Newbie here with a Right to Choose (RTC) question. I’m about to go through tritation with Psychiatry UK (PUK)as an RTC patient. Because of other health problems they want me to have an ECG and other heart checks plus bloods.
They wrote to my GP but my GP practice is refusing to refer me because they believe it’s for PUK to organise. They don’t do that and have no one to refer to. When I ask what they do with private patients they said they get them to sort it themselves as they are an online psychiatrist service. The choice is now be discharged untreated back to my GP or find a new GP. This seems like a tall order as how do I find a GP who wouldn’t behave the same way.
My gut feel is my GP should be doing the referring as RTC is mental health only but the GP doesn’t know enough.
does anyone know what the RTC pathway should be please in this instance ? Has anyone got it so I can show it to my GP.
I have so far contacted ADHD UK, PUK, ADHD foundation and the local integrated care team this morning and no one is answering their phones and all I feel is really stressed and upset.
thanks
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Eimear78
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Hi .....sounds like such a pain and so frustrating. I was in a similar position as I had to go private for an assessment and after my diagnosis the consultant had a long list of tests I had to have before he could start any kind of medication and that included an ECG. The consultant had said I would probably have to go private as in his experience GP's would not carry out these because I went private. I looked into the prices and they were phenomenal, couldn't believe the costs especially the ECG. I approached my GP and to my surprise they were very accommodating as they were frustrated that I had to pay private considering they referred me to the local mental health team for an assessment and it was a 2yr wait. However there was quite a significant delay after all the test as my GP didn't think I needed a ECG as id had all the other tests so it was a bit of ping pong but I eventually got it done and it showed that something was blocked (cant spell the medical term hahaha) so it added to the delay in prescribing. Finally 4-5 months after diagnosis I started on my journey of medication and 3 months after starting Im still trialling diff meds as nothing so far has worked which is so frustrating as Im still paying private as I need to be stable on ADHD meds before my GP will take over the care.
thank you for replying. I have been in touch with The ADHD foundation and they say that the GP has an obligation to carry the tests out and I need to speak with the commissioners to get support.
I think the GP doesn’t understand what right to choose means. They just think I am going private.
ADHD Foundation are wrong if they say GP has that obligation. GP's obligation is strictly to take care of medical need here (not want) and avoidance of harm (if you end up with permanent pain from nerve damage through the needle with bloods unnecessary you could in theory have enough for a claim in court ie with bloods unnecessary, as outlandish as that may sound to some).
In the NHS any specialist can refer to another specialist. Problem: any doctor including our esteemed colleagues psychiatrists need to justify requesting/arranging any medical service because of costs. ECGs cost, "bloods" cost. It all adds up and as a patient you can expect from the NHS what you medically need, not what you want. For anything you want, but not need, you should pay out of your own pocket or via your private health insurance if they are happy to pay - which they also not always are. Health services cost money and money adds up. Which is why the NHS is evidence- and national-guideline-driven, not wants-driven.So to apply this to your case: your GP is told by a psychiatrist to request/arrange these services - in your case ECG and blood tests - because of his - the psychiatrist's - perhaps unsubstantiated assumption it would be best if you had these tests (this might in fact translate into "I don't know much about ADHD and stimulants in people with a medical history of XYZ so let's do an ECG and bloods, just to be sure" or in other words, is this psychiatrist's assumption evidence-based?) He/she could ask a cardiologist or refer you to one, wgereby the cardiologist would most likely just advise as per the evidence for your case but this would be fine. He/she (psychiatrist) may have to go through the trouble of getting your medical details from your GP. And him/herself read up on evidence which he should do anyway before he jumps to advising patients and your GP, or let another, experienced-and-updated-on-stimulants-and-various-comorbidities psychiatrist decide. It's quicker for him/her to dump this on your GP who is expected to do it by yourself and the likely less knowledgable (when it comes to your medical history and chronic medical conditions) colleague psychiatrist and possibly despite the lack of evidence, and THEN has to justify this expense before the commissioning authority ICB. They will not accept when the GP says it was advised by the psychiatrist. They will say, but the request to do, hence finance, these tests came through YOUR surgery! A cardiologist would base his assessment and decisions on evidence but there may be no evidence for a need for these tests.
Uptitration (of stimulant I presume) and a notion of "other health problems" are probably not a justification or too vague to be accepted as warranting ECG and "bloods". Which bloods by the way? There are hundreds!
So unfortunately you can't be cross with your GP. Be it with government who through flashy words such as "Right to Choose" pretend they give you a quasi-private service throughout, and with your psychiatrist for either not explaining to you why exactly you need these tests, or is too lazy to do his homework and the work of asking advice from other secondary services or colleagues and a coward for not admitting he/she is unsure and therefore has to get back to you before uptitration.
Also, in reality a lot of secondary care work is dumped on primary care. I understand my GP colleagues that they are fed up with it. It goes to the expense of their time and resources and a GP has on average 1800-2200 patients to look after.
I hope I've made it all a bit clearer why these decisions get taken. If you still wanted the tests you could Google private ECG near me and private blood tests near me etc. You would have to pay for it obviously. Or - my preferred option - look up the evidence yourself and if you don't need the tests don't have them "just in case".
Recognise that's a combination of worry and the shrink having planted the idea in your head.
Can I just check with you as you seem to have a lot of knowledge on this subject, are you saying no tests are needed before a GP/'shrink' prescribes ADHD meds, stimulants or non stimulants?
I paid private as there is a 2yr wait and due to all the negative press about ADHD and mis-diagnosis by private clinics I researched for a long time and found a specialist ADHD consultant which was a lot more money than the rest that are offering assessments.
The consultant in my opinion has been very thorough from my assessment through to my meds and when I have found the right meds and the right dose I shall be transferred to my GP on a shared care arrangement. Hopefully soon as I am getting into a lot of debt.
I have an underactive thyroid and have a risk of heart issues because of the medication so they want to check my heart before they give me the Elvanse. I am not sure if that would be the case for everyone and it will vary between psychiatrists I would imagine.
I have been on Liothyronine/Levothyroxine combo for 4 years and my TSH has been suppressed. In the last 2 years my t3 levels have been over the range a few times and my endocrinologist wants me to have ECG and bloods too. She wrote to my GP but they never received it and she’s private so they probably wouldn’t.
my goodness what a nightmare NHS seems to be for you you guys! thanks for this whole explanation- USA healthcare is a racket for sure, our FDA ( food n drug admin) n pharmaceutical companies are same so essentially the food regular americans have public access to lead to sickness that require lifelong pills n meds to live. ugh! but it sounds like universal healthcare in UK has different but equally as frustrating hoops to jump thru!!! thanks for sharing all this. ADHD in USA and ADHD in other countries face different challenges in treatment n it was helpful to me to read this to better understand what my non USA ADHD tribe go thru.
Yes indeed. One can't compare the two. Too many different aspects and those matter to different people/populations to say one is better than another. Same with NHS and Germany. Not so simple.
I have an underactive thyroid also that's why Im really interested in Hominid711 reply as I just thought it was standard to request all these tests. I also had to have a drug test alongside all others.
other friends who’ve been diagnosed have not had ECGs just blood pressure monitoring. I have been on a T3/T4 combo for years with a suppressed TSH and over the range on t3 occasionally so they are concerned about the affects on my heart. I had an ECG in 2021 for a similar reason.
Presumably that was normal? Doesn't sound like you need another. Psychiatrists and psychiatric nurses obviously don't have the same amount of exposure to physical disease or physical co-morbidities (unless they do Gerontopsychiatry) and therefore "unlearn" or loose confidence with interpreting physical medical history, pharmaceutical history and doing physical examinations, therefore they are keen on bloods and ECGs because there's an idea out there that this covers most contraindications although even normal results don't rule out all existing diseases. Some arrhythmias are intermittent and "bloods" could be reduced to thyroid function to rule out an OVERactive thyroid.
it was normal but my health has declined since then whilst trying to balance the thyroid hormones. My current endo suggest I need another as has Psychiatry UK separately
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