Local healthwatch not acting appropriately on behalf of patients?

[AnneEvo]

I won't bog you down with past history.

I recently saw a nurse practitioner who prescribed 50mcg levo and told me to come back in 6 months for blood tests! I did not question her as, though I knew from here I should have blood tests in 6 weeks, I wanted to check what the NICE guidelines were. I intended to write to the practise manager but while looking for an email address I came across the local healthwatch body so wrote to them. This is their response:

"Hi Anne

Thanks for getting in touch. Can I just check whether you have already asked the nurse practitioner or GP for more regular blood tests? If not, I would suggest doing this first as it might be fairly easy to arrange."

I have written back explaining that I did not think staff at the surgery would take kindly to being told by a patient that they'd got it wrong and more to the point it would not help other patients who are unaware of NICE guidelines if I managed to get more regular blood tests. I suggested they send an email saying it has been raised as an area of concern by a patient and point out the guidelines not just to my surgery but to all surgeries in their area.

[Kes8]

If I was playing devils advocate and was speaking for the GP practice I would say that you weren't actually refused an appointment in six weeks.

Potentially the nurse meant weeks not months?

Perhaps ask without telling them they are wrong?

[AnneEvo in reply to Kes8]

Thanks. So are you suggesting I ask for blood tests in 6 weeks even if she did actually mean months? Another point I did not mention as I didn't want it to be too longwinded was that I tried levo about a year ago (as I don't actually feel ill I wasn't convinced at the time I needed medication) and the doctor who prescribed it didn't even ask me to come back at any time to have my bloods checked.

[Kes8 in reply to AnneEvo]

Yes, I would definitely ask - if you receive a negative response act surprised and ask as politely as possible why you don't require one when advise, NICE guidelines and even Levothyroxine's PIL suggests otherwise.

I think some doctors are good some are not - to survive for want of a better phrase the NHS, and having learnt the hard way myself I think is to have as much knowledge as possible and be able to ask for the things you need. Some will go the extra mile for you or even I might suggest care others really don't.

[SilverAvocado in reply to AnneEvo]

I'd think about approaching them completely with the assumption that she did misspeak, and that you then missheard, and play innocent if you get questioned.

Then if you don't get the appointment you can return to Healthwatch and say you've asked, too.

[SilverAvocado in reply to SilverAvocado]

Doctors take a lot of managing, and I very much agree with your frustration that less well read patients get worse treatment, unfortunately the treatment is already in such a terrible state there's not much we as patients can do.

Not in that avenue, anyway, it might be more productive to campaign for change overall, rather than do it through your own treatment.

[MaisieGray]

Firstly, remember that guidelines are just that, they aren't rules. As NICE puts it "NICE guidance: Evidence-based recommendations". I have never used Healthwatch, but a quick look at their website doesn't 'seem' to indicate that they would be involved in the general issue of round robin reminders to GP practises, in the expectation that some staff may not be working to this or that protocol. I doubt they have the remit. But that not withstanding, if we have a complaint, or have identified a shortfall in service, the recommended way of dealing with it is directly with the person or organisation concerned. I say that as a former Convenor and Chair of Panels to hear complaints against GP practices when I was on the Board of a Health Trust; and also as a qualified mediator. As convenor though, I would return all complaints to the practice or patient, where the practice's own complaints procedure hadn't been properly applied or fully exhausted. Otherwise how might they have the opportunity to check out what's going on, and if necessary, put things right? It doesn't have to be confrontational - a request for the protocol to be clarified for your information, and a discussion about how the practitioner has fallen short, if indeed they have; or a discussion about how the protocol is mismatched with NICE guidance to see if it might be more closely aligned.

[AnneEvo in reply to MaisieGray]

Thanks for that. As I said I was looking for an email address for the surgery but when I came across Healthwatch for our area I thought they would be the best people to contact in view of the fact that me getting more regular blood tests wouldn't help others.

[AnneEvo in reply to MaisieGray]

I did get back to the person at Healthwatch who'd emailed me saying that after asking others' advice I realise I may have got their role wrong and if that was the case I apologised. However she said, "I can pass your feedback on to the Clinical Commissioning Group as they have a Primary Care Team who could probably help with your query." I said I was unsure what route to follow - whether to just try to get an appointment in 6 weeks (but as I'd said my thoughts were that many surgeries wouldn't be asking people to come back for testing every 6 weeks until on the correct dose so thought it best if someone could ensure that the recommendations were followed), or let the PCT deal with it. I agreed to her passing on my feedback and then wait and see.

[AnneEvo in reply to AnneEvo]

Thought I'd post an update. I received this email today from Healthwatch:

"Hi Anne, I’ve had a response from the Clinical Commissioning Group (CCG) which says that they can’t comment on individual patient issues as they have no access to medical records and that you should have a conversation about the frequency of blood testing with your doctor or practice nurse. I’ve explained that you wanted to make sure that other people didn’t experience the same issue and that you want to feel reassured that GPs follow NICE guidance; the CCG said that they appreciate that people want to help others who may not be aware of guidelines, but ‘when it comes to healthcare, one size can’t fit all’.

The CCG went on to say that ‘If someone is complaining that a service we commission isn’t working, or they’re complaining that we don’t commission it, we can be more help’."

Hmm - ok, one size doesn't fit all. But when it comes to hypothyroidism it seems there's no size that fits anybody.