Injection Methotrexate

[welsh12]

Saw the Rheumatology nurse who is doing a shared care agreement so I receive methotrexate from gp currently it's oral dose. If I need injections will the GP arrange this or do I need to return to hospital arrangements. While I am happy to move to GP prescribed and blood tests I hope this is going to be smooth as getting a blood test normally at GP is difficult for anything else. My stomach plays up sometimes with methotrexate that's why I may need injection but Rheumatology were quick to skim over this and said GP needs to investigate.

[AgedCrone]

You. Will need to ask your GP practice nurse …she will know how your particular practice deals with shared care agreements.

If the practice is listed under Swiftqueue you could get your blood tests done at the place they use.I find you can get appointment there much faster than at my GP.

[welsh12 in reply to AgedCrone]

Thanks

[Boxerlady]

I think that it depends on your health authority's policy. Mine won't allow GPs to prescribe Methotrexate injections so the shared care arrangement for that was stopped when I moved over from tablets and I get mine from the hospital pharmacy through Rheumatology - they post them to me. They also prescribe my Sulphasalzine but the GP prescribes my Hydroxychloroquin 🤷Rheumatology also orders the blood tests but I book those through SwiftQueue whoever orders them.

[welsh12 in reply to Boxerlady]

Thanks useful

[cyberbarn]

You should have been given a copy of the shared care agreement when it was set up. The ICB or the hospital trust may also have it on their website. Every area is different.

[rmros in reply to cyberbarn]

Should. Hands up everyone who was given a copy of their shared care agreement!

[cyberbarn in reply to rmros]

True. I got my copy out of my electronic GP record initially, as it hadn't been sent to me. So when I went in to have the weekly blood tests and the surgery nurse asked what they were for and why, implying that I shouldn't be having them, I referred her to the shared care agreement which I had printed out and was in front of me. She asked where I got it. I pointed out that if she just looked in my records she would see it there, as that was where I got it.

Oh, she said, and then quietly read the agreement and drew the blood!

[rmros in reply to cyberbarn]

I won't go into another rant about both my hospital and GP and their poor patient communication but the transition to shared care was far from smooth. It was like I was left to guess how to get my blood tests were to get done, only the correct answer changed from month to month if not daily. Switched GP practices last year and it's like night and day. Everything so organised and well communicated.

[welsh12 in reply to rmros]

This is my concern

[welsh12 in reply to cyberbarn]

Yes at the mo if I see the GP about anything they are rushed not read notes and I go through all relevant history to what what I am asking about dangerous position often with GPS now and she is one of the better ones.

[rmros]

I'm fairly sure the rheumatologist would have to make a change like that, as it's only being prescribed by the GP under their instruction. It's not a treatment a GP can initiate, so I expect that extends to making changes like how it's administered. It's not a like-for-like switch, the bioavailability of the drug depends on the method of administration so the dose is effectively altered when you switch, too.

I'd like to know for certain though as I'd like to switch to injections.

[Happy5]

In my case due to unpleasant side effects it was my RA consultant that swapped e from tablets to injections. Once you're sorted the GP takes over your general health needs. I always call the RA advice line if I'm in a flare or need RA advice, which is what my surgery told me.

[bienassis]

I suppose the arrangement for injections must vary from Trust to Trust. While I was on the tablet form of methotrexate the GP prescribed them on the hospital’s order. Now that (since 2015) I have been having injections the hospital prescribes the metojects which are collected at the hospital pharmacy, and are either self-injected or, as in my case, injected by my husband.

Our GP doesn’t take care of any injected medicine. I don’t know why. My 6 monthly Denosumab injection is also handled by the rheumatology department.

[welsh12 in reply to bienassis]

I don't think my GP would oversee injections either

[bienassis in reply to welsh12]

I have no idea whether the program you mention is in operation here, and our GP has very particular ideas about what he will do as far as cooperating with hospital departments are concerned.

He will arrange for my blood tests for methotrexate and denosumab via the District Nurse. So that’s fine. But I also have an occasional blood test for a haematological condition and the GP refuses to do it, claiming that he is “not funded” for it. The haematologist has always been astounded at this refusal and has argued with the GP that he has never come across a GP who has refused to carry out the test. Why other GPs are, presumably, “funded”, and mine isn’t, has never been explained to me!

The haematologist has now lost the struggle! My next blood test will take place in the hospital. My problem with that is because I need hospital transport to get there and back, a simple blood test taking a few minutes means half the day spent at the hospital - mainly waiting to be picked up by Patient Transport.

Such is life!

Bienassis x

[welsh12 in reply to bienassis]

Yes feel your pain had blood tests and meds at hospital for 2 years it's a good half day the meds take 2 hours at least to get. My GP initially didn't agree to prescription of methotrexate and they said I was on too high level of hydroxychloroquine but that has reduced so we will see.

[Pulfs]

my GP is on a shared agreement with rheumatology and as I’m on the DAWN program my blood forms are sent regularly to me and nurse at surgery takes my bloods. Also both gp and rheumatologist see the results. GP prescribes my methotrexate injections monthly that I collect from local pharmacy.

[Cuffs]

I was recently changed to methotrexate injections as I was feeling really nauseous on the tablets. The rheumatologist prescribed them as I had an appointment, though she did say the rheumatology nurse could change the tablets to injections. The first lot I picked up from the hospital chemist and now I get them as a repeat from my GP together with folic acid and hydroxychloroquine. As for bloods, my GP said if they're needed for Methotrexate monitoring they will always fit you in as you need the blood test. Like Pulfs I'm on the DAWN monitoring so get sent the forms and take along to the appointment.

[welsh12 in reply to Cuffs]

Thanks