Basis of denial of T3

[Mikegov]

Hi All,

Does anyone know if a GP can deny a patient T3 purely on the basis of cost and not efficacy?

Have been to see an endo privately today who is prepared to write private prescriptions for T3 on a quarterly basis as long as he monitors my bloods and I see him every quarter (£175 a visit). Obviously this is an expensive way to buy T3 (I would get the prescription fulfilled by a German supplier).

I mentioned in a previous thread that I'm trying to obtain T3 via the NHS but realise that is going to be very difficult. The endo is going to write to my GP about our discussion and his offer of private prescriptions so I'm wondering if I can ask my GP why he would deny it to me on the NHS if the endo thinks it is working for me? Obviously it will be due to cost but doesnt the GP have to make decisions based partly on efficacy?

Thanks

Mike

[DippyDame]

Wondering the same thing!

[Hennerton]

I was under the impression that if you have been referred to an NHS Endo and he feels you need T3, your GP should prescribe it on the NHS. I am sure that was written in one of the many statements, after the decision was made to stop prescribing in primary care. Someone will come along with more information, I hope.

[SlowDragon Administrator]

The new guidelines just published by NHS on liothyronine will only prescribe if an NHS endo says you have clinical need

They have to put reason why in writing to your GP

Will add link later

[Mikegov in reply to SlowDragon]

So the endo does see patients on an NHS basis although I saw him privately. Would that mean even though he recognises I have a clinical need, that I couldn't get it on the NHS as I saw him privately. Would I have got a different response from him if I had seen him on the NHS?

Mike

[SlowDragon Administrator in reply to Mikegov]

That’s the million dollar question

Is this endo bullied by CCG NOT to diagnose clinical need if you see him on NHS

Ask for NHS referral to him

[SlowDragon Administrator in reply to SlowDragon]

As you saw him privately you can not get T3 on NHS ...or extremely unlikely to

[MaisieGray]

A private Dr deciding or prescribing anything does not obligate an NHS GP in anyway. It's one Dr's professional opinion versus that of another, and there's certainly no hierarchy where private trumps NHS. The NHS GP has responsibility for his practise's prescribing budget devolved to it by the CCG, a private Dr can't obligate him to act in a way that would impact on that. The NICE Clinical Knowledge Summary guidance for treatment of hypothyroidism is very clear: "For people who do not need admission or referral, treat overt primary hypothyroidism with levothyroxine (LT4) — do not prescribe combination therapy (LT4 and LT3) in primary care." If A GP also has, shall we say, "guidance" from the CCG that local prescribing should take account of any blacklisting or redlighted decisions about liothyronine, reached by the CCG; and the GP's training & professional advice leads him to accept that levothyroxine is the gold standard, why would he deviate from all that? He doesn't need to concern himself with cost in that case. Obviously there are GPs who aren't closed to the possibility that combo-therapy or mono-t3 therapy can help some patients and in the past it has been relatively straightforward for them to prescribe accordingly, albeit relative cost has always been an issue even before the 6000% increase in T3 price; but now of course, new prescribing, or continuing prescribing of T3 is a secondary care decision only.

[MaisieGray in reply to MaisieGray]

I forgot to say that you don't need a private Dr for a private prescription - your NHS GP can write you a private prescription with no cost, (other than to have the prescription dispensed of course) if he is so minded.

[Mikegov in reply to MaisieGray]

Thanks Maisie

[MaisieGray in reply to Mikegov]

Mikegov I've now reminded myself of the latest RMOC statement 'Guidance - Prescribing of Liothyronine' (11/2018) regarding your questions around private clinicians/prescribing:

"In accordance with NHS guidance on ‘Defining the Boundaries between NHS and Private Healthcare’, patients who are currently obtaining supplies via private prescription or self-funding should not be offered NHS prescribing unless the guidelines in this document are met. Patients who have been seen privately retain the option of being referred back to the private service for private prescription. "

[Hillwoman in reply to MaisieGray]

MaisieGray please could you tell me which document contains your quote? Thanks.

[MaisieGray in reply to Hillwoman]

Hillwoman Yes, it's the recent (Nov 2018) RMOC document which slightly fleshes out the original NHS England paper on T3 prescribing, entitled "Guidance - Prescribing of Liothyronine"

sps.nhs.uk/wp-content/uploa...

[Hillwoman in reply to MaisieGray]

Thanks very much.

[shaws Administrator]

If in the UK, most GPs have told patients - even ones they've prescribed to before that they will no longer prescribe T3. Obviously due to cost and I believe GPs must have been told not to precribe or to withdraw T3.

[SlowDragon Administrator]

Very interesting that they quantify adequate replacement on Levothyroxine as having TSH between 0.4-1.5

If only most GP's would allow high enough dose of Levothyroxine for patients to get TSH within this range!

See page 8

sps.nhs.uk/wp-content/uploa...