# GP practice refusal to give repeat



## cookiemonster (Apr 21, 2015)

Does anyone else have very rude GP practice?
I submitted my usual request online for insulin and received an email back saying that they wont let me have it as my annual checks are due!! I called them and asked why, they said they will do it this once but if I don't have a blood test and see the nurse before the next one is due they will not prescribe any more insulin. I work full time and struggle to make appointments in the day due to location plus they will only prescribe for a month at a time which is frustrating. Can they threaten me like this?
Thanks
Paul


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## KookyCat (Apr 21, 2015)

Mine aren't quite that rude, but yes they have a right to ask for annual checks (or less) if they are prescribing the medication.  I had a wee wrangle with mine who wanted me to go in and have a Hba1c, I have them every three months as part of my consultant visits so I wasn't happy having another with them and it wasn't necessary.  They get the results of my 6000 (that's what it feels like) tests every 12 weeks so in the end they backed off, but if you don't have an annual check elsewhere I suspect they'll do that every year.  It's a good idea to have the check so you can see where everything is up to, but I'd be tempted to provide feedback to the surgery about the way their communication makes you feel.  Sorry you've had a hard time with them, as if it isn't hard enough already


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## Northerner (Apr 21, 2015)

What??? No, they cannot deny you insulin - you need it to stay safe and healthy! Do you see a consultant at all for your diabetes? If so, then contact them and get them to have strong words with the practice. Insulin is not like a pill - it can't just be missed and no real harm done! 

I can see that it is a good idea to have your annual checks, but they should not blackmail you by withholding vital medication. I would write to the practice manager asking for a full explanation and asking them if they are prepared to place you at risk of a hospital admission (or worse) by withholding insulin on this basis. Appalling, and ignorant behaviour. If you get no satisfaction there then I would suggest making a complaint:

http://www.nhs.uk/chq/pages/1084.aspx?categoryid=68


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## cookiemonster (Apr 21, 2015)

whilst i am not under a consultant for my diabetes (they manage it locally in my region) i mostly look after myself. My day to day control is pretty good however the practice diabetic nurse is not the best and seems more intent on ticking boxes than anything else. I asked for referral to a consultant but was refused a couple of years ago as they like to manage these things (or not!) on a community level.   
I have had 3 operations in the last 12 months for which they tested my Hb1 levels and these were fine. Despite the GP having these results they still need to tick the box for a biannual test in the surgery.
I really don't mind getting checked as it makes good sense, its the way they have been heavy handed and blackmailing me with medication I object to.


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## everydayupsanddowns (Apr 21, 2015)

I've had a similar (poorly worded) letter/note from my practice once. 

So I booked to see the GP and stared him dead in the eye when he asked why I wanted to see him, "I have no reason. Except that you said you would refuse me insulin unless I came in."
He looked quite shocked, "Oh no! Of course we would never do anything like that!!"

I suspect it's just a form-letter for general repeats where annual medication review is important and it's *not* something like insulin where refusal to prescribe is so dangerous.

I would go to see them and set them straight. Perhaps suggest that they review their practice admin/procedures to prevent it happening to anyone else.


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## Robin (Apr 21, 2015)

It sounds like an automatic email response. our surgery has a similar system. You have an annual prescription review with the GP, irrespective of any other checks with the nurse. Mine takes up approximately 30 seconds of my doctors time, and about an hour of mine, getting ready, going to the surgery, waiting because she's running late, etc. but my paper prescription has the review date printed on it, and when it's coming up, there's a reminder on the bottom as well, so it's my own fault if I've forgotten to renew it. if you do overrun, the system will tell you you can't have your repeat, but if you do mess up, they always let you have it on condition you make an appointment for a review ASAP, despite the dire warning notices posted round the surgery. I think it was brought in when there was a blitz on stopping doctors doling out repeats of anything and everything without ever seeing the patient to check if they were still in need of it (or still alive!)


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## everydayupsanddowns (Apr 21, 2015)

Robin said:


> I think it was brought in when there was a blitz on stopping doctors doling out repeats of anything and everything without ever seeing the patient to check if they were still in need of it (or still alive!)



I'm sure you are right Robin. You do hear some horror stories!


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## Northerner (Apr 21, 2015)

My concern would be that, whilst many would see the importance of continuing with their insulin I am sure that there are also those who would simply go without it. If they do have to automate and generalise then they should have some kind of indicator/selection that would exclude potentially life-threatening situations occurring. The closest I have come was when my surgery tried to reduce my test strips, but a strongly-worded letter got them restored.

Also, how wasteful of NHS resources is it to insist on tests that have already been performed elsewhere and presumably on record?


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## Sally71 (Apr 21, 2015)

My goodness I am shocked!  We must be really lucky!  Don't know if it's different for children, but it seems that our surgery are pretty well sorted in comparison to what some of you have to deal with!

My daughter sees a hospital team at least every 3 months (we can request extra meetings with the DSN if we think we need them).  The results of all these meetings, including HbA1c, is sent in a letter to our GP and copied to me.  GP then presumably puts all of this onto my daughter's medical record so that anyone at the practice can see the latest state of play with her diabetes.  I have noticed on the repeat prescription (which runs to two pages)  that all the items have a number of issues remaining; when they get down to 0 though somebody just resets it to 12 (presumably because they can see she's had all the tests done fairly recently).  They will also allow me to request items which are not on the repeat, as long as they can see that we've had them before they just supply it again without argument.

What a shame not all doctors work like this!!  I would definitely request an appointment with yours, or write a strongly worded letter to the practice manager, explaining that withholding your insulin would make you critically ill very quickly and whilst you can see the sense of having the tests, perhaps the staff could be a little more sensitive and polite about arranging them!


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## Hazel (Apr 21, 2015)

The latest from my practice who are usually very good, was when I requested lancets, prescribed 'Libre' single needles, box of 100.

But I use Accu Check meters - lancets in a 4 needle drum - been using them for 10 years plus.

Their explanation?     Doah!!!!

All sorted now, but I had in the short term accused the Pharmacy of incompetence.

I will take it up with my GP when I see her, she is the senior partner - looks like careless admin support, or as I fear, they are told to prescribe the cheapest.     The fact that what they prescribed was not suitable, I give up.


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## delb t (Apr 21, 2015)

We have had the exact same thing on H's last prescription - he had an annual review in may last yr - then they wipped a couple of things off the prescription in August and when I rang they said he had to come in again to discuss- they suggested results day!!!!!!!!! - I refused wrote to the only doctor who was  helpful in the past and she re-instated them.He has a review tomorrow at the uni docs and I guess when he comes back in the summer and re-registers here he will have to have another review! as my daughter did .


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## Bessiemay (Apr 22, 2015)

Unnecessary duplication of blood tests is expensive. I have regular appointments with consultant with hba1c and other blood tests.  Copies of  letters go to my GP and there must be a way of him accessing the results online because he's done it  while I've been there. The practice nurse says she doesn't know how to do that so she takes the bloods again 'for their  records'.  I have only been restricted to 4 test strips a day because he considers the accu-chek mobile strips too expensive. So I buy codefree to top up myself. Local doctor so no problem with attending reviews.


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## Northerner (Apr 22, 2015)

Bessiemay said:


> ...I have only been restricted to 4 test strips a day because he considers the accu-chek mobile strips too expensive. So I buy codefree to top up myself. Local doctor so no problem with attending reviews.



That's a ridiculous excuse for restricting strips, I would complain. Practically all test strips cost the NHS around £15 for 50, although some CCGs may have done deals with specific meter companies and imposed a particular meter on all patients.

Given that 4 strips is an absolute minimum when injecting on MDI, what does he expect you to do when hypo/driving/ill/hyper etc. etc.? Stupid penny-pinching and misguided. He could probably save more money for the NHS by learning a bit more about diabetes and offering better treatment and education to his patients


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## trophywench (Apr 22, 2015)

The practice nurses do not have access to hospital systems, it's restricted to the doctors at our surgery too.  Most of them aren't 'nurses' in the true sense these days either, just Healthcare practitioners.

Our hospital doesn't write the letters they used to either - unless you have something new which your GP specifically needs to know about - like a change of brand of insulin or needing eg different BP tablets cos the old ones caused a shortage of something else they tested your blood for.


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## heasandford (Apr 22, 2015)

cookiemonster said:


> I asked for referral to a consultant but was refused a couple of years ago as they like to manage these things (or not!) on a community level.



I also think you should ask again about this. It took me ages to get a consultant, but it has been another of those major steps along the way to improved results. My latest consultant does not believe that T1 (T1.5 too?) should be treated in general practice as they do not have the expertise needed.

Does anyone know if they can do this now, I thought we had a choice?


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## tejbat6 (Apr 22, 2015)

Ordered some needles for my flexipen early this morning and noticed I had to be reviewed by GP/nurse before I can reorder insulin
Requested this be done asap as not wanting to have problems  when we suddenly decide to take a trip away for  a couple of weeks....see what happens
I get this kind of thing on a regular basis since the GPs got hold of the purse strings
Never actually been refused but have had to make similar response as mentioned above
Computers eh! who`d have them


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## Ayesha (Apr 22, 2015)

Hiya, i have had simmilar problems with my GP as they refuse to put my test strips on repeat which means every 2 weeks iv got to go to my GP and request it and sometimes i just dnt have the time to visit. The reason why they wouldnt put it on repeat in their word is due to "health and safety reason". Im not sure what that means.. has anyone else had the same problems? how can i go about getting the test strips on repeat?


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## Ayesha (Apr 22, 2015)

Bessiemay said:


> Unnecessary duplication of blood tests is expensive. I have regular appointments with consultant with hba1c and other blood tests.  Copies of  letters go to my GP and there must be a way of him accessing the results online because he's done it  while I've been there. The practice nurse says she doesn't know how to do that so she takes the bloods again 'for their  records'.  I have only been restricted to 4 test strips a day because he considers the accu-chek mobile strips too expensive. So I buy codefree to top up myself. Local doctor so no problem with attending reviews.



I was told by my GP that i should only test my BG only twice a day when my diabetic consultant at a clinic said i should do it more often or when i feel necessary so sometimes when i have ran out of test strip in the past iv been too shy to request more...


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## everydayupsanddowns (Apr 22, 2015)

Ayesha said:


> I was told by my GP that i should only test my BG only twice a day when my diabetic consultant at a clinic said i should do it more often or when i feel necessary so sometimes when i have ran out of test strip in the past iv been too shy to request more...



That is absolutely terrible advice, and completely inappropriate for someone trying to effectively manage their diabetes and calculate insulin doses if you ask me.

I would find another clinic Ayesha.

Also check the Diabetes UK '15 checks' that you should be getting every year. Would not surprise me if other things were getting missed too.


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## KookyCat (Apr 22, 2015)

Ayesha said:


> I was told by my GP that i should only test my BG only twice a day when my diabetic consultant at a clinic said i should do it more often or when i feel necessary so sometimes when i have ran out of test strip in the past iv been too shy to request more...



I was given the you only need to test twice a day advice in hospital, but like your consultant, mine then shook his head as said you need to test at least four times a day and however often you feel comfortable with.  I got my consultant to request three pots a month on repeat in his letter, at which point the GP just complied.  A lot of the prescribing practices in GP practices are aimed to limit test strips for people with type 2 (which I think is entirely wrong btw) but for type 1 you need to have enough test strips to keep you safe, so before you inject insulin and whenever you feel "odd" (always a good idea to check that the odd feeling isn't low or high blood sugar).  So maybe ask the consultant to request that the test strips are put on repeat (three tubs will cover 4 tests a day and then other tests as needed).  I know it's hard to ask for more but you really shouldn't be without test strips when you are injecting insulin.  Good luck


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## trophywench (Apr 22, 2015)

Ayesha - do you drive?


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## Bloden (Apr 23, 2015)

Ayesha said:


> I was told by my GP that i should only test my BG only twice a day when my diabetic consultant at a clinic said i should do it more often or when i feel necessary so sometimes when i have ran out of test strip in the past iv been too shy to request more...



Yeah I was told 3 times a day (when adjusting doses), and that I could have days when I didn't test at all! I was shy at first about asking for strips too, but I've grown a thick skin. I'm not going to accept random medics and nurses, that don't have diabetes, telling me not to prick my finger so much! I drive, I'm responsible for children at work, I have overnight hypos...there are lots of reasons - more than 6 - for pricking throughout 24h.


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## Bessiemay (Apr 23, 2015)

Northerner said:


> That's a ridiculous excuse for restricting strips, I would complain. Practically all test strips cost the NHS around £15 for 50, although some CCGs may have done deals with specific meter companies and imposed a particular meter on all patients.
> 
> Given that 4 strips is an absolute minimum when injecting on MDI, what does he expect you to do when hypo/driving/ill/hyper etc. etc.? Stupid penny-pinching and misguided. He could probably save more money for the NHS by learning a bit more about diabetes and offering better treatment and education to his patients


Thanks for your reaction Northie. He is prepared to give me test strips for a different meter ( I didn't even consider it) because they are cheaper than the mobile. Anyway I have just had instructions from consultant to test more often as I have appointment for pump assessment. I had a CGM for a week and it showed I was having unknown hypos during night. So I will be sending in requests for strips more often and be ready when I get a phone call from surgery.


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## trophywench (Apr 23, 2015)

I'm feeling exceedingly spiteful towards your GP and I truly hope the hospital ask you if you'd like the Roche Accu-Chek Insight pump, with the matching meter/remote control, because then you will HAVE to have expensive strips - and of course test an awful lot more than 4 times a day !!!!


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## Ayesha (Apr 23, 2015)

Hey trophyWench I do drive… and to bloden thanks for that I may need to become more stern with my GP and push my case in getting more strips and putting it on repeat


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## robert@fm (Apr 24, 2015)

I think I'm fortunate; I had a clinic appointment yesterday, and on seeing that my recent control has been patchy (I suspect the steroid/antibiotic cream that's being used on my leg sores), he switched my insulin from Insulatard to Novomix 30, gave me a new NovoPen 4 (which I'm keeping as a spare for now), and told me to increase my testing to 3 or 4 times a day.


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## Northerner (Apr 24, 2015)

Ayesha said:


> Hey trophyWench I do drive… and to bloden thanks for that I may need to become more stern with my GP and push my case in getting more strips and putting it on repeat



I found early on that you need to put your foot down and if your arguments make sense then they will usually comply. When my surgery tried to change my repeat from 300 to 100 strips I wrote the following to the practice manager:



> I have Type 1 diabetes and test on average 6-8 times per day. I need to test for a variety of reasons, but have a valid reason for every test, using the information in order to stay safe and maintain good blood glucose control. This is reflected in the fact that I have maintained an excellent HbA1c  since diagnosis five years ago. I need to test before administering insulin doses, for cases of suspected hypoglycaemia or hyperglycaemia, and to monitor the effects of changes to my diet on my levels. I am also a runner and need to test before and sometimes during exercising to ensure my levels are within safe limits. I also need to test more frequently during periods of illness, or when my insulin requirements are changing due to a number of factors thus making insulin dose calculation less reliable. Furthermore, it is a requirement of the DVLA that I test before driving, and during long journeys in order to avoid hypoglycaemia.
> 
> Restricting me to 100 strips per repeat will entail putting in a new request every 12-14 days instead of the current 6-8 weeks. All other items on my repeat provide for 6-8 weeks supplies. It is illogical and inefficient therefore to place this restriction on my supply of test strips since it entails not only inconvenience and wasted time on my part, but also extra work both for the surgery and pharmacy, and therefore extra cost to all parties. I feel that this is an unnecessary and inappropriate use of NHS funds.



My repeat was immediately restored


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## Bloden (Apr 24, 2015)

I like it, Northener! 

It's really frustrating, Ayesha. We have to be really assertive! I don't think our doctors realise how tiring that can be. Don't worry tho - you'll get used to it, and even laugh about it eventually.


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## Bessiemay (Apr 24, 2015)

trophywench said:


> I'm feeling exceedingly spiteful towards your GP and I truly hope the hospital ask you if you'd like the Roche Accu-Chek Insight pump, with the matching meter/remote control, because then you will HAVE to have expensive strips - and of course test an awful lot more than 4 times a day !!!!


I have read about the insight and it sounds nice. I don't know which pumps my area favours but after reading a lot of the pumping pages here I am hopeful that I get something.  I used to think it would be too complicated but it sounds like it's worth it cos you all seem to love your pumps. 

After we had finally agreed I could have 4 strips a day the GP actually said 'don't broadcast it' !!

I like your letter Northerner.


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## tejbat6 (Apr 26, 2015)

cookiemonster said:


> Does anyone else have very rude GP practice?
> Paul



No, but they are/can be ever so stupid
And to think that they are closed every Thursday pm for "staff training"
 last week logged onto their site to reorder needles
noticed the insulin pens were `not renewable until review by nurse/gp`
so via the comments box asked them to get the review sorted asap as I didn`t want any delays when we decide to go away for a week or two between now and the middle of next month (got to see the toenail nurse this coming Thursday for a review of big toe nail removal progress, trip depends on her view, just to be on the safe side.....already booked the site at Buxton   )

Wife returns from shopping yesterday...."got your pens and needles from the chemist" 

"I only ordered needles, oh well stick them in the fridge with the other 2 boxes


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