-
Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.
-
Learn more about joining the Diabetes UK Support Forum team here: https://forum.diabetes.org.uk/boards/threads/volunteering-opportunities-why-dont-you-join-us.112862/
Just who do YOU listen to
- Thread starter Steff
- Start date
- Status
Adrienne
Well-Known Member
- Relationship to Diabetes
- Parent
Do you have to wait until February, that's ridiculous. Do you now have the appointment system where if you want to see someone that morning you ring them at 8 am ish and you get an appointment that day? If they say it is for urgent stuff which they generally say then it is urgent, it is your life, that is urgent in my books 🙂
Steff
Little Miss Chatterbox
- Relationship to Diabetes
- Type 2
Er never have had that kinda systen even before I was diabetic,he is like lord lucan you see him 1 month you might not see him again till 4 month later
Einstein
Well-Known Member
- Relationship to Diabetes
- Type 1
There is a major confusion in peoples minds, especially type 2's I fear about a GP practice DSN and a hospital DSN or DNS... One close term for two very different people.
The former, at the GPs is a nurse whose received some training about managing type 2's, now we know this is hit and miss, even nurses who themselves are type 2's are confused with the advice they give patients.
So they have an 'interest' in diabetes. I use the term loosely. They are ok for doing your annual MOT, blood pressure, injection sites, pulses, feet etc...
Now the nurses who work with my diabetologist are first class. They will adjust my regime, change insulins etc and there is a form I hand to my GP's for the prescription. Not once has this ever been questioned.
These nurses live and breath diabetes and nothing but, they weren't doing family planning this morning and diabetes this afternoon, weighing babies later on etc. All they do is diabetes and as such pretty soon they see most if not all of what there is to see.
My GP doesn't get involved in my diabetes, if I ask her she will, but I don't ask directly about it, I have direct access to the specialist nurses who live and breath diabetes, and through them to the consultant. What more do I need?
However, I accept certainly for non insulin dependant type 2's the situation is quite different and there is a battle.
Ultimately there aren't many nurses I know of who can prescribe, however, if your nurse recommends one treatment and your GP chooses to differ in his opinion it should be a matter for them to clarify without your being in the middle. GP's seem happy to offload diabetes management to their nursing staff, so perhaps they should treat the nurse as a professional when it she makes a decision.
With the advent of EPR (Electronic Patient Records) which is now almost entirely deployed in the GP's surgery, but not in many places elsewhere across the NHS, documents, letters, reports now arrive in to the mail room at the surgery and are scanned onto your notes. Dependency on test results of the lab advising in or out of range is often the trigger to call a patient in, otherwise, the letter may or may not trigger an acknowledgement for the GP. Then there is the matter of how many letters they get each day, how many are 'ok, file that for later' or 'needs action now or the next time they are in' then they need to remember the action later on.
Blame it on the computer I guess, but at least patient records/notes within the GP's rarely get lost now.
sofaraway
Senior Member
In my experience you are right Einstein there is usually a big difference between practice nurses and hospital DSN's. I saw one terriable one at my last practice, this one I have seen once on registering here and not seen the need to again, even though she said she would call for me yearly, she didn't. Not sure if they are getting their QOF points for me or not.
I don't think it'll be too long before there won't be any hospital DSN's seeing outpatients. There will only be the inpatient DSN's left based in hospitals.
Hearing a nurse consultant in diabetes talking earlier this week she was saying that her trust aims to discharge 100% of their caseload into the community.
I don't think it'll be too long before there won't be any hospital DSN's seeing outpatients. There will only be the inpatient DSN's left based in hospitals.
Hearing a nurse consultant in diabetes talking earlier this week she was saying that her trust aims to discharge 100% of their caseload into the community.
Einstein
Well-Known Member
- Relationship to Diabetes
- Type 1
Well, they'd better get their finger out and sort out the dire nurses in primary care. I wouldn't trust one of them to give me any advice - the last review I had decided my kidney and liver functions hadn't been tested in 12 months and quizzed me as to why - I'd had two lypids tests and two HbA1Cs funny enough I don't tell THEM what I'm having blood tests for.
So she attempted in both arms to take blood, telling me to make another appointment for blood tests - MORE of my time, getting Bruce ready to come out of the house because as a nurse she can't even take blood successfully!
The nurses in clinic wouldn't attempt to take blood in the first place, they don't have the kit there, it's the only time blood has never flowed, so I can only assume there was a high level of ineptitude.
RachelT
Well-Known Member
- Relationship to Diabetes
- Type 1.5 LADA
I'm a tad confused on this issue.
Ok, a Nurse Prescriber has, as Sofaraway, i think, has said, is a nurse who's done a course and can prescribe "any licensed medicine for any medical condition within their competence, including some Controlled Drugs." (Thank you Department of Health). So the nurse's prescriptions are limited by what she's "competant" to prescribe.
I don't think that either of the three DSNs i know of can do so. There's Angela and Janet at my surgery, who are both fab, by the way, (and if the GP prescribes me something odd i tend to go away in tears, and then go back later and they explain it to me in a much more positive way) they can't prescribe, but seem to know heaps about diabetes and how to treat emotionally volatile patients. Then there's Eileen at the hospital, she's part of a team and might even be a Nurse Consultant. She runs DESMOND and DAFNE courses and comes to give talks to confused Pharmacy Techicians about insulins and pens. I don't think she can prescribe, the only time i've seen her about me, as it were, she had me put on Metformin and had to go and ask one of the consultants to write the prescription for me (which i promptly took back to my workplace and got somebody else to dispense.,.). She also gave me a piece of paper asking my GP to write me up for test strips, lancets and a bin, which he promptly ignored. Eileen and her team are also fab, but i don't see them very often.
The other point is that your Primary Care Trust is limited in what drugs it can prescribe. This is why people get in a big old fight when they can't get the cancer treatments they need. If a drug is too expensive or the cost is deemed to outweigh the benefit it can't be precribed, at least, not routinely.
In my local PCT, Byetta is never started by the GPs , it's always started by one of the hospital based consultants. You get your first month's supply written up by the Consultant and dispensed by the Hospital Pharmacy (who are also brilliant....well...we try hard.. some of use are more brilliant than others 😉.). The second month is also usually dispensed by the hospital, as the second month has a dose increase and is written up that way by the doctor. Some patients do get month two from thier GP, and from month three everybody does.
Pheww, that got a bit long winded but at least i'm less confused now.
Rachel
Ok, a Nurse Prescriber has, as Sofaraway, i think, has said, is a nurse who's done a course and can prescribe "any licensed medicine for any medical condition within their competence, including some Controlled Drugs." (Thank you Department of Health). So the nurse's prescriptions are limited by what she's "competant" to prescribe.
I don't think that either of the three DSNs i know of can do so. There's Angela and Janet at my surgery, who are both fab, by the way, (and if the GP prescribes me something odd i tend to go away in tears, and then go back later and they explain it to me in a much more positive way) they can't prescribe, but seem to know heaps about diabetes and how to treat emotionally volatile patients. Then there's Eileen at the hospital, she's part of a team and might even be a Nurse Consultant. She runs DESMOND and DAFNE courses and comes to give talks to confused Pharmacy Techicians about insulins and pens. I don't think she can prescribe, the only time i've seen her about me, as it were, she had me put on Metformin and had to go and ask one of the consultants to write the prescription for me (which i promptly took back to my workplace and got somebody else to dispense.,.). She also gave me a piece of paper asking my GP to write me up for test strips, lancets and a bin, which he promptly ignored. Eileen and her team are also fab, but i don't see them very often.
The other point is that your Primary Care Trust is limited in what drugs it can prescribe. This is why people get in a big old fight when they can't get the cancer treatments they need. If a drug is too expensive or the cost is deemed to outweigh the benefit it can't be precribed, at least, not routinely.
In my local PCT, Byetta is never started by the GPs , it's always started by one of the hospital based consultants. You get your first month's supply written up by the Consultant and dispensed by the Hospital Pharmacy (who are also brilliant....well...we try hard.. some of use are more brilliant than others 😉.). The second month is also usually dispensed by the hospital, as the second month has a dose increase and is written up that way by the doctor. Some patients do get month two from thier GP, and from month three everybody does.
Pheww, that got a bit long winded but at least i'm less confused now.
Rachel
sofaraway
Senior Member
Thank you for your detailed post Rachel, You explained why nurses might not be prescribing something, the other factors limiting them rather than the fact they they just unable to prescribe a drug. Like nurses are unable to prescribe blood transfusions, thats a blanket thing not a local policy.
Alba37
Well-Known Member
- Relationship to Diabetes
- Parent
The fact that metformin isn't doing the job now, and you are happy to try byetta I think you should be listening to the DSN for sure. How do precription budgets work in England, could it be the cost is coming out the practice's budget and that's why he's against it? Can the DSN talk to him? He'd have to give her a good reason why he doesn't want to prescribe it for you, I'd of thought.
Steff
Little Miss Chatterbox
- Relationship to Diabetes
- Type 2
She seems to use letters as a way to communicate she only comes into my surgery on the days she has patcients to see so i dunno how pally she is , I will ask her when i see her then unless when i see gp he puts me on it before hand , well i can dream!
Alba37
Well-Known Member
- Relationship to Diabetes
- Parent
I guess the fact that he didn't even open the origional letter shows that might not work then! Still might be worth phoning, emailing or writing to the DSN though to let her know the GP won't prescribe it, as she obviously thinks it could help you. I hope you get it sorted out soon.
Steff
Little Miss Chatterbox
- Relationship to Diabetes
- Type 2
Ty Alba im abit sick of doing all the doing tbh, i did it all myself to start with when i was on my tod, now i aint i want them to do something for me, so I will be bringing it up along with many QS with DSN in Feb.
- Status