Heart Failure and barriers imposed by... - British Heart Fou...

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Heart Failure and barriers imposed by GPs when prescribing medication

Worried-dughter profile image

Has anyone else encountered issues with their GP practice? My dad is under the care of his heart specialist and is being prescribed an endless list of medication. However, when he needs a repeat prescription the GPs refuse to give it to him with little to no reason why . They will continuously challenge the medication issued by the heart specialists.

For someone that has just had a pacemaker fitted, been diagnosed with heart heart and waiting a further operation, all in the space of 2 months, this is hugely detrimental to his health. Can anyone suggest a way forward, or better still anyone experienced this?

30 Replies

I would suggest that you contact your fathers heart specialist and ask them to contact your GP to ask why.

Thank you. He tried that a few weeks back and the specialists have exhausted their avenues also. I wonder if we can raise a formal complaint.

Can I ask what reason is given for refusing?

Sadly they are not providing a reason. I do wonder if it has something to do with funding.

Milkfairy profile image
MilkfairyHeart Star in reply to Worried-dughter

If you are in England it maybe the Clinical Commisioning Group's CCG in your father's area that is restricting the prescription.I suggest you contact the practice manager at your father's GPs practice and ask for the issue to be resolved.

You can make a formal complaint to the CCG concerned or NHS England.

nhs.uk/using-the-nhs/about-...

CCGs are gradually being replaced by Intergrated care systems.

In Wales, Scotland and N. Ireland the system is different.

Can I ask what the drugs are?

There are a few reasons why a GP would/could not issue them, they would not refuse with no reason. And for the record cost is not one of them.

E.g one is if they are clinic issue only.

Hi wd. I understand your problem, from my own experience, but I'm afraid I can't explain why! I had a lot of problems with atorvastatin causing liver problems. My doctor was unsure what to do so consulted a lipid specialist. I had a one hour (yes really, a whole hour) telephone consult with him which was very in depth and informative. He outlined 3 possible ways forward and recommended his preferred option. He wrote to my GP and copied me in as well. I heard nothing from my GP so arranged an appointment to discuss it. The doctor is not convinced and is still just repeating blood tests. Why did they ask for advice, then ignore his advice? I also suspect it was a budgetary issue. Milkfairy has given wise advice as usual. I hope you and your dad can find a way forward. Best wishes.

Curlyman83 profile image
Curlyman83 in reply to Nettekin

I had massive liver issues with Atarvostation prescribed by my consultant. My GP was superb in switching me onto Enzetimibe as soon as the issue was noticed.

Atarvostatin is an old, and therefore “cheap drug” - I imagine this is why some surgeries are reticent and reluctant about prescribing alternatives.

Nettekin profile image
Nettekin in reply to Curlyman83

Hi curlyman. I was indeed switched to Ezetimibe in February this year but the consultant was keen to add in another tablet as cholesterol still a little high. Also looking at familial hypercholestim

Nettekin profile image
Nettekin in reply to Nettekin

Oops, pressed wrong button!! Meant to stay consultant also looking at familial hypercholesterolemia, but awkward as adopted and no family history. Thank you for your time. Atorvastatin does seem to be an issue for some.

Curlyman83 profile image
Curlyman83 in reply to Nettekin

Mine is also familial…mum and dad both on statins for high cholesterol, so nothing down for me.

My cholesterol wasn’t ridiculously high at 6.9 but in the statins it dropped almost overnight to. 2.35. Unfortunately my liver function went to 146 😳

Statins stopped and my cholesterol jumped straight back up to 6.2…there’s absolutely no way of me controlling this naturally!

Thankfully, the enzetimibe is slowly bringing the cholesterol down (4.85 at last bloods) and my liver is slowly repairing itself (91).

Can I ask what other tablet you’ve been prescribed?

Nettekin profile image
Nettekin in reply to Curlyman83

Hi. The consultants preferred choice was colesevelam. Doctor not convinced and topic still up for discussion. Btw Apparently if my two sons are tested it may be an indication of whether it could be familial or not. Guess with the test tube situation those blood tests won't be happening anytime soon! Best wishes x

Curlyman83 profile image
Curlyman83 in reply to Nettekin

Thanks for this. I hope you get some answers soon x

If and I don't know if possible change surgery, I found the same issues and it seemed to be break down in communication..(Hospital to surgery)..? I attend St Thomas's in London which lucky has an onsite chemist and my heart failure nurse just provided what I required..I take 9 different tablets daily so understand your father's predicament.Either of changing GP or asking cardiac nurse might be a solution..Hope this helps.

I suspect it's a funding issue, I had the same issue with my gp after had stents fitted after having HA whilst on holiday in Spain, they refused to prescribe the same drugs as the Spanish specialist because they were too expensive!!!!!I formally complained first to practice manager and the to local trust, blackmailed them by threatening to go to the press worked btww!!!!

Don't be intimidated, we taxpayers pay their salaries!!!

Check your Dad’s hospital discharge letter. I had a mitral valve replacement in June and my hospital discharge letter lists all the medications and all the ongoing ones have a note saying “GP to continue”. Surely the GP can’t argue with that?

Hi, I am in Scotland and I had to change my GP after 54years at the same practice, I had a heart transplant last year and on discharge my GP refused to prescribe my imnosuppresents,my transplant nurse and cardiologist were horrified but apparently they can do what they want and they didn't want me, I live alone and 3 weeks after my op I was sitting in tears trying to get a new GP to get Life saving meds,it was horrendous, when I got one they didn't understand why I had been basically told to leave my previous one, it wasn't like I bothered them much about anything,the hospital done everything for me,if the GP is like that at the moment I would change them it sounds like they don't care enough, I do hope you get it resolved the stress is awful char

Thank you, it was just awful I felt so ill and having never changed my GP in my life I had no idea what to do and no one to help, I wouldn't wish it on anyone, New heart doing well echoes have all been good, I have not to go back to the hospital for 8 week's for an MRI, it's usually an echo so I am not sure why!char

I had heart failure in November 2019, I still have to battle with my doctors all the time,I think its called politics and money

As Gaz_chops points out and despite some of the answers you’ve received cost isn’t one of the reasons for a GP refusing to prescribe. It doesn’t come out of their budget.

I was told that a GP has to be comfortable with the responsibility for you taking a certain drug, and if they don't want to prescribe they don't have to. I believe drugs can be obtained via the hospital, but for a lot of us this can be inconvenient.

Gaz_chops profile image
Gaz_chops in reply to TRST

Not quite true

If a drug is licensed for Primary care use then the responsibility is removed, other than following certain protocols e.g. monitoring bloods etc.

If a drug is not licensed for primary care use then they can still prescribe but the responsibility then lies with the GP.

Partner20 profile image
Partner20 in reply to Gaz_chops

Unfortunately, an NHS GP is under no obligation to accept advice or treatment plans from a consultant, even an NHS one. They are most likely to refuse to continue with a treatment plan if they are not confident in their ability to monitor it.

Gaz_chops profile image
Gaz_chops in reply to Partner20

It would have to be a pretty complex case/treatment plan for a GP to not be able to monitor it. The meds management team in my practice have over 20 years experience and have never seen a GP refuse a 'Licensed' drug!

Partner20 profile image
Partner20 in reply to Gaz_chops

As in an earlier reply to me by TRST, it is not at all unknown for a GP not to follow a treatment plan and consultant-recommended prescribing. As well as not being contractually obliged to do this, and/or maybe not feeling confident in doing so, many GPs prefer not to lay themselves open to being sued if things go wrong by taking on the responsibility of managing certain medications, which happens far more frequently than you might think. I have seen this disinclination to accept specialist prescribing and advice both at first hand, and from situations described in the various medical groups I follow. Our family GP prefers to keep well away from any condition that has been referred because a lot of the time she simply doesn't understand it, and will simply re-refer if necessary rather than try to manage the condition herself. It has nothing to do with the question of whether the medication is licensed or not, or its cost. A GP is just that, a General Practitioner, without any personal specialist training, which is why referrals are made, and responsibilities for the management of those referrals are given to the specialists involved.

TRST profile image
TRST in reply to Partner20

I agree. I have come across this in the past.

lmc.org.uk/visageimages/gui...

"Each GP will make prescribing decisions based on what they are or are not prepared to take clinical responsibility for. There are cases, where one GP is prepared to take responsibility, whereas another GP may not."

"It is the doctor who signs the prescription who carries legal responsibility, not the doctor who may suggest it."

Fair enough. GPs are only human and it's a big responsibility.

Partner20 profile image
Partner20 in reply to TRST

Absolutely correct. A GP is not a specialist, which is why the consultant referral system exists. Taking on responsibility for something you do not fully understand or feel at ease with is not what the majority of us would be willing to do, after all!

Gaz_chops profile image
Gaz_chops in reply to Partner20

Isn't this what 'shared care' is for?

Hi my husband got something like covid 19 in 2014 he was on life support for 14 weeks and in hospital 7 months I contacted the royal Brompton myself as a desperate measure as we where in Bupa

They said he was to poorly and complex to be moved

But they gave me what I calla care plan saying what medication to take as the hospital said he had fibrosis of the lungs the royal Brompton thought not and had a treatment plan

He actually got a virus that attacked his lungs that made his immune system overreact just like covid

So h now has a damaged immune system and a condition called Jo/1 which is rare

Basically a damaged immune system

I got the treatment for him

As they where sending us home on PALATIVE care

Anyway once home I asked to go to the Brompton which was fine

Then the hospital he attended found it just to much trouble to see him every six months to dispense his medication

He asked our Gp to do it

She went absolutely mad saying this was special medication and a specialist should dispense it any way she sorted it out and his medication comes straight from the royal Brompton now and has done for many years

Why can your Gp not do the same for you

If your dad has medication recommended by a specialist

This is a care plan.

So your dad is not being giving the care he needs some one must sort out where the medication comes from

Ask your Gp to do this

The doctors that treated my husband told me

He is only here because of me

I was never rude but went to no limits to get the care that my husband needed

They told me every day for 179 days he would die

He came home on PALATIVE care

But I chased up every bit of care myself

Don’t be afraid to ask direct questions and help from every one out there

A care plan is a care plan and someone has to put a name on it

I had to ask several doctors on my journey who was responsible for his care as the care was lacking in some instances

Good luck

If the cardiologist has recommended that certain drugs be prescribed for your father and has written to the GP asking them to prescribe these on a repeat basis then that is what should happen. If the GP has concerns about prescribing these drugs or monitoring them then he should be discussing this with the cardiologist - not refusing to issue repeat prescriptions.

You need to discuss this again with the cardiologist and the GP and if the issue can't be resolved then you should make a formal complaint to the GP Practice and to the Health Board/Health Trust. The situation you describe is simply unacceptable. Good luck and good wishes to your dad.

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