Has anyone else been told by their gp that they will not give a prescription for hydroxychloroquin in spite of 2 letters from my consultant informing them that it is an essential part of my treatment. At the moment rheumatology are supplying the scripts until I find a different gp.
Gp refuses hydroxychloroquin : Has anyone else been... - NRAS
Gp refuses hydroxychloroquin
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Jumbo2012
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36 Replies
•
What is their reason?
When I was first prescribed hydroxychloroquine the rheumatologist didn't give me enough to last until my next appointment so I asked the GP. Initially the GP refused to prescribe without a shared care agreement.
The rheumatologist (my first rheumatologist, who was AWFUL) then started arguing the toss over whose responsibility it was and whether a shared care agreement was necessary. So I was batted back and forth between the GP and the consultant's secretary - in the same time the rheumatologist could have just written me a prescription.
Eventually a more senior GP agreed to prescribe the hydroxychloroquine and now I get it from the GP regularly.
There is a general feeling among GPs that they have too much work dumped on them by secondary care and in theory I think they can refuse to take over prescribing. But it's quite normal to do this and hydroxychloroquine is not high risk and requires no particular monitoring so I'd be interested to know why your GP does not want to do this. Perhaps they just need some additional education on this drug to feel competent prescribing it.
Why would the consultant not implement a shared care agreement with the GP. Without such an agreement the GP is taking sole responsibility for prescribing a drug that they may not have much experience of in the treatment of RA. I consider the GP was being responsible and the rheumatologist was being unreasonable.
Apparently they can choose not to regardless of the bad effect on the patients health because of not having that medication
write and complain to the pracrice manager. If this has been ordered by the hospital they should comply.
Ordering and complying is not how it works! GPs are not consultants' subordinates. GPs take over prescribing by agreement, not under orders. Whoever prescribes the drug is responsible for it so it's the GP's decision. The BMA is clear on this, GPs have every right to refuse - it's in their contracts.
if they are not going to comply then they should refuse the shared care agreement. Patients should not be stuck in the middle!!
Of course they shouldn't, I've been there myself - see my first reply to the OP. But the fact is there is no complaint to be made here - the GP is within their rights to refuse, though it's a shame they feel the need to. Usually it's because a more inexperienced GP will feel that it is beyond their level of competency, but that can be addressed. In the meantime, it's the responsibility of the doctor who initiated the treatment to continue it, which they are doing.
I`ve found with having an autoimmune condition that stress is the number 1 cause of flare ups especially for myself and I`m sure it will be the same for many others. Why on earth should patients have to deal with this pathetic red tape, political type scenario - it`s not my job, it`s your job, I`m going to throw my dummy out of the pram. All of this stress makes the patient`s condition WORSE and is not fair on those patients. Considering we`ve paid contributions into the NHS since 18 year old, we pay the Doctors wages so if they don`t want to do their jobs, then they should leave. GP`s today have it easy compared to GP`s from many decades ago who done the day clinics then had to do on call on nights and weekends because there was no one else to cover. They worked hard. Sitting in a nice office, working office hours and earning a six figure salary is very nice for them. I don`t feel for them one bit. Doctors from yesteryear, Doctors who work in A and E, Doctors who work in war zones and for aid charities etc have it hard and have to work really hard.
Even thought the UK and worldwide population is alot bigger so technically you could say that GP`s have alot more patients to treat, well they can`t use that excuse because it`s very difficult to get a face to face appointment with a GP and if they do deign to see you - make sure you put some money into the shrine that is dedicated to the worshipping of the godly holiness, their majesties etc etc of the magnificent General Practitioner. Don`t forget to nominate them for the Dr Harold Shipman mortality award , they need those figures up.
At least if I haven`t offended anyone then I hope I`ve given you a laugh!
The GP is doing their job by making sure they are only prescribing within the realm of their competency. I understand it's really stressful being caught in the middle, see my experience above, but the GP is not at fault here.
Anyway, you clearly don't have a very high opinion of GPs so I doubt I'm going to convince you. Good luck.
My comments apply only to this particular gp practice. Prior to moving to this area six months ago I have nothing but praise for all the other GPS I've had caring for me in the last 76 years.
I was married to a GP for 15 years in the 1980s and 90s, and you are so on the ball about the hours worked in those days. I would add and the impact on the family, as all of the out of hours calls came to the wife of the on call Dr (and it was wives, and it was unpaid).
So from 6 pm until 8 am the calls came into the household of the GP on call, and averaged one call per hour, including overnight, the exhaustion was unbearable. For the GP too, who had to day a full days work afterwards. The wives couldn't leave the house, there were no mobile phones in those days, and still had children to look after, meals to cook, run the house.... and some of us had our own jobs too.
Today's GPs do have a lot put on them, but many work 4 long days, then have 3 off and no on call. Their evenings and weekends are their own. There is no disruption to family life and their pay has increased enormously.
As you say GPs salaries were increased enormously & by giving up I think it was the princely sum of £3000 of that increment they were relieved of on call duties…but as I remember there was no control over who they used for on call visits..…which resulted in the totally unsuitable doctors who now often turn up in an emergency.
I remember at the time of the GP contract being discussed, many GPs, including my husband were more than happy to do some on call duties. But, with no calls coming into the wives and for the GP to perhaps cover several local practices and have the day off after being on call to sleep. But, alas we have NHS111 to call, and any random Dr to cover. Some flown in from Europe at enormous expense for the weekend.
Additionally, in those days GPs had to live within a mile of their surgery (talking rural areas here) so that they could reach all patients when they were one call. They also covered the cottage hospitals including maternity. I gave birth in a cottage hospital on a Sunday afternoon in 1996 and my GP came out to help progress things. Despite missing his afternoon with his family, he was happy to be there.
I used to enjoy listening to the stories of the 'old times' of 30 years ago from the newly retired GPs.
Yes, the new contracts are difficult for them, but newer GPs in some ways are more 'employees' than vocational. The recent GPs might have a better 'work life balance' but with that comes the demands of contracts that are not always the best for patients.
We had to live within 3 miles of the village PO. The new contracts are about businesses, hence they need a practice manager.
The wives did this work in my time, all unpaid (not that I particularly wanted paid. I'm just stating it here as the NHS got a good deal). You could not get a GP post unless you had someone to take the out of hours calls and undertake a share of management of the practice. Essentially the GP had to married, it was very difficult otherwise, unless the GP lived with his / her parents for example, and they were willing to take on the role.
Ah yes…111..,who take Christmas & presumably every National Holiday off ..leaving just a few to answer the hundresds of phone calls,as I found when I caughtCovid over .Christmas l
Just look at the present situation…Doctors jwant to get on with their job looking after people & the majority have no contact with their union representatives. The BMA tell them what the BMA want for them, & busy doctors think they must be right.
Sadly the result is the upcoming junior doctors strike. Apart from a few thinking a 35% pay increase is really on the cards,I’m sure most would like a balanced discussion & a quick resolution.I’m sure no doctors worth their salt are enjoying the present chaos.
I know the Admin staff are not always as efficient as they could be, but atm if they don’t know when a certain doctor will be working, how can they organise appointments?
We have to remember..…Drs up to the rank of Registrar are regarded as junior doctors, when tomorrow they could be a Consultant.
I know that doesn’t help those waiting months for appointments, but until the situation is settled…..nothing can really be organised.
• in reply toCelticdancer
Woke world not the eal one 😜
The person…..in this case the GP …who signs a prescription is responsible for dealing with any side effects that may occur.
So that person must have confidence that he or she has full knowledge of a drug, because if a patient did have a bad reaction to it, that person is 100% responsible for dealing with it,& should the patient be caused irreparable damage by a drug that the GP did not know how to deal with could have a disastrous results.
Of course there are some GPs who just do not want the responsibility, but in the past I have found if the Consultant & GP actually speak to each other & don’t just rely on messages between other staff it can usually be sorted out.
But better safe than sorry.
The para below is from the NHS website & is probably the explanation why your GP will not go ahead signing off on a prescription without a Shared Care agreement.
I think if he he feels he doesn’t have enough experience of Hydroxy he is right to want to set up the agreement with your rheumatologist. Have you spoken to your rheumatologist’s secretary explaining the situation…maybe wires have got crossed somewhere & this agreement hasn’t been mentioned?
From NHS Website🔽🔽🔽
“It is vital for safe and appropriate patient care that there is a clear understanding of where clinical and prescribing responsibility rests between Consultants and General Practitioners (GPs).
This guideline reinforces the basic premise that:
When clinical and / or prescribing responsibility for a patient is transferred from hospital to GP, the GP should have full confidence to prescribe the necessary medicines. Therefore, it is essential that a transfer of care involving medicines that a GP would not normally be familiar with, should not take place without the “sharing of information with the individual GP and their mutual agreement to the transfer of care.”
These are not rigid guidelines. On occasions, Consultants and GPs may agree to work outside of this guidance. As always, the doctor who prescribes the medication has the clinical responsibility for the drug and the consequences of its use.”
to me it is equally irresponsible of a GP not to provide a drug proposed by a consultant and then not do anything about it! Hydroxy for heaven’s sake - it”s not methadone,,,
The truth is, sadly some people…me for example…. can have terrible, dangerous side effects from a drug that 99.9% of the population can take quite safely. If a GP feels he does not have enough experience of any drug, I would rather he said so…..than have someone end up in a coma like I did….thankfully I was in hospital at the time…so the situation was dealt with & I was unharmed, but had I been at home without support, who knows what the outcome could have been?
The consultant initiated the treatment. It is ultimately their responsibility. The GP can agree to take over prescribing, but there's no obligation. As I've said, GPs are not there to follow orders from hospital doctors. It is not irresponsible for a GP to refuse to do something they're not comfortable doing. Quite the opposite.
I agree completely. GPS need to have a shared care agreement in place, and be happy they have the knowledge to take ownership of prescribing responsibility . You are correct the GP is not in the wrong, and the rheumatologist should continue prescribing in the meantime. Gps have it so much harder than gp years ago. Patients used to stay in hospital to recuperate years ago. When I started nursing hip replacements were in hospital for 3 weeks, now it is 2-3 days. The extra work that comes with all these prompt discharges falls on the gp and community nursing teams. Two of my daughters friends are gps both late 20s, they certainly don’t work 9-5 as Celticdancer suggests, often putting in 60hr a a week, yet still feeling they haven’t done enough. They also don’t earn 6 figure salaries, although I bet they wish they did. The media is partly to blame for the hatred fuelled by some towards gps, and is completely unwarranted.
It may be worth the OP checking if a shared care agreement has been set up, my rheumatologist sent me a copy of what they were asking of the GP, so I knew who was responsible for what.
As a an ex GPs wife, I don't accept that GPs today have it harder than GPs of years ago.Yes, GPs get a lot put upon them today, but they work less hours, have no on call and no disruption to family life of calls coming into the house, and the dependency of the GPs wife to take the on call phones for an average of 22 hrs per week, un paid, whilst they have their own jobs, families and a house to run.
Today's GPs are also paid considerably more than GPs were before the GP contract was implemented.
(See my response to Aged Crone above)
but my point is that refusing to prescribe without making any effort for the well being of their patients is just wrong. Did they contact the hospitals to tell them? Did they even attempt to do anything? Or just say no. That is not what I expect of a highly trained professional. And I have never experienced that with UK GPs. If there us an issue they have always helped to sort it.
You live in France HH…the service some GPs now get away with in the UK these days is completely unacceptable.I have a friend living in France whose GP visits every week to give her a vital injection. I honestly don’t think that would happen in this country….she would have to go to the doctor/hospital.
Another example being when I checked to see if the request from my consultant rheumatologist, to my GP that my name should be on the list forwarded to the CMDU, I got the reply….”Covid is nothing to do with us -call 119”.
Even copying the NHS Directive to Primary Care Providers was resisted until my rheumy spoke to the GP …,a complete waste of everybody’s time, but sadly that happens now. Not everywhere…but too often,& until a solution is found it will continue.
jumbo, why not give Hydroxy……, I was put on it as I have a high -CCP but not RA yet. As a precaution when I refused MTX. I did this through a private consultant.
Recently my GP mentioned that I should have blood tests at some point due to Hydrox…. But wasn’t overly worried.
So I am puzzled by your experience. Remember it was D.Trump who took Hydrox…. to prevent him getting Covid.
Terry
I should have added that my GP prescribes a monthly supply.
Morning 👋
That’s a shame - my GP is very good, they have prescribed everything so far recommended by my Consultant.
At least you can still get it from the Hospital, although obviously not as convenient as your GP.
I was on Hydroxy for a while with my Mthx, sadly it gave me awful stomach problems and I ended up in A&E, but we are all different. But while taking it at first, before the tummy problems started, it was probably the best I’d ever felt, I didn’t even have the dreaded fatigue.
I hope it works for you and maybe changing GP will help.
👍
Hi I would have thought your Rheumatologist would prescribe the Hydroxychloriquine as their specialty. You actually do need to monitor your eyesight regularly as Hydroxychloriquine can be Toxic to the Retina. My Rheumatologist sends my prescriptions to Gp and I have no problem with getting anything. I am actually happy to have a specialist prescribing as a l drugs have side effects. I am on triple therapy so have bloods often.
yes Lex54……..also ototoxic….I was in the 3rd week on it when I developed continuous tinnitus. I stopped it immediately but no reversal of the tinnitus.
No more wonder of silence sitting beside a Scottish loch and it has ruined the way I hear music - especially live classical playing. So this has seriously effected my quality of being in the world ( as well as the RA of course and since 1998 chronic fatigue)
Neither consultant not GP accept this consequence, even when it is known to be ototoxic. I cited the number of covid patients treated with it and left with tinnitus- they didn’t accept this either.
And yes, in the bigger picture, things can always be much worse, so I thank God/the universe for every day.
My GP practice prescribe my leflunomide every month. I used to get a 2 / 3 month supply, but due to my ongoing hypertension and low WCC they will only prescribe a month at a time now (fair enough) and ring rheumatology frequently for advice.
In my experience I ordered Methotrexate & Leflunamide (DMARDS) prescriptions for many years thru the GP (once prescribed initially by the Rheumy) & there was never an issue (never had HydroxyC though). But once prescribed more 'risky' or specialised Biologics & Jak-inhibitors, these go nowhere near the GP, being directly ordered by the Rheumy & delivered by separate companies (Alcura, Sciensus etc) to my home address.
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