “ I think you know more than us!” Yup, she got something right! Definitely just a box ticking exercise.