RA review

[Pythagorus]

I have been contacted by my medical centre to have an RA review by an assistant physician. I feel a little bemused in that I have had RA for about 16 years and have been well managed by the hospital in all that time. My drugsBenepali and Methotrexate both prescribed by the consultant at hospital. I have never before had a review at the medical centre and until now I had never heard of an assistant physician. (Google helped me here)! Has anyone else had a review ? and for whose benefit is this review being carried out? I know if if I had a problem with my RA the rheumatology department would be my first port of call . I would love to hear your comments if you have had a similar experience.😊

[MuppetBaby]

GPs are expected to review patients with a chronic condition annually as part of their targets. Some are great at doing this and others not so much.

Pressure has increased on GPs in recent years to ensure they are meeting these targets for funding etc and COVID put a lot of surgeries well behind so some are catching up now.

There was a discussion on it on here last year too as more people are getting the invites.

[SpaghettiIsGood]

Sounds like you're not in the u s., as being called in for a review sounds unheard of over here. Maybe the practice is in new hands. But don't you see your rheum every 3 months and also get a blood test at that time?

[Mall in reply to SpaghettiIsGood]

I am lucky to be reviewed by rheumy face to face every twelve months over here in Uk as my disease is under control. My last annual rheumy appointment August 22, was by telephone. I also have an annual rheumy nurse appointment 6 mths after the rheumatologist appointment and this has also been by telephone since the start of covid. A nurse at the GP surgery takes blood tests every 3 months which the hospital can access to monitor methotrexate and Benapali.

I can’t get a GP appointment with the GP of my choice without a 3 week wait and that is only a telephone appointment after which they decide if the want to see you. I would love my GP to call me in for a face to face appointment. If this was to happen it’s likely to be with the duffer in the practice that no one wants to make appointments with just so the box is ticked and they can pick up the government cash.

[Madmusiclover]

me too. It was a complete waste of time on Friday. Blood pressure; (sky high: always is:bp kit causes fibro pain =high bp so follows a week of readings from home on my own kit) blood tests (which I have every 3 months anyway) weight (which I told them from Slimming World’s weigh in) and height (which I told them). They know nothing about my RA. I won’t go again.

[helixhelix in reply to Madmusiclover]

A friend of mine had her (previously unknown) osteoporosis picked up because of a height check. Not that stupid a thing to do every now and then!

[sylvi]

My dr tells me to contact my hospital if i ring them about my ra. I do get a phone call about a drugs review though. xx

[Sheila_G]

I have just had exactly the same experience. I told the surgery that I had regular blood checks with rheumatology and as the experts I was happy that they know all about me. The receptionist went to ask and said GP still needs to speak to me. We arranged a telephone consultation and I got my phonecall. Lots of questions from a very nice man about RA and general health then I asked him if he was a doctor and he said he was an assistant clinician. I since googled and they are basically a triage service. I have since had another telephone call from an assistant clinician telling me I am taking too much thyroxine and I had to tell her to look at my notes as I have a strange thyroid and blood reaults say the opposite to what I need. My notes, from the Consultant, clearly states this so when I pointed it out she said ok I'll call the Pharmacist. Why? She rang me back to say she had spoken to the Pharmacist and he said it was ok for me to continue on same dose of thyroxine. Why Pharmacist? Sometimes I feel like I am in a West End Farce. I know they are very busy but really???

[cyberbarn in reply to Sheila_G]

At the moment physician assistants or associates (PA) can't prescribe. So they have to go though either a pharmacist who has prescribing rights, or an Advanced Nurse Practitioner who can also have prescribing rights.

They are working on the procedures for PAs to be able to prescribe, but it is taking time.

Many Allied Health Care Professionals can prescribe within their competence now. I used to explain this to patients that that meant my podiatric surgeon can't prescribe birth control! They have to do extra training. GPs do this training in their medical degree, other health care professionals have to do it after they graduate.

[Sheila_G in reply to cyberbarn]

Ok. Thanks for the explanation. I'm still not happy with it. If I need to speak to a doctor, I want to speak to a doctor but if that's how things are these days then I have to accept that albeit very reluctantly.

[JGBH in reply to Sheila_G]

Indeed another example of the NHS wasting money ! We don’t need all those useless people who are not really qualified to tell us what to do with our drugs, especially when we are being monitored by a consultant!

[ruth_p]

I’ve had these, they’re pointless but the surgeries are required to do them.

[Leics]

Yeah my surgery send me a questionnaire but don’t care if I don’t fill it in. I usually forget haha. Also had a phone appointment with the pharmacist who rang me an hour and a half early but apparently if I hadn’t spoken to them they’d have stopped my meds but they don’t prescribe any RA meds for me so what’s the point ? probably to save money and try and remove something but there’s not anything to remove so a box ticking exercise.

[mjrminor]

I had one of these for the first time last year and I have to say it was a more thorough review than I've had with a rheumatologist in the past few years. But I think that says more about the current state of my local rheumatology department than it does about my GP...

[Sheila_G in reply to mjrminor]

Oh I agree with that. The Assistant clinician I spoke too was very nice, very thorough and very helpful just not a qualified doctor.

[janmary]

If you have RA you are at higher risk of cardiovascular problems . GPs are required to review such patients to monitor general health, and assess their risk levels ,not to review RA which is (always?) managed in secondary care. Usually just ends up as a box ticking exercise.

[Lizard28]

I had a phone appointment for a review a few months ago. All my medication has been prescribed by consultants at the hospital. When she called she asked me why I was on my drugs???? I told her briefly as I could have spent an hour telling her all my problems. She then told me two of the drugs I’m taking shouldn’t be taken together and would I make an appointment for an ECG. I did that and everything is ok, she said I should get one every year which is rather worrying. I think GPs have to look at your medication every year or so but I was worried they were going to stop or change them which didn’t happen. Another Tick Box for the GP as if they don’t have enough to do.

[Flinda]

My surgery rang me last month - they never ring me!!

Would I like to make an appointment with their pharmacist to review my medication?

I thought I was being given the choice so declined, as the pharmacist where I collect my prescriptions looks after any concerns I might have and keeps an eye on things.

She didn't like my response and persisted, so I persisted - until I felt as though I might be slightly rude (because she wouldn't take no for an answer!).

In the end, she accepted my decision.

Maybe it's a way of ensuring the NHS control the cost of drugs issued, without taking up GP time?

She did say the pharmacist was a relatively new member of their team, which is an additional cost to the NHS - but I would question the value for money!

[Hidden]

Yearly med reviews are standard now. If you are over 40 (?) a CVD check is advisable as we are a high risk group. I have recently been asked for a BP check but have yet to arrange.

Loads of money is wasted each year by people ordering meds they don’t need or use. I expect that is behind it. It’ll be for everyone, not just us special peeps 😎.

[Pythagorus in reply to Hidden]

thanks for your reply , this RA review comes in addition to my yearly check with the nurse. We are advised also to take our BP for 5 days to get an average before we have the appointment with the nurse. Really wondering where the RA review comes in when I have only ever dealt with the hospital regarding RA

[Hidden in reply to Pythagorus]

I think I may have had one last year now you mention it. I never go to the GP, so maybe they just want to check we are ok?? New guidelines I expect.

[Sheila_G in reply to Hidden]

Well if that's the case I have been missing out on checks for 22 plus years. Better late than never!

[barbieg]

I was asked to book a medication review from my surgery a few weeks ago. It turned out to be a telephone review. It was a doctor I had never seen , she went through my medication and said all good. At this point I asked why she hadn’t mentioned Idacio? She knew nothing about it even though I had asked for it to be added to my medical notes before Christmas. I kept checking the NHS app , it took 8 days to be added.

My surgery also do a general review which involves blood pressure, water works, height and weight. I’ve not been called in for 4 yrs. It seems very random .

[Pythagorus in reply to barbieg]

thanks barbieg for your reply it does all appear that what medical reviews we get depends on our location . Thankfully I feel well cared for here 😊

[Gnarli]

These tick box excercises really tick me off. I've been forced to have the pharmacist check my meds or I wouldn't have been able to get any more. He can't have read my notes so didn't know about the MTX or Amgevita. He expressed some dismay at my blood pressure and cholesterol levels and magiced up a face to face with a GP (grumpy person) who dismissed all concerns but told me to order an ECG! With cardiovascular issues in the family and RD I expected a more vigorous response. Silly me

[cyberbarn]

As others have mentioned, this will be to do with funding. GP surgeries have to supply specific core services to get their funding per patient. This is the Global Sum. There is then optional services that attract additional funding. So every time someone has their blood pressure, weight and height measured, that will be a tick in the box for the surgery to get the extra money. This is called the DES (directed enhanced services). On top of that there are local initiatives, which is the LES (local enhanced services).

This is why they are trying to get everyone in to these checks, it gives them the money they need to fund the practice. Because the global sum isn't high enough to cover all the people that have long term conditions that put pressure on the surgery (not saying that RA does, many of us have reviews from secondary care, but think of those with diabetes or high blood pressure or heart disease too) so the more money then can make from taking people's blood pressure, the more likely it is that the surgery will financially survive.

Here is a page from the King's Fund that briefly explains the GP contract and funding streams.

kingsfund.org.uk/publicatio...

And if you are bored and want more information, you could try the NHS websites on it

england.nhs.uk/gp/investmen...

You can find further details on the DES here

england.nhs.uk/wp-content/u...

[Pythagorus in reply to cyberbarn]

Thanks cybernarn for your informative reply and for the links. I shall definitely read them and get myself up to date what is going on in general practice.

[helenlw7]

My RA was diagnosed in 2004 and I’ve never had a review by my gp either, even though I’m on shared care between my gp and my rheumatologist. Last year, for the first time I had a general heath review. It was done by an HCA, and because she wasn’t a nurse she couldn’t do my asthma review. She basically weighed me, told me I was overweight, and did my blood pressure. I then had to make another appointment for my asthma review. I think gp surgeries are just ticking boxes!

[medway-lady]

Bum on seat = funding. and thats it, the GP's under shared care agreements have to see patients as they prescribe and monitor medications so run clinic's. I asked if as there was nothing wrong could I keep the appointment for when I did need to see a GP ? and its a no as they get funded to review patients although in my case I see a Consultant every six months and the GP's can't change the meds without the permission of the RA consultant. It amuses me but came in handy as I said you've sent for me and no problem with RA so can we discuss ??? and he did.

[oldtimer2]

In my experience having an annual review at a GP practice is a way for me to educate the doctor, pharamcist or practice nurse specialist (I've had all three). They ask me why I'm on the various medications and I explain what they are for and how they work.

I try not to be impatient, after all I'm the expert in my condition and they are generalists, but I must admit to be a little annoyed when they exclaim over the number of medications that I have to take as if it is somehow my fault.....

In another way, I appreciate the opportunity to make some contact with the practice which is not an emergency as otherwise that's the only time that I see them and then they are often perplexed by the complexity of my care.

[stbernhard]

It's another box ticking exercise for GPs. It can be useful if one hasn't got regular reviews with Rheumatology. I asked for it to be a telephone appointment to save me the travel and parking experience.

[Pulfs]

my GP called me in for a review of RA and all my meds. Seems they have to do this periodically. Everything was fine and also have 6 monthly reviews with RA nurse at hospital x

[JulieAndrea]

I generally have an annual review with GP and this year it was actually in person. I was actually quite grateful this time as I have not had any appointment with a rheumatology doctor since a phone consult in summer 2020 despite being on biologics. ( I do have regular nurse appointments).

The doctor took the time to look at my hands and seemed reasonably knowledgeable. I usually feel the GP review is a waste of time but this time I felt quite appreciative.

[gillpalmer]

I have been having review with Dr for my r.a. since the start have bloods taken every other month. If a problem they contact me also hospital will. I go to hospital for check up about every 8 months.

[Ruffles13]

I have just had a text to say go to doctors gir a RA review. Like you I have been under the hospital for 8 years. What’s going on. If I wanted a doctors appointment can never get one . Xx

[MerielPB]

I have one every year but my mtx is prescribed by my GP. To be honest, it is a pointless appointment, like you when I have a problem I contact the hospital. It's just a tick-box exercise.

[Bailybiscuit]

I have an RA review every year for the last few years. I have 2 annoying pharmacist reviews a year , suggesting I take other drugs that they prescribe. I asked to speak to my GP about a stomach protector one and she asked why I was taking it seeing as she said that I didn't need it. I explained about the pharmacist and she told me I could stop it. I do have excellent service where the practice is concerned. All through covid I had same day phone appointments ,on a couple of occasions I requested a phone appointment on the on-line form and twice my GP called me within minutes. I have had same day appointments too.

[Afcbsupporter]

Snap - i had text today saying my RA review was due at my Doctors, & could i arrange a blood test first.....last year was the first one & when i went in the Dr asked how he could help, so i said 'no idea you have asked me to see you'!. He then started reading on screen what he needed to do, but after checking the first few joints he said im not going through all them! Like you, if i have a query i refer to my rheumatologist at the hospital. I also have 4 weekly blood tests at the hospital, surely the NHS arent going to waste funds doing the same test at the Drs surgery? I would be interested , like you, to know why work is being duplicated?, whats the reason?, & what happens if they would like to do something a different way? & finally doesnt the rheumatologist send the GP a letter after each appointment to update the notes at the surgery...

[GordonEdin]

A lot of negative comments here!

I'm assuming that we are talking about the UK here. System varies somewhat between Scotland and England but GPs are certainly encouraged to offer annual reviews for various chronic conditions. Diabetes, Kidney Disease, RA etc.

Practice here (Scotland) is that the hospital Rheumatology Dept specifies the treatment but the GP prescribes the actual drugs, gets the bloodtests done by their phlebotomist and monitors blood results - and the GP contacts Rheumatology if they are uncertain about what to do.

The annual review tends to be with a Practice Nurse - maybe a Nurse Practitioner. Nurse practitioners can vary some medications. If you have more than one condition, the review may cover all of them - which might be an opportunity to discuss interactions.

Some nurses are better than others but you tend to get much more time with the nurse than the GP and, having attended some with my wife who has other conditions, they can be a good opportunity to ask questions, maybe get records corrected, show what is happening with your joints etc and maybe be referred on to other services that you could need (physiotherapy? occupational therapy?). If you are getting worse, then hopefully raising problems here may help get you some priority with the GP or have your problems expedited with Rheumatology.

So, if all is going reasonably well, the review is maybe just a formality but at the least it should keep your records up to date and may help get some problems sorted.

[Jackie1947]

I too had an annual review from an Advanced Nurse at my GP surgery for RA. I opted for a telephone call. I found it useful and good to know my surgery were doing that. They checked that my outreach medication hadn't changed,was I okay and how I was managing daily. Did I need any aids to help day to day living. I actually found it beneficial.