Rare inefficiency from GP surgery!

[Sally71]

Yesterday I tried to order some Novorapid vials for my daughter, we now do online ordering which is easier than having to traipse all the way to the surgery to drop your prescription off. I could have ordered anything else I liked - glucose strips, ketone strips, Libre sensors which we no longer use, needles which we use once in a blue moon, penfill cartridges etc - but the Novorapid vials had a note on them saying that we couldn’t have them again until we’d had a review, please contact your GP! Erm, excuse me???? Now I’ve heard many people complaining on here that they’ve had letters from their GP along similar lines, so I know they are probably just going through checking anyone who is on long term medications and didn’t think properly that once you’re a type 1 on insulin you’re going to stay one forever! Our surgery until now has been more efficient than that, it used to say on the prescriptions that you have 12 remaining etc, but when it got down to zero it was automatically reset without me having to do anything.

Luckily they now also have a way of contacting the GPs for various documentation, advice etc online thus avoiding having to queue on the phone system, so I went straight on there and posted a question “what exactly is there to review please, type 1 diabetes does not get better, please reauthorise the insulin!” And then went on to explain that we are still using a pump which is why we mostly use vials instead of penfills, but please keep the penfills on the prescription too as we need a few of those in stock for emergency backup just in case the pump fails. I received a couple of automated messages to say that my enquiry would be dealt with as soon as possible, and not to contact them unless I haven’t had a reply by Thursday evening. Not Thursday yet but I went to the online prescription ordering again tonight and hey presto the vials have been reinstated! So have ordered some quickly!

I do keep a good stock and order when I’ve still got plenty left so wasn’t panicking, these little trials are a bit annoying though!

 

[Bruce Stephens]

I think Partha Kar recently tweeted that threatening to withhold insulin for this kind of reason just shouldn't happen.

Life with diabetes can be stressful enough without this kind of silly bureaucracy. Fine to want to do a diabetes review once or twice a year (and to do a quick review of whatever's on the repeat prescription) but they don't need to threaten to withhold stuff from me!

 

[DaveB]

GPs are often forced by their CCG to do renewals on all meds every 6 months or so. All of my meds are 'reviewed' and approved by my DN before the 6 month date. Best to ask your GP/DN to do it at one of your reviews if you can

 

[Sally71]

We have reviews every 3 months at the hospital, not the GP

 

[eggyg]

My pharmacist does my med reviews on an annual basis, not this past year obviously as the “ office” she uses is little more than a broom cupboard! The only “review” I’ve had with the GP was when they decided I didn’t need an Accu-Chek mobile and cassettes but the cheapest of the cheapest bog standard meter was perfect for my needs! Hmm...soon sorted out with a polite but firm phone call. Very annoying for you though @Sally71, a simple case of the left hand doesn’t know what the right hand is doing is my guess. Glad you got sorted quickly, we shouldn’t have to be worrying about not being able to get our life preserving medication.

 

[helli]

I've had this kind of thing and assume it is a requirement for them to do a regular medication review. If it happens and what I need is not urgent (it rarely is because I keep a good backup), I leave it a couple of days and find it is sorted. When I have been running lower than I feel I should, a phone call to the surgery has triggered an instant review.
Given we are in the middle of a pandemic which is affecting the NHS more than most, I am not surprised they may get a bit behind on some of the reviews.
It's easy to say that we all need our insulin so what is the point of a review. But occasionally I read about someone who's review has been automatic for so many years that they are still on fixed mixed insulin doses. I believe the review should be considering whether there is something more appropriate available.
A few years back, my surgery were ultra efficient in their review - they removed anything I had not requested for the last 12 months ... including my back up pen insulin cartridges in case my pump fails. I had a discussion about this with the prescribing pharmacist at the surgery and ... she won't be removing it again!

 

[grovesy]

My pharmacist does my med reviews on an annual basis, not this past year obviously as the “ office” she uses is little more than a broom cupboard! The only “review” I’ve had with the GP was when they decided I didn’t need an Accu-Chek mobile and cassettes but the cheapest of the cheapest bog standard meter was perfect for my needs! Hmm...soon sorted out with a polite but firm phone call. Very annoying for you though @Sally71, a simple case of the left hand doesn’t know what the right hand is doing is my guess. Glad you got sorted quickly, we shouldn’t have to be worrying about not being able to get our life preserving medication.

I had medicine review with my GP's Pharmacist in August via the Phone.

 

[Sally71]

Left hand not knowing what the right hand is doing is a good point. We have our diabetes reviews at the hospital not the GP, hospital team write to the GP after each one and we get a copy of the letter. GP so far has just continued to issue whatever we ask for that’s diabetes related without arguing. I agree there need to be checks in place to make sure that dosages, types of medication etc are still correct and the best available, the hospital team do that for us though. I order 4 vials of Novorapid at a time, used to get 2 but daughter’s insulin requirement shot up dramatically during puberty and 2 vials didn’t last a month any more so I doubled it (and it was quite a palaver getting the prescription changed). 4 vials is probably a bit much now but it just means that I put the prescription request in every 6 weeks instead of every 4, which saves everyone time, so unless her requirements drop drastically I shan’t bother to change it back.

Had someone on the phone from the GP surgery a few weeks ago who had noticed that we have not requested Libre sensors for a few months and asking if we still need them. I was honest and said that we’ve now switched to Dexcom and are getting on well with those and are unlikely to change back so they took them off the prescription repeat. Then a week or so later we had hospital review, the letter they send to the GP included instructions to keep issuing Libre sensors on prescription because daughter fulfills the criteria to get them. So now the GP has not only put them back on the prescription, he also sent a request to the chemist and I got called in to collect a prescription that I hadn’t asked for and then refused it and told them to give it to someone else!! Sigh. So now I shall have to ask the hospital team why they keep putting that on the letter, should we keep them on the prescription just in case anything goes wrong with Dexcom or did they just forget to take the instruction off the letter?! Fun and games!

 

[JohnWhi]

Just looked at one of my prescriptions. Written at the top, "Review date at which the prescriber would like to review the treatment with the patient: 06/08/2020". There is no obvious way of making this happen, though I did speak on the telephone to a GP last August and persuaded him to add a couple of essential items that had been automatically deleted. The last review I had with the GP was in September 2019. Fortunately the hospital diabetic clinic are marvellous, and they write letters to the GP describing updates in treatment.

 

[MarkGeordie]

Ive not had a review for years. They seem to issue me anytime I request. They must just do the review without me.

 

[trophywench]

My surgery do a Diabetes review every 12 months - had mine on 18th December. Since that is the only time I ever get my toes 'tickled' every year it is OK, except she was having to use a lancet to test this time, as no longer allowed to use a microfibre filament, they not being single use items. Hence instead of me saying yes yes yes, I said Ow ow ow ! Just silly.

 

[helli]

@trophywench a medication review is not the same as a diabetes review.
Toe tickling (or stabbing) is not necessary to check you still have the best available insulin.
Now, the definition of "best" may be open to interpretation but as the patient does not have to be present for a medication review, it could mean "cheapest": a more common than it should be outcome of a medication review is downgrading a blood glucose meter to one that uses cheaper strips.

 

[everydayupsanddowns]

Ugh! I hate these kind of automated system-based refusals for pharmacy reviews.

I can understand it as being a good general principle, but for specific cases like insulin, it really isn‘t fit for purpose! It can be helpful to have a. occasional review to weed out anything on your repeats that you no longer need though.

If you make an appointment with the GP, they have no idea why you’ve come in, and and ask “So why have you come in today?”, then when you say, “It’s because you threatened to stop my insulin” they are horrified!! “Oh no we’d never do that!!” Pretty much verbatim the conversation last time this happened to me. I’ve not had insulin supply questioned since.

Do you have a ‘next medication review’ date on your prescription tick-list that comes in the bags from the pharmacy?