GPS not allowing more regular injections or stopping them altogether, Why?

[LittleA]

I have had problems with my gp with my B12 injections and not taking into my account my symptoms or evidence I have given.

Is there a reason why gps are reluctant to not allow more frequent injections ? and stopping them altogether ?

[Sleepybunny]

Hi,

"Is there a reason why gps are reluctant to not allow more frequent injections ? and stopping them altogether ? "

I think there are lots of possible reasons....

1) Financial

Nurses' time to give injections is expensive so there is a financial incentive not to give more frequent injections. B12 ampoules are cheap, probably less than a £1.

2) Lack of knowledge

Sadly in UK, many GPs seem unaware of the national guidelines/advice on B12 treatment.

BSH Cobalamin and Folate Guidelines

b-s-h.org.uk/guidelines/gui...

BNF

bnf.nice.org.uk/drug/hydrox...

NICE CKS

cks.nice.org.uk/anaemia-b12...

3 ) Local Guidelines that restrict the treatment GPs can offer.

Gloucestershire in UK has a treatment pathway that advocates oral tablets in most situations. I find this shocking as this goes against what is in BSH, BNF and NICE CKS.

b12deficiency.info/blog/202...

Be warned if you're in UK, I think this is likely to happen in many areas.

4) Impact of pandemic

I think pandemic is being used to get as many as possible onto oral tablets and to reduce frequency of injections so fewer visits to GP surgery and less risk of Covid being passed on.

[fbirder]

It's a combination of several reasons.

The British National Formulary says that we only need jabs every two to three months. Most of the time the BNF is the prescriber's bible. What it says is gospel truth and must not be challenged.

All doctors get fed up with patients seeing them after they have consulted with 'Dr Google'. They come in with ridiculous things they're read on the Interwebs, saying that "ground wombat poo mixed with blackstrap molasses will cure my warts, and can I get it on the NHS?". Which is why I always try to advise using proper papers from medical journals. My GP started listening to me when I handed him a paper from the BMJ.

Doctors don't know much about B12 deficiency. They study Pernicious Anaemia for a few hours on a Wednesday afternoon, alongside all the other vitamin deficiencies that have much cooler names, like scurvy, pellagra, and beri-beri. That's why I gave my GP a copy of Martyn Hooper's book. Which he read and then passed around the rest of the practice (although that might have been because they get 'continual professional development' points for reading it).

Finally, there is the cost element. The B12 itself isn't that expensive. It's the cost of the nurse's time that makes a difference. Sending the patient away with a prescription for cyanocobalamin tablets (50 mcg) isn't a lot cheaper as 100 tablets (three month's worth) costs more than one injection. But if you can persuade the patient to buy their own tablets then it's a lot cheaper.

Of course, all these problems, for doctor and patient, would be solved if hydroxocobalamin were made available OTC. b12deficiency.info/blog/202...

[Cherylclaire Forum Support in reply to fbirder]

Of course, there would be some saving made through not needing nurses to do a routine 3-minute injection once every 8 weeks or more.

But this must then be offset against what would be the cost if deterioration occurred long-term, such that the B12 deficient patient became unemployed, or unable to walk, or registered disabled.

Or misdiagnosed with something else ( rather than admit the likelihood of a return of original symptoms) - causing another long round of consultants, tests, etc !

I remember learning about scurvy, beri-beri, malaria, tsetse flies and rickets at school.

I also remember doing sums.