# GP refused my prescription for insulin!



## Babysaurus

Another rant, so I won't be offended if you log off now and don't read any further 

Just went to get the prescription I ordered on Saturday only to be told by the pharmacist that the surgery wouldn't issue it and instead were apparently going to call me (they haven't.) I used the absolute last of my insulin last night filling my pump and it would be due, all things being normal, to run out tomorrow mid morning. Hence, I would have NO insulin. 

Thankfully the wonderful pharmacist has 'loaned' me a couple of bottles of Humalog which they had in to keep me going. I have a midwife appointment at the surgery tomorrow so plan to have a word with the practice manager. My mother also suggested I ask the GP to write down precisely the amounts they are prepared to prescribe, and the reasoning behind these decisions. I will then ask for a copy and suggest they keep a copy on the basis that if anything happens to either myself or this baby as a result of this I shall sue. 

So f**king angry! As if I don't have enough on my plate!


----------



## hotchop

OMG are they allowed to do that??? its like a death sentence!!


----------



## Hanmillmum

Would that not account to medical neglect, not prescribing something you need to live and to ensure your baby develops well ? You need to get on this and do make threats - they are putting your life at risk, get your consultant and dsn on the case too.  Let us know how you get on and best of luck


----------



## Northerner

This has disgusted me and the doctor responsible needs reporting to the appropriate bodies. What the h*ll are they playing at? I'm truly sorry that you  have been subjected to such ignorance from someone who is no doubt earning in the region of ?100k a year to do an absolutely terrible job that everyone on this forum could do better.

Thank goodness that your pharmacist has more sense. I hope that you receive a profuse apology and that the surgery are suitably reprimanded for their ignorant and dangerous actions.

Grrrrrrrrr!!!!!


----------



## margie

Babysaurus whilst its all fresh in your mind and before baby comes along - write down the whole story - so that you know exactly what happened and when.

If you can before you go to the Midwife appointment contact both your diabetic team and obstetric team. If they have answer phones call the switchboard number and ask for the person you want to be bleeped.  I am sure that they will understand as if the pharmacist hadn't been prepared to give you a loan (which will be covered by your next prescription) you would have ended up at A&E. 

Make a note of what they say and make sure that you tell the midwife - and insist on seeing the Dr. Hopefully by then someone at the hospital will have called your surgery and had words.

I hope that you are able to get some satisfaction.


----------



## Babysaurus

Thank you everyone. I am still quite flabbergasted at it all. It is truly bonkers.

I am going to ask to get everything they are saying in writing tomorrow - I have a midwife appointment and then a hospital, diabetic ante-natal, one in the afternoon - asking them, the GP surgery, to explain their reasoning behind their decisions on what I am supposed to require each month. I also hope by doing that they may actually think twice about what they are saying and the reasoning behind it. 
The GP clearly does not know about Type 1 diabetes and pregnancy, and as I said before this is not a problem (she's a GP not an endocrinologist after all) but to then make decisions based on very limited knowledge is completely wrong.  
I'll keep you posted - thanks again for the virtual support! x


----------



## Robster65

Never mind loggin off. I want to come over there and have a word with your GP !!!

Excellent advice from everyone. It could be one hell of an embarrasing case for the surgery if the GP doesn't crawl under a stone and hide. 

Speechless.

Rob


----------



## Twitchy

Time to contact PALS & make a formal complaint I think, as if your pharmacist hadn't saved the day your baby could have died as the extreme consequence of this GPs ignorance - sorry if that's blunt but as you obviously know it IS that serious.  Do you have a practice manager / senior partner at your surgery? I would be putting a formal complaint in that way too.  I really think you need to go formal on this as this plonker clearly needs retraining & someone else another time might not be so lucky as you have been in having a good pharmacist. 

Another angle of attack too - do you have the DUK booklet on pregnancy & diabetes? Costs about ?3 i think but worth it - you can get it onthe DUK website - its simple & clear & i was able to use it to justify myself when i went in asking for the prescription dose of folic acid before ttc & later when they were getting shirty because i was testing / injecting a lot during pregnancy. Sad / infuriating that we have to fight these battles!!!!!! Seething on your behalf!!!  Hope you're ok & not letting this stupid situation stress you out too much!! Xxxx


----------



## Pumper_Sue

I would want to know what qualifications this so called GP has to with hold insulin from a type 1 diabetic.

Perhaps the GMC should be involved as well?
Letters CC 
GP
Consultants
DSN's
Practice manager
PCT
GMC

DUK ring their care line and tell them what has happened.

If no joy the press as well at a later date asking if this is taking cost cutting a bit to far (with holding insulin from an insulin dependant diabetic)
Bottom line though is this so called Dr should not be allowed to practice.


----------



## Austin Mini

Babysaurus, before you do anything let your practice give you an explanation. The reason I say this is that if you fall out with either your GP or the practice they can, and they certainly do, cross you off the patient register and then you will have to attend another surgery. Write everything down and Best of luck. AM x


----------



## Pumper_Sue

Austin Mini said:


> Babysaurus, before you do anything let your practice give you an explanation. The reason I say this is that if you fall out with either your GP or the practice they can, and they certainly do, cross you off the patient register and then you will have to attend another surgery. Write everything down and Best of luck. AM x



Sounds as if attending another surgery would be in her best interests.


----------



## Smit

This is disgusting! Def get your diabetes consultant on to this! As soon as mine emailed about test strips I've never had a problem. Also a great idea to get things in writing. Keep us posted chick and good luck. X


----------



## margie

I would just add a word of caution here. 

I would get the facts from the GP before compiling a complaint.  You need to be sure just who has refused to issue the prescription, ie the Dr or a prescription clerk. In your previous thread you said that you were told that if you needed more insulin you would need to make an appointment and explain why. Its possible that a clerk could read such an instruction on your notes and not produce the script for the Dr to sign. 

This would change the nature of the complaint from one of a GP refusing to issue a prescription to a procedural issue within the surgery.  

I know from a practical point of view the result to you is the same - but the point at which the refusal occurred would be of prime concern to anyone investigating the complaint.


----------



## Babysaurus

Thanks for the advice everyone. I am hoping that meeting the practice manager will start to help with getting to the bottom of this. *Margie* the pharmacist said it was the GP (it's actually a large practice) who queried it, but I will have to double check precisely who decided what. I am still quite appalled at the orginal GP with their talk of only needing 4 test strips a day etc, so regardless of this recent event feel as if this needs to be raised. 

*Twitchy* I get the impression you had similar issues re having to justify what you needed....? Its horrible isn't it! I felt quite tearful earlier as I felt quite powerless, and as if they were assuming I was asking for far too much or had an illness that was either my own fault or not a big deal. Surely they ought to know that my requests are not absurd considering the circumstances, and also if they don't know due to their lack of knowledge on the subject perhaps they are not the one's to be making the decisions. As someone said in my previous ranting thread, _if _ things went wrong with me or the baby it would be documented as poor self management on my part rather than anything else. 

I'll keep you all posted. Thanks again x


----------



## Twitchy

Babysaurus said:


> *Twitchy* I get the impression you had similar issues re having to justify what you needed....? Its horrible isn't it! I felt quitRe tearful earlier as I felt quite powerless, and as if they were assuming I was asking for far too much or had an illness that was either my own fault or not a big deal. Surely they ought to know that my requests are not absurd considering the circumstances, and also if they don't know due to their lack of knowledge on the subject perhaps they are not the one's to be making the decisions. As someone said in my previous ranting thread, _if _ things went wrong with me or the baby it would be documented as poor self management on my part rather than anything else.
> 
> I'll keep you all posted. Thanks again x



Sadly yes, personal experience! There are quite a few gps in our practice & not all are as up to date as you'd like/expect...I had one try to tell me lots of ketones wouldnt affect the baby! Erm, not what DUK say!!  Thankfully after another blip re test strips they tend to let me get on with things but you're right, it's so horrible having to fight for something they take for granted - like hubby said, ask that doc how much insulin they used on a given day & whether it was 'reasonable'!  All in all it seriously tempts me to buy one of those T shirts that says 'be nice to diabetics - they have enough pri**s to deal with already!' (i wonder if they do maternity sizes lol?!) 

Hang on in there hun...best of luck for tomorrow, will be thinking of you. X


----------



## Robster65

I agree that you need to establish the facts before complaining.

I would hope that there will be a more senior partner of the practice who will be unimpressed at this GP potentially putting the practice in a position of malpractice.

We had a situation recently where one GP had been very dismissive and not ordered tests that we felt he should have done. A follow up appt with a more senior GP has recitified it and he ordered them rather hurriedly. There are GPs and there are GPs. Some think they know it all from day one and can't be told anything. The practice may be grateful of being made aware of this so they can keep an eye on them in future.

Rob


----------



## allana

Awful! I have had problems myself when requesting BM strips.

Hope you get some answers please let us all know.

You have everyone here behind you xxx


----------



## Babysaurus

Morning! I am a bit more calm and logical this morning, which makes things better for going into the surgery and speaking to, I hope, the practice manager. I think I was more prone to getting wound up and tearful yesterday which wouldn't have done me many favours, today I am a lot more calm about it. 
Following advice on here, I am going to find out exactly who decided what, and then I am going to ask why. Exactly why, and also why they came to the decisions they came to and why this decision was thought to be in the best interests of both the patient and the practice. I think whittled down to this may expose that a) it is actually just due to cost and b) the doc (if it was a doc, but if definitely was the first time) doesn't have the level of expertise in the area needed to make such decisions. I am then going to ask for all this written down, along with agreements about future amounts I am 'allowed.' 
I am hoping that this will get them thinking a bit more, and also being a bit more flexible. I will state that I will NOT need these amounts forever, but currently they are crucial for the wellbeing of both myself and my baby. 
Grrrr....


----------



## margie

Good luck and don't hesitate to get them to speak to your DSN if you think that is necessary.


----------



## Pumper_Sue

> I am then going to ask for all this written down, along with agreements about future amounts I am 'allowed.'



There are no if's or but's regarding how much you are allowed! You need as much as you need. There is no negotiation in this dept.


----------



## Babysaurus

Margie, the ridiculous thing is that they have already been sent letters from the DSN which is why I am now allowed 10 strips a day rather than 4 - personally, this is still not good enough really as I often use far more (I do a lot of exercise and this can make my levels drop off suddenly, and its not like I can raise them high enough to start with as I am pregnant.) Its also nice not to be on the edge of running out at the end of each month. ON Sunday I was unexpectedly high, not sure why, and so was testing every hour and giving extra insulin till it came down. If this happens again it would mean I 'use up' more than I am meant to for that day - truly bonkers, it really is! Especially as pregnancy is so unpredictable at times that it takes a lot of hard work to keep on top of it! 

Sue - I'm with you! Lets hope I can convince the surgery of this too! I was already fuming about the rationing of strips so also plan to address this when I see them. The more I think about it the more I resent the fact that I have been told I can only have a certain amount and have to buy the rest. This isn't good enough either! I will point out that, hopefully, after the baby is born and things get back to normal I won't need to put in a prescription AT ALL for a while if I have enough in and hopefully things would level out a bit. I can't bear not having any back up at all at home either.


----------



## Catwoman76

Robster65 said:


> Never mind loggin off. I want to come over there and have a word with your GP !!!
> 
> Excellent advice from everyone. It could be one hell of an embarrasing case for the surgery if the GP doesn't crawl under a stone and hide.
> 
> Speechless.
> 
> Rob



I have just read this, totally unacceptable, no wonder you are SO angry and rightly so, OMG it's neglect.  Please let us know how things go and I hope you and baby are well   Sheena


----------



## Abi

Witholding insulin from a pregnant insulin dependant diabetic= potential death sentence for you and the baby.
Complain
Now


----------



## Northerner

Babysaurus said:


> ...Sue - I'm with you! Lets hope I can convince the surgery of this too! I was already fuming about the rationing of strips so also plan to address this when I see them. The more I think about it the more I resent the fact that I have been told I can only have a certain amount and have to buy the rest. This isn't good enough either! I will point out that, hopefully, after the baby is born and things get back to normal I won't need to put in a prescription AT ALL for a while if I have enough in and hopefully things would level out a bit. I can't bear not having any back up at all at home either.



NO WAY should you have to buy your own strips! I wonder how many people with other problems they issue inadequate supplies of medication to and then say they should make up the necessary shortfall out of their own pocket? I'm appalled. If they want to make savings then they should at least be making them where they have the full facts and where the consequences are not so potentially dangerous. You should not have to fear running out before the next prescription can be put in, it is a totally unnecessary extra stress they are placing on you. I know test strips seem expensive, but they are not in the scheme of things - they cost the NHS about 30p each which is a tiny amount of money to pay for the vital information they provide. Grrrr!!!


----------



## Babysaurus

Bit of an update. 
I called the surgery yesterday with the idea of going to speak to the Practice Manager after my midwife appt. Unfortunately he doesn't work on Wednesdays apparently so instead I found myself, as they asked for details, explaining to the receptionist why I wanted to speak to him. She then, it was a hard work tbh, started talking about how the Practice Manager could not alter my prescriptions (I did say several times that I knew this, but wanted to complain but she seemed to go selectively deaf) and there was no point trying to see them, instead I needed to see a GP. So, I now have _another_ appointment with the GP to discuss 'my increasing requirements.' 

The receptionist also said that the original GP had done nothing wrong, she had simply questioned the amount but then plans to issue the prescription which ought to be with the chemist today - hmmm... make of that what you will (they usually take two days at the most, and I put in the original request on Thursday morning.) Regardless if that really was the case, the prescription was delayed, nobody called me to let me know and I would have been left with no insulin and have to have taken myself to hospital should my pump have run out (which was pretty likely as at 5.30pm on Tuesday I only had about 30 units left.) 

When they call on Tuesday, it's a phone appointment, I am also going to insist that there are NO limits on what I need for the time being. I will also explain why I don't want to have to run out completely before I can put in another prescription request as this too seemed to be no big deal to the GP. If the GP, yet again, does not appear to have a full understanding of why I am asking for the amounts I may be asking for, I will insist on speaking to someone else and I shall also, if neccessary, report them. 

Yes, I am on a bit of a roll! BTW I am not normally so, but this has really wound me up! 

Lastly, my lovely DSN who I saw yesterday at the ante natal at the hospital said she had written to the GP and explained so there ought to be no issue, but if there I need to to get them to call her. She said the GP's often don't like it when they increase the prescriptions required for patients as they have to foot the bill. 

Extra lastly, I ended the day feeling very pleased with myself as my latest HBA1C came back - it's 5.1! Now try achieving _that_ on four blood tests and limited insulin a day


----------



## margie

Glad to hear you will get a prescription. When you speak to the GP ask if they have read the letter from your DSN (maybe call the DSN and check when it was dated so that you know they are reading the right letter). If they haven't suggest they read it before continuing the conversation as it should explain why you are asking for more.


----------



## Northerner

Well done on the HbA1c! 

As for the receptionist, I don't think it's her place to block you from communicating with the Practice Manager. I would get in touch with PALS because this should not be wriggled out of by saying that the prescription was always going to be filled - there is much more to this than that. I don't know how things work in medical practise, but in financial services if a company receive X number of official complaints in a given time period then they will be investigated by the Financial Services Authority (or whoever has replaced them!), so they have to take them very seriously. 

Pals contact details are at: http://www.pals.nhs.uk/cmsContentView.aspx?Itemid=944

Imagine if you had been the type of person who feared the authority of the GP and simply accepted their restrictions, or didn't have the knowledge to know how dangerous it might be to stop testing and reduce your insulin? The whole situation needs clarifying so that no such 'misunderstanding' occurs for you or anyone else in the future. Good luck!


----------



## Robster65

Really well done for standing your ground in the face of adversity (or the receptionist as they're otherwise known). 

It sounds like things may have been said and it could well have been a brush off tactic to get you speak to the more senior GP so they can spin a cover story. Pure speculation but interesting that the receptionist didn't quite get the gist and wouldn't let you speak to the manager. Cynical? Me? 

Good luck with the phone call. And huge congrats on that HbA1c!! 

Rob


----------



## cherrypie

The receptionist does not have the authority to block your request to see the Practice Manager.  The fact that they were not on duty should have been followed up by telling when you would be able to see them.  Receptionists seem to think they are in charge about everything even though they do not have any medical knowledge other than what they have gleaned during their employment.
I need an emergency appointment this week and was asked by the receptionist to explain the emergency.  I told her in no uncertain terms that I was not prepared to discuss my medical needs with her. 
She seemed taken aback but then said that if I liked to wait about 10 minutes she would be able to fit me in.  You have to play them at their own game.  I would say that they are not all like that though.
One got verbally aggressive with me one day and started shouting.  I suggested to her, in a very calm manner, that I was not deaf and asked her if it was a requisite of her employment to be rude to people.  She always seems very busy when I approach the desk now and someone else takes over.


----------



## Babysaurus

When I wrote my original update I was a bit concerned I was going to come across as overly cynical and suspicious but it seems as if I am not the only one who has a slightly cynical nature when it comes to these things. Phew! 

No, the receptionist does not have the authority to block requests and I do now regret telling her what it was regarding in the first place. I find it is a hard balance to get to the bottom of what you what in a precise manner but not come across as unneccessarily (to them) arsey while doing it. I now wish I had simply gone in today when, I presume, the manager was working but I can't undo that now. 

I guess we shall just have to see how things pan out following the conversation on Tuesday really. I shall, of course, keep you all posted! 

Thanks again for the moral support and help x


----------



## Northerner

Have you read my poem about receptionists?

http://www.diabetessupport.co.uk/boards/showthread.php?t=1376


----------



## imtrying

Hope you get this all sorted out, and quickly. I can't believe (for whatever reason) that they have refused or delayed you getting the drug that keeps you alive 

Regardless of the reason, it needs looking into by the surgery to ensure it never happens again. 

Good luck!


----------



## PhoebeC

imtrying said:


> Hope you get this all sorted out, and quickly. I can't believe (for whatever reason) that they have refused or delayed you getting the drug that keeps you alive
> 
> Regardless of the reason, it needs looking into by the surgery to ensure it never happens again.
> 
> Good luck!



And its not only you its your baby too.

I really hope this is sorted out soon.

xx


----------



## Ellie Jones

I think before you going rushing in complaining and throwing allocation around you really need to think about 'what' your complaint actually is otherwise I feel that you will be slapped straight in the face with an unfounded complaint.

Your surgery and GP, haven't broken any 'duty of care' or fallen foul of SOP's of prescribing.  They have followed the proper procedure surrounding this throughout...

Your GP did contact you concerning your repeat prescription request in accordance with SOP, and I very much expect that when your last repeat was refused that you had used up the allocated amount before review or reauthorisation, again SOP followed.

If you had phoned the surgery to order your repeat prescription then you would have been told straight away that it was being refused until you seen your GP..  But this was delayed due to you ordering via your chemist.  Now did the surgery fail in a duty of care not informing you directly?

Well it could be argued that you were aware of a problem with your prescriptions requests, you hadn't satisfied your GP's query by phone, and it's possible that the letter from your DSN hadn't arrived yet!  And reality here is that she can request on your behalf with a request such as 'plenty' but she can't  instruct only an consultant can do that..

If you used vague phrases, 'I'm pregnant', 'I exercise a lot' it's could be said, you hadn't provided the GP with enough information nor had you offered to show your GP information/data to back up your word..  Also what did you do before your GP phone call  to get your repeat prescription to be amended to reflect your new needs, assumption is that repeat prescriptions are issued to cover 28 days..  So did you just order more frequently. Until they complained!

To be a devil advocate here...  A pregnant women doesn't normally spend hours down the gym or go on a 5 mile run...  So you need to clarify what exercise you do, how you use your test strips within this regime and your daily routine...  Which means showing your doctor your data from your pump and glucose monitoring, talking them through it and reason why...  

Don't forget even though our medical team are oblige to issue us our medication to our individual needs, we also have the obligation to prove that we are using it effectively or why we require more than the customary amount prescribed.

As for the Practice Manger.

They are Admin personal, not medical personal so don't normally have contact with patients, they can't over turn the medical opinion of the doctor.  All they can do is investigate a patients complaint to see if the there is any foundation within the complaint. If a complaint is considered founded, they then act as a go between between GP, patient to rectify the matter in hand.

Normally the practice manager will deal with a patients complaint either when the patient has followed the grievance procedure, and the patient has failed to get redress at each level, levels being, GP, Duty Manager.  When involving the practice manager a written formal complaint and/or a request for a meeting.  They don't normally tackle complaints that haven't followed this route unless the complaint comes from outside of the practice such as the Health Authority or PAL's...

So the receptionist rebuff of your verbal request to speak to the practice manager is acceptable action as she did refer you to the start of the procedure by talking to the GP about your concerns...  

So your complaint isn't that they failed in their obligation or duty of care, that put you and your baby welfare in danger.  As it could be argued that you didn't bring the attention of your changing needs before they complained.

Your complaint is based around diabolical 'bedside manners' and how they handled the situation as a whole, making you feel stressed, worried etc...


----------



## Pumper_Sue

Ellie, the complaint is about not providing insulin not test strips this time.
GP was saying OP was using to much so no prescription was issued.

What would your reaction be if you found no insulin prescription had been issued?


----------



## Robster65

And no one from the surgery contacted her before or after the event to clarify or check she had enough.

If the chemist had played by the rules, she would have run out and would have had to go to A&E for backup. Not how any PCT would want their GPs to act I wouldn't have thought. All of this following the GP stating that she doesn't need more than a certain amount of insulin per day and no more than 4 tests.

No part of it can be defended by claiming they were following procedures. There was no attempt at duty of care. I presume the practice manager is the first line of complaint. 

Rob


----------



## Ellie Jones

Sue

If you read my post, you will see that I'm giving her information so when she makes a complaint she complains about the right thing namely the handling of the situation not whether the doctor acted illegally without consideration of duty of care which left her without insulin...

If you are going to start 'blaming' people you've got to consider what blame you yourself have within how the situation panned out..

The doctor and the surgery carried out their duties complying with the various rules, regulations and legislation that govern the issuing of a repeat prescription.

But did BS uphold her obligation of informing her GP of changes in need of medication that effected her repeat prescription

Err no she did not, her insulin requirements increased significantly but instead of requesting a consultation with her GP to review her increased needs so that her repeat prescription could be adjusted accordantly,  she chose to increase the frequency of her requests for a repeat prescription.

Another responsibility of the patient, is that when we've used the allocated repeat request that either we have our medication reviewed or reauthorised, which is something know of actually do, just assume our surgery will do it automatically..

So there is a possibility that she didn't check whether she had the clearance to request a repeat..    

So in fact both sides were in the wrong...


As to what I feel about if I'd had a prescription refused, wouldn't know never been in the position and doubt that I would end up there, due to ensuring that I make my GP aware of any changes to what I need without them having to second guess or chase me around etc..


----------



## Northerner

Ellie Jones said:


> As to what I feel about if I'd had a prescription refused, wouldn't know never been in the position and doubt that I would end up there, due to ensuring that I make my GP aware of any changes to what I need without them having to second guess or chase me around etc..



I have never discussed my insulin requirements with my GP, she understands that it is the Consultant and DSN who approve the medication I require for my diabetes. Babysaurus' GP is forcing an unsafe situation without adequate knowledge of the needs of a pregnant diabetic. Even I know that pregnancy imposes huge changes on a person's requirements. It may be OK to question the supplies being requested, but not to withhold them without adequate warning or explanation supported by clear evidence.

Even if this turns out to be a result of an administrative problem, it is not the patient's responsibility to determine the root cause, but to make the practice aware that there is a problem and for them to sort it out. Not everyone who attends a surgery has the wherewithal to analyse why things happen, as I have said before - and those people may be left feeling they have to stick to the reductions imposed.


----------



## Cate

Wow Ellie, I've never used up my GP's time consulting her about how much insulin I need!  Do you really do that?  How often do you need an appointment for it?  (Genuinely curious btw!)  Also, how can you tell, as for me my requirements change based on day/weather/time of the month etc.

My GP knows that my diabetes care is done through the hospital, and that I will request repeat prescriptions as and when I need them - for insulin, test strips, etc.  Also, at my surgery there is no ability to request prescriptions via telephone.  It has to be either in person, in writing (NOT email), or through a chemist.  For me, that makes doing it through the chemist (who will take a repeat requests over the phone...  ) is by far the most convenient method.


----------



## Ellie Jones

I wouldn't call discussing your insulin needs with your GP as a waste of time, if you need your repeat prescription changed to reflect a increased need that out  strips your normal usage, a repeat prescription is supposed to be a minim of 28 days supply.  There's a lot of surgeries who will not entertain issuing a repeat prescription until 21 days have passed since the last request.

If I'm correct BS would have been put on a standard 2 vials of insulin per month, now she's using 300 units in 2 days or just over which would mean she's looking at 5 vials a month..  A big difference.

So with this in mind, who blames a GP with yes limited understanding of the needs of a diabetic which wouldn't be helped as most of the diabetic patients will be on 2 or 3 vials per month, and probably go 6 weeks plus before putting in a request (I have 2 vials on my repeat, and order every 3 months or so) 

So was the GP trying to restrict BS insulin or was in fact the doctor trying to get her into the consulting room to see medical proof or should I say her pump data/bg data to confirm what BS is saying over the phone, where the GP has no indication other than tone of voice used to determine is what she says is correct.  The GP needs to see body language and some evidence to establish what's going on..

As yes pregnant women during part of their pregnancy will suffer from increased insulin resistance so require more insulin, but it's not that often that there's a dramatic increase that requires major alteration of frequency of repeat request or adjustments to the prescription.

And the quickest way for the GP to get his/her patient into the consulting room is to refuse the repeat prescription, if they need it they be swift..

Sometimes we have to educate our GP to what our needs are..


----------



## trophywench

I'm awfully sorry Ellie, your post has come over a little bit sharp.  It does sound as if you think B is going off on one and accusing people of doing things she has no proof of.  She really isn't - she's just trying to stay patient until the geezer deigns to ring her (that's bad enough - the surgery don't seem to see her and her child's life as being either important or urgent) and she can discover at whose door to place this disgusting failure on their part.

But I'm guilty of sounding sharp enough times myself.


Anyway - now that's really interesting because earlier this evening I was on the revamped BNF website (everyone has to re-register from 13 March 2012 to accept new T&C) and I read the prescribing guidelines amongst other things.

One thing amongst the very few items doctors are instructed to never NOT prescribe when requested is INSULIN.  I was pleasantly surprised about that but thought no more of it ...... you can coss question the patient after the event.  But the Hypocratic oath also requires you to do no harm and to preserve human life in all circumstance under your control.  So IF the doctor HAS refused then he ain't no doctor, and if he did do that frankly, I've now upped my game.  I now want to report him to the GMC.

And the same instruction the pharmacists - as long as they personally 'interview' the patient, are satisfied that they need it, AND have had it before (this wasn't specific to insulin, it was all the things on the list I refer to above) - then they are instructed to lend the patient some, just as Babysaurus' one did.

But until B interviews him on Tuesday, she won't know if it's his fault or not, will she?


----------



## Cate

Sorry Ellie, I didn't mean that you were wasting the GP's time by doing this, I was just surprised about it as an idea (having read back what I wrote earlier, I agree it comes across like that, which I didn't mean!  I originally wrote, then deleted, a bit about only visiting the GP for antibiotics and flu jabs  ).

Personally I have 5 10ml vials on each repeat prescription, and I collect that about every 2 months (all my repeats are on a 2 month supply).  When pregnant, I collect around once a month instead, which still meets the 28-day criterion I suppose.

Also, even on a meds review and needing to make an appointment with the GP, I thought it was standard practise to issue a prescription for 1 vial (or pack, or whatever) as an interim measure.  Maybe not.


----------



## Pumper_Sue

My test strips and insulin are PRN.
IE, order when you like and as needed. I have never in 47 years of insulin had the amount of insulin retricted. The thought of it shocks me beyond belief.
OP has already had a consultation with her GP re her test strip requirements, who from the sounds of it has a power complex problem and also suffers from anal retention. 

OP needs to take a list of demands for her prescription repeats.
Test strips PRN
Insulin PRN also spare syringes or pens incase of pump failure
Glucogen.



> So was the GP trying to restrict BS insulin or was in fact the doctor trying to get her into the consulting room to see medical proof or should I say her pump data/bg data to confirm what BS is saying over the phone, where the GP has no indication other than tone of voice used to determine is what she says is correct. The GP needs to see body language and some evidence to establish what's going on..



Sorry Ellie, could you come and clean my keyboard up for me just spilt my coffee on it 
Hands up anyone who has a GP who even knows what a pump looks like let alone knows what data is even if they had the software to upload it to their computer


----------



## Ellie Jones

Babysaurus said:


> Another rant, so I won't be offended if you log off now and don't read any further
> 
> Just went to get the prescription I ordered on Saturday only to be told by the pharmacist that the surgery wouldn't issue it and instead were apparently going to call me (they haven't.) I used the absolute last of my insulin last night filling my pump and it would be due, all things being normal, to run out tomorrow mid morning. Hence, I would have NO insulin.
> 
> Thankfully the wonderful pharmacist has 'loaned' me a couple of bottles of Humalog which they had in to keep me going. I have a midwife appointment at the surgery tomorrow so plan to have a word with the practice manager. My mother also suggested I ask the GP to write down precisely the amounts they are prepared to prescribe, and the reasoning behind these decisions. I will then ask for a copy and suggest they keep a copy on the basis that if anything happens to either myself or this baby as a result of this I shall sue.
> 
> So f**king angry! As if I don't have enough on my plate!



This is what BS posted at 6pm 13/3/12 which is a Tuesday, 

Now I think everybody should read all of BS's replies throughout this thread...

As it tells a different story to the one people seem to be making comment on..

 from this first post, you can see that BS has left ordering her insulin up until the last minute when she's almost out of insulin.  

Her GP hasn't said anything about restricting her insulin, BS's is attempting to instigate this.

So looking at this one post, you can see that BS's isn't concerned enough to ensure that when ordering her insulin supply that she's making a reasonable allowances to cover any hitches, such as the wrong insulin is ordered, the request goes missing, hitch in supply at the chemist (these all happen) or the refusal of her repeat that did happen.

But it's wrong for the doctor to refuse a repeat prescription when that repeat flags the system, which the doctor has to investigate by law

So the fact that BS's was put into the position of not having enough insulin to last is partly her own fault..

In other posts,  she's going to see everybody complaining about this GP, except the GP themselves,  sorry her midwife and the practice manage can't issues/authorise repeat prescriptions or change them, nor can they instruct/demand the GP does..

How does BS's know that her GP doesn't know anything about diabetes, she may well be an Endo...  You train to be a GP after you've qualified in a particular medical field as a doctor, so all doctors have an area of speciality.

So all those who's saying that a GP is putting the welfare of their patient and the child they carrying in danger by placing unfair restrictions of insulin use on them or refusing prescriptions think again...  As I don't believe this is happening, their is certainly lack of communication going on but even with that BS's isn't talking to the GP but everybody else instead!  

And I do wonder what 'exercise' actually means in the case of a almost 7 month pregnant women!

As my niece compete's in Triathlons, when she was pregnant her training regime changed, by 7 months she her exercise consisted of long walks, no gym, no cycling and no running, drove her bats, she didn't resume training until 8 weeks after her son was born.

So in many ways I'm intrigued to what 'exercise' means and why can't it be put on the back burner or changed until after the baby is born


----------



## Pumper_Sue

> The doctor and the surgery carried out their duties complying with the various rules, regulations and legislation that govern the issuing of a repeat prescription.


No they didn't this involved insulin. They can not withhold it.



> How does BS's know that her GP doesn't know anything about diabetes, she may well be an Endo... You train to be a GP after you've qualified in a particular medical field as a doctor, so all doctors have an area of speciality.



Read previous posts re test strips


----------



## Ellie Jones

Sue

Sorry but they have the 'right' to refuse to issue a prescription if the authorisation of issuing a prescription breaches the rules, regulation and/or legislation set down in law surrounding the issuing of medication..  To do so, would mean that the could be struck off or even face an custodial sentence...

To suggest that the doctor withheld a prescription that would endanger his patients welfare, s/he would have to refuse to authorise the prescription with full knowledge that the patient didn't have insulin available or know that the amount of insulin available to the patient were such that it would run out before authorisation issues that need to be investigated are completed.

And at what point did BS' notify her GP (or should say the authorising GP or surgery) that she was almost out of insulin?  Tuesday the day after the GP refused to authorise the repeat!

Now the first person to know that BS's was seriously low on insulin was the chemist on Tuesday...

Now on Tuesday when the GP was made aware of the situation in hand, swiftly issued a prescription for the necessary insulin is this an admittance of guilt on part of the doctor,  No it isn't if the doctor had been aware of the full facts on Monday when s/he was signing off all the repeat prescriptions it would have been authorised. 

So making allocations that her GP is trying to restrict, with held or with hold insulin is unfair and unfounded.

After in a court of law, a defending lawyer would point out that BS's was fully aware that there were issues surrounding her repeat prescriptions, which if I remember right she was made aware of this just over a week before!  So why had she left it until the last minute to request new supplies which would leave her with less than 24 hours worth of insulin when she picked her new supply up? 

At what point had she contacted her surgery to clarify if her repeat prescription had been adjusted to meet her new requirements or to pre-warn the surgery/GP that she was almost out of insulin.

Has BS's at any point asked for a second opinion from another doctor in the practice to make amendments to her repeat prescription to reflect her new needs, so it avoids unnecessary flagging the system causing her problems getting her repeat prescription NO she hasn't what she has done is approached other medical professionals  who even yes can support what she says, they can not over turn the medical opinion of the doctor.

In fact apart from the initial phone call from her own GP who phoned BS, she has not requested a consultation in surgery with any GP within the practice to discuss her needs at all...  Which doing so give's her the advantage of showing her own or another GP clinical data, to show yes her insulin needs have dramatically increased and explain her need for a unusual amount of test strips with the backup data that proves that she's using them effectively to maintain diabetic control that is conducive both to her and the baby she's carrying welfare...

A lawyer would also point out that if BS's felt that her GP's qualifications meant that she didn't have the medical understanding to make a suitable clinical decision concerning her diabetes combined with pregnancy needs, why hadn't she requested a transfer for her care to be overseen by another GP within the practice that she felt did have the necessary qualifications or knowledge?

Even with the complaint procedure at the practice all these questions will be asked...  What part did the individuals play, what actions were taken by both parties.  What effect did these actions have on the situation etc...

Which in this case, I feel the real failing on the surgery point of view, is that the GP failed to insist that BS came into the surgery to show the clinical data she holds (her pump data and BG data).  Which in hindsight this would have avoided unnecessary aggro for both parties.

If you'll going to throw blame and allocations around.  You need to except what part you played in it...

As from experience with dealing with complaints of lack of professionalism or misconduct you often find, that blame can be proportioned between both parties...  more so when situation like BS's have a snowball effect to them ending up in a very difficult situation.


----------



## margie

Ellie 

It may be that based on that conversation Babysaurus came to the conclusion there was a lack of knowledge - if this is the case then she has not had an opportunity to request a transfer. 

The earlier thread indicates that the surgery had said they were going to restrict the insulin to what they thought was sufficient. The thread says how much Babysaurus is using. If this information was passed to the surgery then they should be able to calculate the usage in a month and based on the prescribing history have an idea of when the insulin would run out.


----------



## Pumper_Sue

> Anyway - now that's really interesting because earlier this evening I was on the revamped BNF website (everyone has to re-register from 13 March 2012 to accept new T&C) and I read the prescribing guidelines amongst other things.
> 
> One thing amongst the very few items doctors are instructed to never NOT prescribe when requested is INSULIN. I was pleasantly surprised about that but thought no more of it ...... you can coss question the patient after the event. But the Hypocratic oath also requires you to do no harm and to preserve human life in all circumstance under your control. So IF the doctor HAS refused then he ain't no doctor, and if he did do that frankly, I've now upped my game. I now want to report him to the GMC.



Yesterday 11:29 PM 
trophywench 

I rest my case



> Which in this case, I feel the real failing on the surgery point of view, is that the GP failed to insist that BS came into the surgery to show the clinical data she holds (her pump data and BG data). Which in hindsight this would have avoided unnecessary aggro for both parties.



Oh come on no GP will ever ask for pump data, they don't have the software on their computers to download. Most GP's have never seen a pump.
There's 46 or 7 in Cornwall. I'm at a surgery with 8000 patients. Guess who's the only pumper?

Same with BG meters none have the software on their computers.


----------

