Treatment from GP to Hospital?

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MGR

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Type 1
I have been a type 1 diabetic for 24 years. This is very well controlled. Apart from an initial referral to hospital when first diagnosed i have always had my reviews at my GP practices.

I have had a number of issues with my GP lately and have lost confidence with their abilities. I have suggested to the practice manager that i wish my reviews etc to be referred to the hospital. She has advised against this. She made reference to the fact the GP surgery are commissioned to treat my diabetic care. No other reason really was in my opinion was valid.

Can I ask the hospital to take over my annual review. I acknowledge that the GP surgery would also have to refer me to them. Can the hospital refuse? Can the surgery still care for non diabetic issues?
 
MGR said:
I have been a type 1 diabetic for 24 years. This is very well controlled. Apart from an initial referral to hospital when first diagnosed i have always had my reviews at my GP practices.

I have had a number of issues with my GP lately and have lost confidence with their abilities. I have suggested to the practice manager that i wish my reviews etc to be referred to the hospital. She has advised against this. She made reference to the fact the GP surgery are commissioned to treat my diabetic care. No other reason really was in my opinion was valid.

Can I ask the hospital to take over my annual review. I acknowledge that the GP surgery would also have to refer me to them. Can the hospital refuse? Can the surgery still care for non diabetic issues?
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I was discharged back to my Gp son after diagnosis, and had my reviews with the surgery nurse for several years. But there came a point when I wanted to get the Libre on prescription, (which GPs weren’t able to authorise at the time), and asked to be referred back to the hospital. After a lot of faffing about (it was during the Covid lockdowns) the surgery managed to do the referral, and I was seen at the hospital, got the Libre, and the hospital have been doing a review every year since then. I’ve continued being seen by the Gp surgery nurse for an annual review where she tickles my feet, does BP, smoking and alcohol questionnaires etc, and orders blood tests.
Thats a long winded way of saying, if you can think of something that the surgery can't help you with, because it is beyond their knowledge of Type 1, or beyond their remit, you are entitled to ask for a referral, and it might be a way of getting a foot back in the door of the hospital clinic.
 
I’d give the DUK helpline a quick call and see what they say.

If you’re not happy with the service you’re getting from the GP you ought to be able to move but give the experts a call.
 
If your diabetes is well controlled it may be more difficult to get your care transferred to the hospital but you can ask your GP to refer you there.

The easiest way is to think of some hard diabetes questions that the GP won’t be able to help you with, or that they won’t be able to prescribe, eg want to discuss option of insulin pumps to help with (insert specific difficult issue that would entitle you to a pump), or want to improve knowledge of carb counting and insulin adjustment (some hospitals run training courses in this that you need to be under hospital care for).

How do you manage your diabetes at the moment and do you have any specific problem areas?
 
The same sort of thing happened to me earlier this year, after being in the care of my GP for some years, after an annual review when I started asking about better ways to tweak my insulin to improve overall control the DSN at the GP asked if I wanted to be referred to the hospital as they would have more knowledge and be able to help. She then said that the GP health centre do not routinely look after any patients on insulin, referring all of them to the hospital for care. So that is how I started with the hospital, had my diagnosis changed from T2 to T1, started on the Libre and now continuing in their care.

That said, my GP still handles HbA1c and other blood checks, tickle feet (as @Robin says:rofl:), BP, etc. as well as any other non diabetic related issues. It seems to be that they refer patients to hospital where they don’t have the full experience and skills to help.
 
After several years of hospital appointments I started getting invited to annual reviews at my GP surgery. I was pottering along what felt like OK at the time, so after a few double appointments I asked to be signed off back to the GP.The hospital were happy, but said I could come back any time.

Stayed like that for several years, but then things started to drift.

As others have said, it was asking some pointy about swapping insulins to get round a specific issue that made them look a bit pale and quivery and suggest I ought to go back to the hospital and ask for their advice.
 
everydayupsanddowns said:
I was pottering along what felt like OK at the time, so after a few double appointments I asked to be signed off back to the GP.The hospital were happy, but said I could come back any time.
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I didn't ask to go back to GP care, that's just how the area does things generally: the hospital team normally sees people for a few appointments and signs us off when we're doing OK. But I can always go back if there's a reason to.

And my last review at the GP surgery also had one of the DSNs present, so I think it's possible that's how they want to manage T1s who're generally not seen by the hospital. (I don't know the numbers, so maybe the DSNs don't visit often enough to see everyone once or twice a year, but even if they see us now and again that would be better care than waiting for something to go wrong.)
 
Can only speak from experience, care at hospital clinic is far superior to what you get from gp surgery, mainly as they are specialists in all things diabetes. Plus, again from own point of view your more likely to get access to insulin pump & all latest tech being under hospital care.

So my advice would be to push for a switch over.
 
nonethewiser said:
Can only speak from experience, care at hospital clinic is far superior to what you get from gp surgery, mainly as they are specialists in all things diabetes. Plus, again from own point of view your more likely to get access to insulin pump & all latest tech being under hospital care.

So my advice would be to push for a switch over.
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Definitely agree with that! Years ago I asked my GP if I could go onto basal-bolus as the twice a day mixed insulin made life a nightmare with having to eat at set times, hypos if I didn’t. He referred me to the hospital and they were brilliant and got me started straight away on Levemir and Novorapid and gave me loads of help in explaining how to adjust it and carb count. Then this year when my GP referred me to hospital and I am so impressed with how they are with tech and specialist help. Plus i can actually call them for advice anytime, leaving a voicemail they have always called me back the following day. With Libreview they can look at my charts and talk through over the phone so it just makes life so much easier.

I would definitely ask for more specialist help and seek a referral to a hospital diabetes clinic, you will get much better advice and help than from a GP, who by definition are generalists rather than specialists.
 
I didn't know gps did t1 checks, always been at hospital, though the gp nurse did a great job at my initial diagnosis. After loosing faith in first hospital's abilities (diabetes nurse saying abasaglar lasts 3 days and other nonsense) am now on second place and they are lots better - actually dealing with my issues. You deserve proper help, do what you need to do to get it
 
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