prescribing RA drugs

[Gottarelax]

Hello, me again Counting down the days to my rheumatologist appointment (10 days left). I have a query regarding prescribing. I have a semi-private insurance in which I can get the diagnosis paid for but not the treatment. Usually this would mean that the consultant would make a diagnosis and write to the GP with recommendations for treatment and the GP would prescribe. Now I understand that for certain treatments, only the rheumatologist can write the prescription and this would mean I'd have to wait for a consultation with an NHS consultant or pay for it myself. Has anyone else had experience of using a diagnosis only healthcare plan or paid for a first consultation and then had to get meds through NHS?

[Wobbies]

Paid for my first consultation then rheumy wrote to GP asking him to refer me on the NHS so that he could then prescribe.

[Gottarelax in reply to Wobbies]

Thank you wobbles that’s put my mind at rest. I was suddenly concerned that I’d still have to wait to see an NHS rheumatology for treatment 👍🏻

[AgedCrone in reply to Gottarelax]

Ask the Private consultant’s secretary if he has an NHS list you could go on.Most if not all Consultants who work with Medical Insurance companies-do have to be NHS registered….so you shouldn’t have a problem.

[Gottarelax in reply to AgedCrone]

The consultant does do NHS but is not based in my local hospital. My hospital is York and he is in Harrogate. Through my insurance I didn't have a choice for a York consultant. If I can get a referral to Harrogate though I'd travel (if he is good).

[AgedCrone in reply to Gottarelax]

I think that would depend on your local health authorities …whether they allow you to cross borders or not! But if you can get a referral to anybody and start your medication I’d do that and sort out the travelling once you are settled on treatment.

[Wobbies in reply to Gottarelax]

The only downside is that I have to travel 60 miles as the rheumy I chose does not practise at my local trust. Still, I don't care as he is so good, oi would travel anywhere to see him.

[helixhelix in reply to Wobbies]

Mine is nearly 100! Worth it.

[Gottarelax in reply to Wobbies]

Can you get referred to an NHS doctor outside your local area? It's complicated for me as I live just over the county border to my local hospital but our gp refers there as it's closest. However, the consultant I'm using is 30 miles further and not in my county.

[Wobbies in reply to Gottarelax]

Yes you have a legal right to be referred to any NHS hospital of your choice. My GP did not bat an eyelid when I asked for that. Also insisted going out of area for a colonoscopy. Do not trust my local hospital, too many bad experiences. Good luck.

[Sheila_G]

My first consultation was private so I could get a quick diagnosis. My treatment continued with the same Consultant on the NHS. That was 20 years ago and although the Consultant changed to a far nicer one I have had no problems with treatment throughout.

[Katie-Mag]

Hello Gottarelax,Sorry to hear about your likely RA.

I received my diagnosis from a private consultation. The rheumatologist gave me a private prescription for my first batch of methotrexate and hydroxychloroquine neither of which were very expensive. I was then referred to his NHS clinic where I’ve been treated ever since.My RA is now in remission on biologics.

Good luck with your treatment & in trying to relax 😊

[CagneysMum]

I paid for a private consultation (to jump the 3 month queue 😬) with a rheumatologist I’d chosen after researching A LOT on the internet. Luckily he worked in both private and NHS so I could continue with the same guy as an NHS patient. In fact he advised me that he had better facilities at his disposal at the NHS hospital than the private setting. You might find the same. 🤞

[helixhelix]

In general when you are first diagnosed you are started on one or more of the first line treatments - methotrexate, leflunomide, Hydroxychloroquine and/or sulphasalazine. They are tried, tested and effective treatments, so can make a massive difference - a combination of these put me into remission that lasted 8 years. All can also be prescribed by a GP on instructions from a specialist.

It is biologic treatments that have to be prescribed by an NHS rheumatologist. But I would ‘t worry about that yet.

[Frances_UK in reply to helixhelix]

But the NHS GP is not obliged to and some are understandably reticent to take orders from private doctors. If the treatment had already been started, then yes. But if I were an NHS GP I wouldn't initiate specialist treatment because someone had paid for a diagnosis as they put it. This whole area is dodgy. Why people think they should be able to pay a private consultant once and then jump straight to the head of the NHS queue I don't know.

[medway-lady in reply to Frances_UK]

I don't see why its dodgy to pay for something actually twice. I see a private consultant if I want too but I pay for it and also paid into the NHS all my working life. So in my view that means I free up an appointment for someone who may have been waiting for some months to see an RA consultant. And to boot some meds are cheaper on a private prescription anyway MTX being one. I think you have an element of angst and I'm not sure this is a matter that should be addressed here. My GP is more than happy to do private referral s he said he'd do the same. It's about choice and not being dodgy but proactive about health care and pain relief.

[Frances_UK in reply to medway-lady]

But that's not what I'm talking about. Of course people are free to seek private healthcare. I don't blame them. I'm talking about facing a wait on the NHS and paying for one private appointment and then expecting to not have to wait for subsequent NHS treatment. It's okay to disagree on this, I don't think it makes anyone a bad person. It just seems to be against the spirit of the NHS. It means someone without the means to pay waits even longer.

[Gottarelax in reply to Frances_UK]

No one will wait longer on the NHS because of me! I have forfeited my NHS appointment, freeing it up for someone else. It will take a GP very little time to read the consultant’s letter and prescribe accordingly. Should I need an NHS rheumatologist consultation I will, quite rightly, be put in the queue like everyone else. I’m currently almost bed ridden with immobility and constant pain from being healthy 3 months ago. Naproxen is not touching the pain. I have not troubled the GP since the first appointment (a month ago) for any additional help. If I didn’t have this consultation I would have to go back to the GP to see what they can do while I wait but I am being patient as I know that GP appointments are precious. With the aggressive onset (anti CCP+ve) my GP recommended a private appointment as any delay could result in permanent damage which would mean more NHS treatment. The long waiting times for urgent cases are what is against the spirit of the NHS.