I've been asthmatic since childhood. I consider it well managed even if I need to use my Ventolin inhaler on top of my preventative Seretide one almost on a daily basis. I have various triggers from both extremes of weather, exercise, dust, allergens and traffic pollution.
Today I've attended an asthma review with a GP's nurse. I've been informed, without consultation or discussion, that I can no longer ask for a Ventolin inhaler on monthly repeat prescription. I was told by the nurse that they have no say over this decision and it's countrywide and came down from on high through the NHS. I've tried searching for the origins of this online with very little evidence that this is the case.
I'm suspicious that this is a decision that's wholly based on budgets and money rather than my care and health. Does anyone have any evidence to the contrary?
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GrizCuz
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That's what I thought. But if I end up in hospital after a bad asthma attack, the NHS will be funding it rather than my GP's surgery, so I doubt that they give a flying fig. I'm absolutely fuming about it. I'm quite friendly with my local pharmacist so I'm going to ask her some pertinent questions tomorrow. I really need to know if this is happening regardless of which GP's surgery I'm signed up with. Because if it isn't I'll be switching GP practice ASAP.
Well my gp prescribed me one even though I told him I didn't need them as I had spares..this was after 2 weeks before another gp doing the same... I have two salbutamol inhalers I don't need... the second gp when I said I don't need salbutamol I have some and some spares... he said we cant take the risk you will run out and need it so printed a prescription for it anyways
I can order a repeat ventolin through my systems online account monthly. When I am unwell I can request two at once. I would question this decision that you have been told, seems wrong to me
These days the rule of thumb is that if you need your ventolin/salbutamol more than three times per week then your asthma is not well controlled, and other things should be considered. It is no longer like it used to be. Did he or she sugggest anything else?
If you look at the asthma action plan on the Asthma U.K. site you can see that advice there, and I sure in many other places on their site. You can also download their asthma action plan.
My understanding is that NHS budgets are devolved to the local Trust, so this could be a local Trust decision. However, it makes no sense as Ventolin is a rescue inhaler, and you MUST have it in order to cope with a flare-up. If the local GP surgery is concerned that you are using too much, then they need to discuss with you why that might be and review your treatment. What they mustn't do is leave you without it.
It may be because they’re trying to bring people in who are going through a reliever inhaler monthly for reviews to potentially up their medication. As one of the findings of the review into asthma deaths was that people picking up reliever inhalers every month were slipping under the net despite having uncontrolled asthma.
Most of the standard relievers have 200 doses in them, so to go through one a month you’d be taking 6 puffs a day on average, when they say that you shouldn’t need it more than 3 times a week if asthma is controlled.
Obviously if you find you need one and you’re unable to order one then the thing to do is to make an appointment with your GP where they can review your asthma and then prescribe one because as you say - being left without one is potentially very dangerous. But that might be why they trying to limit the number people can order
Hi. I would imagine that the instruction to the GP surgery has come from the local CCG (Clinical Comisioning Group) for your area. Basically it is the CCG who are charged by NHS England to determine which services, medication, etc should receive the appropriate funding. Doctors are coming under increasing pressure from the CCG with regard to their prescribing budget/spend. So, on the one hand, it does come down to money in part. However, the other thing that doctors have to take into consideration is, as others have said, whether or not the patient's asthma is under control. If a patient is in effect 'overusing' their rescue inhaler, then their whole medication regimen needs to be reviewed. In theory, if your asthma is under control, then the instruction to GPs is that a person should only need a couple of rescue inhalers a year. Now I know that this is a blanket instruction and not everyone will fall into this. But, if it helps prevent patient wastage (which is a MASSIVE problem in the NHS) then that can only be a good thing. So, you should still be able to obtain a rescue inhaler when you truly need to, without hoarding excess stock, which believe me, people do.
I must admit I read your post a bit differently from many above, but you were there and heard what the nurse said, so I may have misunderstood.
You seem to say that they say they will no longer routinely give you a new inhaler monthly. That is not saying you would not get them at all.
200 doses, that is one inhaler, is way over what you would need monthly if your asthma is controlled. If you need more than three inhalations weekly as standard, or slightly more if needed acutely, you should see someone anyway, for them to consider with you how to improve the situation.
I remember when I brought up our asthmatic daughter that the guidelines were different, and Ventolin/salbutamol was ok to use far more than now, much in line it seems with what you do. So perhaps talk to them again? Or to Asthma U.K. first and then them.
My GP sent me a letter a few months back explaining that only 2 Salbutamol inhalers can be issued by repeat every 12 months now. I believe this to be a good approach to attempt to get poorly controlled asthmatics under control with a preventer inhaler that suits them.
Although I welcome this approach, I can understand how frustrating it must be for patients that have GP surgeries policing this and making it difficult.
I’d certainly revisit your surgery and ask them that if you can no longer order salbutamol, what they will prescribe instead to stop you needing your salbutamol.
Perhaps make GP appointment to seek clarification of the policy you’re being told applies. Maybe ask to see a copy of it. If GP can’t help consider sending a recorded delivery letter to your local health authority raising the issue.
I'd agree that it's not controlled with that level of use, but also that in that case there should be a discussion about how to improve control and reduce reliever use - different preventer, additional doses of preventer, add-on etc. Just stopping Ventolin repeats and citing a policy which at the very least isn't a national one (I still get mine on repeat when needed) isn't helping anyone.
I'd also like to ask GrizCuz if the nurse just said 'no more Ventolin on repeat' or if they actually told you that you are poorly controlled if you need that much?!
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