Threatening letter from GP surgery

Sally71

Sally71

Well-Known Member
Relationship to Diabetes
Parent
My daughter is under hospital care for her diabetes, has been ever since she was diagnosed, and has just transferred from the paediatric team to the young adults team. They see her every 3 months and always send a letter to the GP summarising what happened at each meeting so that it can be put in her notes.

Recently she’s started getting text messages from the GP saying that she needs to book a diabetic review. Why, they are done at the hospital. She was a bit confused and has been ignoring the messages. Today she received the following letter:

“FINAL REMINDER
You are now overdue for your annual Diabetic review. Please contact the reception team and book a morning appointment with a NURSE as soon as possible.
Please also bring a urine sample with you to this appointment (sample bottles can be obtained from the reception desk).
Chronic condition reviews are essential for us to monitor your condition and ensure you are being prescribed the most appropriate medication and dose.
Should you continually refuse to attend for this appointment without contacting the surgery then we shall begin the process of reducing the quantity of medication that you receive on your repeat prescription.
All patients that continuously refuse to attend for monitoring appointments without explanation, despite reminders, may be removed from the practice register.”

The letter isn’t even signed!
In 12 years of having diabetes she has never had any sort of check up at the GP so I don’t know why they suddenly think she should start now, I don’t know if it’s got something to do with her turning 18, I think that’s about when the messages started. And I don’t think threatening to kill her, which is what would happen if they refuse to prescribe her any more insulin, is the way to go about it!

Sigh. Hopefully it’s just a case of bureaucracy gone mad and people not using their brains to join the dots, and will only take one conversation to sort out, but why the bloody hell should we have to? That’s just another annoying little job that we’ve got to find time for. I’m wondering whether to use the online appointment booking form to explain rather bluntly why we don’t need an appointment, or whether it would be better to go in there and demand to speak to someone. Daughter will have to come with me as she’s legally an adult now, but hopefully she will be OK about arguing the case herself!

Rant over
 
Hello, I’ve had sort of stuff from the GP surgery once a year for a “medication review.” “Do you still need insulin?” Yep. I also see a consultant at the hospital too. Usually I need to see DSNs at the clinic appointments prior. I tell them I’ve recently had the “footrasound” tickle & blood/ pee extracted at my surgery. They leave me alone. It’s just how it goes, these days.
 
I get a letter once every 6 months saying you are overdue for your Annual review please book it now I normally tell them underthe Elise b Maybe you should just ring them and explain your daughter is under the care of the hospital team. It may be a case of crossed wires. Dont ignore txts from them in future it may take a while for the message to get thou to GP
 
Ah, yes, the pointless bullying letter followed by a pointless review with the diabetes ‘expert’ nurse who freely admits they know very little about Type 1 and nothing about pumps. I got so sick of mine, I complained to my GP and he stopped them (don’t know how but I’ve not had a letter for years). I’d previously explained that I was under the care of the hospital but I’d been wasting my breath. However, this GP sorted it out (thanks, Dr X!).

Don’t ignore the letters @Sally71 I once had a tyrannical pharmacy staff member refuse to give me my prescription because I hadn’t had the pointless review. She was quite happy to leave me without insulin. I pointed out that I’d die without it and would therefore be going to A&E to obtain some and giving them her name, so she grudgingly allowed the prescription - but removed my testing strips from it! This meant I spent Christmas with no means to test my blood sugar.

So, speak to them asap and be prepared to push back. I think they get money for each pointless review they do.
 
Ugh! These are a pet peeve of mine.

I’ve had a few, and know the drill now. They are meant for ‘other people’, and endlessly stockpiling meds that are no longer taken is a genuine problem - but I still see absolutely no justification for the sort of language and approach used. Especially since the simplest of electronic checks would sort this out.

It is good that there’s a backstop for people ‘falling between the cracks’ to ensure they get checked, but the approach is all wrong, and I suspect would be entirely counterproductive for anyone in a fragile state, or genuinely struggling.

I have called my surgery out on this every time. Particularly when the person running the appointment doesn’t seem aware of the ‘threats’ used

“Why have you come to see us today?”
“Well because you said you were planning to kill me, by stopping my supply of insulin”

*shocked face* 😱

“Oh we would never do that!!”

Etc etc.
 
I understand how this can be irritating and inappropriate for T1s who are definitely not going to be stockpiling stuff and not using it, but best to address the issue with the Practice. So much of the system is now automated and odd letters get sent.

In adult care whilst under the care of the hospital team, they don’t do the foot check. Will that be covered in your daughter’s adult care team @Sally71 ? I find that I combine a Practice foot check, bloods, BP etc and diabetes review with a meds review of other stuff. This ticks the boxes for the Practice, and is now more of an update for the DN at the Practice. I realise this is less of an issue for me as I am retired and can fit this in easily.
 
SB2015 said:
In adult care whilst under the care of the hospital team, they don’t do the foot check. Will that be covered in your daughter’s adult care team @Sally71 ? I find that I combine a Practice foot check, bloods, BP etc and diabetes review with a meds review of other stuff. This ticks the boxes for the Practice, and is now more of an update for the DN at the Practice. I realise this is less of an issue for me as I am retired and can fit this in easily.
Click to expand...

This is the split I settled on too @SB2015

Annual GP Surgery Review for bloods, weight, BP, toe tickle, quantity-of-repeat-meds, checks...

and

Annual Hospital Pump Clinic for bloods (again), and nitty-gritty pump tweakery.

I try to keep them 6 months apart, but they inevitably drift together, and/or one or other becomes 18-month not annual blah blah blah.
 
I am another who gets the GP "invitations" even though I am under the care of the endocrine clinic for diabetes which become more and more threatening if I ignore them.
Each year, I would eventually get around to calling the surgery and explaining why their review was not needed. I even asked for this flag to be put on my records so the computer would stop future invites. This worked for a year and then the invitations returned.
Out of curiosity, I attended one year and the stories of gp surgery based dsns who knows nothing about Type 1 came true. She knew nothing about how my insulin pump worked - she asked how many units of Lantus I took each day. She asked if I had ever had a hypo. This confirmed it was a waste of my time and hers.
Fast forward a few years and my clinic based appointments became further and further apart which nearly caused a problem for my dvla driving license renewal (the form required the date of my last review within the last 12 months). In the past few years (since, I think the pandemic), I have been taking advantage of the GP surgery's bi-annual blood tests but not the follow up appointments. I get to check I am doing ok. The surgery gets to tick the box and everyone seems happy.

As the appointments are by telephone, there is no chance of toe tickling or BP measurement or weight checking but I get these every 18 months at the clinic and are always fine.
 
I'm another who relies on my GP surgery annual review with their nurse for my toe tickling, annual bloods, BP etc.
Ever since I asked to be referred back to the hospital clinic in 2020, I’ve either had a telephone appointment, or when given a face to face, it’s been postponed several times and has yet to happen (last postponed at the last minute in January 2024, rescheduled for March 2025).
I find the GP review slightly annoying, because as well as the stuff I want done, she insists on going all the way through her tick boxes, including alcohol, smoking, (I’ve never smoked), do I want structured education, etc.
 
My DN at the surgery is pretty switched on about Type1 and Libre but she knows that I know more about my diabetes management than she does and sometimes learns stuff from me. I still find it a useful appointment as I have only had a 10 min telephone appointment with the consultant about once year since Covid. I am fine with that, but the GP reviews give me 6 monthly blood tests, a toe tickle and pulse check and BP, so I find the combination works well for my situation. I am however REALLY shocked at the tone of that letter!! ...... And really impressed that your daughter has 3monthly appointments at clinic! Wow! That is good!
 
The nurse who now does the 'diabetes checks' at our GP surgery is as thick as a plank and because she seriously doesn't know the slightest thing about what isn't on her computer screen and furthermore has absolutely no interest in expanding her knowledge, it is a complete waste of time and I know that, but still attend so they can tick all their required boxes, so there can be no arguments about me being non compliant.

In the past I had to see a locum doctor who I had seen before and said in a friendly way that because all my D advice was undertaken by the specialist personnel at the hospital D clinic, if anything needed changing they'd be the ones asking the GP surgery to alter my prescriptions for whatever, and they hadn't recently told me I needed to change anything and she was furious and snapped back to say that any future prescriptions were entirely in her hands and whether she ticked the relevant box on the computer screen, so if she decided to stop my insulin, she was at liberty to do so. My thought went Just Damnwell Try, Mrs! Of course she had no idea that I knew that such action is illegal, nor that I knew exactly which firm of solicitors were excellent in dealing with medical negligence cases, be perfectly happy to ring the Law Society, the General Medical Council, local & national newspapers, the BBC etc etc etc. Just Try It you silly cow! But merely smiled at said nowt. Famous quote, that its futile trying to have a battle of wits with an unarmed person!
 
Sally71 said:
My daughter is under hospital care for her diabetes, has been ever since she was diagnosed, and has just transferred from the paediatric team to the young adults team. They see her every 3 months and always send a letter to the GP summarising what happened at each meeting so that it can be put in her notes.

Recently she’s started getting text messages from the GP saying that she needs to book a diabetic review. Why, they are done at the hospital. She was a bit confused and has been ignoring the messages. Today she received the following letter:

“FINAL REMINDER
You are now overdue for your annual Diabetic review. Please contact the reception team and book a morning appointment with a NURSE as soon as possible.
Please also bring a urine sample with you to this appointment (sample bottles can be obtained from the reception desk).
Chronic condition reviews are essential for us to monitor your condition and ensure you are being prescribed the most appropriate medication and dose.
Should you continually refuse to attend for this appointment without contacting the surgery then we shall begin the process of reducing the quantity of medication that you receive on your repeat prescription.
All patients that continuously refuse to attend for monitoring appointments without explanation, despite reminders, may be removed from the practice register.”

The letter isn’t even signed!
In 12 years of having diabetes she has never had any sort of check up at the GP so I don’t know why they suddenly think she should start now, I don’t know if it’s got something to do with her turning 18, I think that’s about when the messages started. And I don’t think threatening to kill her, which is what would happen if they refuse to prescribe her any more insulin, is the way to go about it!

Sigh. Hopefully it’s just a case of bureaucracy gone mad and people not using their brains to join the dots, and will only take one conversation to sort out, but why the bloody hell should we have to? That’s just another annoying little job that we’ve got to find time for. I’m wondering whether to use the online appointment booking form to explain rather bluntly why we don’t need an appointment, or whether it would be better to go in there and demand to speak to someone. Daughter will have to come with me as she’s legally an adult now, but hopefully she will be OK about arguing the case herself!

Rant over
Click to expand...
Does your daughter have correspondence from the hospital? This might bolster her case that she is regularly checked at the hospital when sorting this out at the GP. I have to admit, I put off the GP checks around my birthday for later in the year. Then around a month or even 2 weeks later the hospital. It all ties in when my licence renewal comes round with the DVLA every three years. I read somewhere GP surgeries get “audited?” (A little like “OFSTEAD” for schools.) the letter (as threatening as it looks.) seems to be a box ticker in urging patients to be compliant in a positive care “score?” (Some sort of surgery “league table” ranking?)
 
everydayupsanddowns said:
Ugh! These are a pet peeve of mine.

I’ve had a few, and know the drill now. They are meant for ‘other people’, and endlessly stockpiling meds that are no longer taken is a genuine problem - but I still see absolutely no justification for the sort of language and approach used. Especially since the simplest of electronic checks would sort this out.

It is good that there’s a backstop for people ‘falling between the cracks’ to ensure they get checked, but the approach is all wrong, and I suspect would be entirely counterproductive for anyone in a fragile state, or genuinely struggling.

I have called my surgery out on this every time. Particularly when the person running the appointment doesn’t seem aware of the ‘threats’ used

“Why have you come to see us today?”
“Well because you said you were planning to kill me, by stopping my supply of insulin”

*shocked face* 😱

“Oh we would never do that!!”

Etc etc.
Click to expand...
What a brilliant way to deal with this rank stupidity. “Well because you said you were planning to kill me” just spilt my coffee on myself thanks to this line :rofl:
I think I’ve started (only started!) to learn to laugh at some of the crazy bureaucracy that goes with this diabetes business!
 
Thank you all for your replies, it’s interesting to see how other people deal with it and that it isn’t just our surgery being awful (to be fair they are usually pretty good). I realise that we probably should have asked them what was going on when we got the first text message, but oh well we missed that one!

So that at least gives me a plan. Assuming daughter agrees, we shall do the following:
1. Ask why do we suddenly need these reviews when we haven’t at all in the last 12 years;
2. What will she get from the review that she doesn’t at the hospital (foot tickling might be one, in which case it will be a good idea to go just for that)
3. If there isn’t anything they do that the hospital doesn’t, why does she have to go then, it’s just wasting everyone’s time (and NHS money, which we all know they don’t have much of)
4. If we really can’t get the appointment cancelled then we shall go reluctantly, but will definitely be complaining about the heavy-handedness of the letter
5. We have already received the next appointment details at the hospital so shall take that along in case they need proof.

My daughter has multiple medical issues now, most of which only came to light or started after lockdown, and is totally reliant on me to get her to appointments. There was a time when we couldn’t go a week without at least one appointment of some sort; thankfully it’s not quite so bad now, but as well as being her taxi she also likes me to come into the appointment with her for moral support. I also have to drive her in and out of college and have spent most of the last couple of years arguing with them about wheelchair access. She can’t learn to drive because she occasionally has seizures, and unfortunately our house is not close enough to a bus stop for her to be able to push herself there and back in the wheelchair without getting exhausted. I would really like to go back to a more full-time job position but can’t until she becomes more independent, and I can’t see that happening for at least another year (she’s hoping to go to uni but we’d have to make sure we could get appropriate support in place). So this is just one more thing… grrr. Sorry, I’m ranting again. Hopefully we can get it sorted this week!
 
I'm sorry to hear of that awful letter. I think you may find that it is the work of the Practice Manager rather than the Doctors themselves.

FWIW and for the information of members, GP's get paid for hitting targets, so seeing/reviewing a certain percentage of their diabetic patients will trigger a payment when they reach their target. I used to know the ins and outs of this system as I took the minutes of the Patient Panel meetings for several years where this subject was discussed, but it's a while since I resigned so would not be up to date quoting exact percentages.

I think they generally earn what they get so, although I am under the pump clinic at the hospital I go along for my review at the GPs. Though the last two have been by telephone and no foot tickling has taken place for over a year.
 
I go along to the blood test for these, even though I’m under the hospital, but don’t make an appointment to review the results afterwards unless there’s something I’m concerned about. They get paid for doing it and the patient gets extra blood checks which I see at useful given my 6 monthly tests at hospital are usually a year apart.
 
I'm sorry your daughter received such a blunt letter, I hope you can get things sorted out and resolved.

Until this month I've managed to get past the request for GP checks on my diabetes with "I'm seen at the hospital pump clinic for my T1 & my legs are in casts and seen by podiatry thanks". I've had a few calls to establish I exist and still require insulin & that has allowed me to have the you may reorder insulin & other medication boxes re-opened on my prescription.

The most recent message from my GP was more of a great big stick to hit me with- you cannot request any further medication and must provide us with 7 day/night blood pressure readings and come in to the surgery for blood tests and follow up appointment

This is 1 month after attending my pump clinic & having relevant blood tests & where the consultant said keep going as you are and started to dictate the letter to the GP whilst I was there.

I really find the you cannot order anymore insulin a worrying statement, it scares me. I know I'll have to go through the hoops this time and prove I need it but it is another hurdle when doing diabetes seems more than enough without repeating things.
 
Flower said:
I really find the you cannot order anymore insulin a worrying statement, it scares me.
Click to expand...

According to the practice pharmacist(!) who conducted my last GP Annual Review, that is precisely their intention. To ‘scare’ people into attending.

Pretty outrageous really! 😱
 
Flower said:
I really find the you cannot order anymore insulin a worrying statement, it scares me. I know I'll have to go through the hoops this time and prove I need it but it is another hurdle when doing diabetes seems more than enough without repeating things
Click to expand...
As you say @Flower we don’t need anything expert to deal with. We are doing enough.
 
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