Hi everyone. If I go to a private consultant to get a... - NRAS

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Hi everyone. If I go to a private consultant to get another opinion, would have to then always go to her and continue paying private?

Kershon profile image
Kershon

Hi. I am thinking of seeing a private consultant, who happens to be part of the rheumatology department I presently see. But unsure how it works for future appointments? Would I have to aways go private?

24 Replies

No. But usually you will need a referral letter from your GP, and then you can ask to be put on her NHS list for the future.

Be aware that if you go private you will have to pay fro blood tests and x-rays or scans as well as the consultation cost (unless you have had these on the NHS and can take them with you).

And a private consultant is not allowed to prescribe biologics, that can only be done via a hospital doctor (which of course may be the same person!). The logic for that is that is could give people who can pay for am appointment an u fair advantage if they bypass the criteria system.

LoneEra profile image
LoneEra in reply to helixhelix

If you’re paying yourself, the majority of private consultants will accept you without a referral from your GP. Money talks! 😂

helixhelix profile image
helixhelix in reply to LoneEra

That’s god to know. The only time I ever went private in UK I had to have a letter...

I checked first if I one is saw also works in the NHS & that I could been seen in that clinic before I chose a specific Consultant for a private consultation but you know this in your case, that she has an NHS clinic. I had to pay for an exploratory op but after that no further charges. As long as you discuss transferring to her NHS clinic prior to consultation taking place then it should be clear. Are you self funding this private consultation? I did (for a different condition) & transfer to the NHS was seamless.

I hope you find the answers you need.

Take a look at the NHS constitution to make sure you know your rights here - your request for a private consultation should not affect your NHS treatment in any way (except potentially improve it).

Is it that you want more time with your current rheumatologist?

whaleroad profile image
whaleroad in reply to whaleroad

p.s. Or, if you just want to see a different consultant in your department you can ask to be switched. I've done it with ease - didn't need a particular reason.

Kershon profile image
Kershon in reply to whaleroad

I go to Bath Rheumatology atm and I am under John Paulng but I have only seen him once in the last 6 years. I always see a different person within the team. This was fine when I was in remission as only went everything 6months or longer for a check up. My humira got switched to a bio similar and things went downhill. This is probably 2 years ago now. They eventually switched me back late 2019. It no longer worked though. By January 2020 my right knee swelled right up and I was having issues with my right hip also. Knee I was told was a bakers cyst which later ruptured. Since then I have had Rituxumab as was also having issues with hands, shoulder (injected). That did nothing. 6 months later started the switch to Tocilizumab which I have been on for 7 weeks. All joints ok (although I was on steroids for 3 months so they were OK anyway but not touched the knee or the hip. I can walk a bit further the a year ago but not very far. Hip is more painful than the knee even though that is still swollen and doesn't bend much. Basically had enough after all this time and wondered if perhaps the knee and the hip are something else but they are blinkered so not really thinking of that possibility. I was recommended to see a woman who is also at Bath but you rarely get to see her unless you go private. But then I never see Dr Pauling either!

whaleroad profile image
whaleroad in reply to Kershon

What a palaver. Sounds a bit like my situation. I've had barely any continuity of care. Once had five consecutive appointments with five different consultants - six for six if you count the appointment with the physician's associate. Every time I saw a new person it felt like going back to square one.

I was told my Humira would be switching to Idacio soon and wasn't happy about it for the reasons you describe. Now we've talked about switching to another biologic entirely as even the Humira doesn't seem to be working that well anymore.

I've also got problems with my hip and knee (and Baker's cyst). Current thinking is that my hip pain is SI pain, not my hip at all. Scan soon.

Hope you get a private appointment with this preferred rheumatologist and get some better answers.

Kershon profile image
Kershon in reply to whaleroad

So you have knee and hip problems as well. Usually it's more small joints and although I have had RA now due nearly 30 years never had any issues with the hip and knee was only an issue when first diagnosed. So I was thinking maybe it isn't the RA after all? It's such a mine field. Hip was x rayed about 18 months ago and although some wear he said it was about normal for my age so really am confused now

whaleroad profile image
whaleroad in reply to Kershon

I was convinced I had problems with my hip, but scans in 2019 were completely clear. So doctor thinks the pain might be from sacroiliac joints - I have psoriatic arthritis and that can tend to involve that area. I'm sure it's inflammatory. But previous scan of pelvis in 2018 was also normal, so it's all a bit of a mystery. Frustrating isn't it.

I think my knee pain might be osteoarthritis. Hopefully will find out from my scan soon. They're scanning the pelvis and my knee. Sure the pelvis won't show anything again, as it's not easily picked up. But there is no way my knee is going to be normal. If they say it is I'm asking for a second opinion.

Kershon profile image
Kershon in reply to whaleroad

Seems to be what everyone is saying to me as well... Get a second opinion

Knip profile image
Knip in reply to Kershon

Knee and hip could be osteoarthritis. You can have both types of arthritis at the same time. I have had RA since I was 22 and I currently have OA in both of my knees. I had a hip replacement when I was 44 and a revision (with a new hip socket after 16yrs). I was told once that RA should really be called Rheumatoid Disease, because it isn't just joints that are involved. So true, isn't it! Hope you get some answers soon.

Kershon profile image
Kershon in reply to Knip

Hi Thanks. Both joints have been xrayed and not significant arthritis in them, certainly not enough to cause this anyway. They tried to drain the knee this time last year but the needles kept getting blocked up as full of crystals. I can't remember what they were called. Also put a steroid injection into it but that no effect either which is unusaul as all other joints have had injected have responded well. Of course not helped by covid and the paranoia around adding steroids in all last year! I kept saying I will take the risk.

Maggsie profile image
Maggsie in reply to Kershon

Sounds very much like my story having been switched from Enbrel to Benepali I had 3 years of hell before Tocilizumab started working. In the meantime I developed severe OA in my knee. Waited 2 years for a replacement and now my hip is going the same way. Get your GP to send you for xrays and if its OA there is a protocol of physio/steroid injections/replacements.

Kershon profile image
Kershon in reply to Maggsie

Thank for this

If you are paying personally you can refer yourself to any consultant you wish to see.But speak to the private consultant’s secretary first to ensure the consultant will then accept you on his/her NHS list....& to check how much the initial consultation will be..,blood & other tests can push the costs way up.

If you are going to pay using private medical insurance you will need a referral from your general practitioner... and as rheumatoid arthritis is regarded by insurance companies as an incurable disease ....these days some insurance companies will not actually pay up any more once you have been diagnosed.

But it’s well worth the initial outlay to get started on the right drugs....

No as per Helix reply I am doing one this week but still see my NHS chap and will give them copies of private notes etc.

Kershon profile image
Kershon in reply to Deeb1764

Thanks

Just to add to what everyone else has said, you can ask the private consultant to write to your GP and ask for the bloods and scans to be done on the NHS if you can’t afford them.

There is some useful info in this thread as well: healthunlocked.com/nras/pos...

In that thread, I explain how to get the most out of a private appointment. Feel free to ask any questions! x

OK thanks x

I paid for a private consultation and a scan . I then explained I wished to transfer back onto the NHS due to findings and I had no trouble . My doctor arranged it for me

Kershon profile image
Kershon in reply to rabbits65

Thanks

My wife had a private consultation with an endocrinologist in Glasgow. She had a total thyroidectomy over 30 years ago and was struggling to get the correct level of thyroxine prescribed. The GPs kept wanting to get her level reduced below a level she felt comfortable with.

There are so few specialists in this area she couldn't get a referral locally. Cost was in the region of £180. Outcome of it was that the GPs in the local health centre accept that she is safe taking a level of thyroxine higher than the guidelines would suggest.

The problem is whether NHS doctors will accept the recommendations of a private consultation especially if there are significant cost implications. In many of our cases the test results are not conclusive and diagnosis is by observation of symptoms and therefore a matter of opinion.

Kershon profile image
Kershon in reply to Scottishlad

thanks for this

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