Starting in ten minutes!
Britain’s biggest chain of GP surgeries accused of ‘profiteering’
BBC Panorama claims Operose Health uses physician associates, who are cheaper to employ than doctors, to assess patients
theguardian.com/society/202...
Some members simply must be attending these surgeries.
(Not intended to start a political thread. Just enable anyone interested to watch. Please bear that in mind if you reply.)
helvella, I watched the Panaroma programme too. I found it utterly shocking. There most certainly will be people on here who unfortunately are signed up with one of Operose surgeries. We hear from a lot of people who cannot get hold of a GP or get an appointment.Didn't they say 6000 surgeries were signed up? Another example of Post code lottery.
I encourage anyone affected to start campaigning to get the issue(s) resolved.
One of the earliest steps probably being to make sure you know the qualifications of the person you are seeing!
We are seeing what ends up a ludicrous impact on GP prescribing. We are told that T3 can only be prescribed by specialists. But if I understand the program's message, T4 would be prescribed by sub-GP qualified people.
I happen to believe that if someone understands thyroid issues sufficiently to be a safe and competent prescriber of T4, then they are likely also competent to prescribe T3 - at least with endocrinology support available, if needed.
But if Free T3 testing is stopped by labs (or even before - with no ability even to request an FT3 test), then the system makes it impossible for safe T3 prescribing, not GP lack of competence.
(Individuals might understand particular areas, such as thyroid, very well or very poorly.)
I could rant all day...
I will look at the programme. In the meantime I read somewhere that research is close to completion for the prescribing of a form of T3 tablets which provide a stable response ( over time) for people who need it. Just reading on the forum there is so much need for thyroid sufferers to change T3 dosages frequently because of the variable responses to the medication over time. There is hope that these tablets will be available in the near future but who can say when? Have you heard of this? I wish I could remember where I heard about this!
Poly-zinc-liothyronine! PZL
Liothyronine has been available for almost seventy years - approved in USA in 1956. Yet it sometimes feels half this forum exists because patients don't get the appropriate treatment - neither recognising the need for liothyronine nor getting it prescribed even when the need has been identified!
Forgive me if I suggest that the likelihood is that the UK will be behind at least the USA and the EU/EEA in PZL getting approved. Then the price will be prohibitive. Which might mean any UK approval being delayed still further - as appears the case for Tirosint gel caps and Tirosint Sol single dose liquid levothyroxine. Why apply when the price is so high no-one would get it prescribed?
Don't get me wrong! I still hope at every level. 
Below several links to more information and discussion:
EXTENDED ABSORPTION OF LIOTHYRONINE FROM POLY-ZINC-LIOTHYRONINE (PZL): RESULTS FROM A PHASE 1, STUDY IN HUMANS
healthunlocked.com/thyroidu...
A new T3 derivative shows promise in treatment with T3 and smaller FT3 spikes after taking it
healthunlocked.com/thyroidu...
Extended release T3
healthunlocked.com/thyroidu...
Very encouraging performance by a chemical analogue of T3 in stabilising FT3 by those who take T3
healthunlocked.com/thyroidu...
Thyroid . 2022 Feb;32(2):196-205.
doi: 10.1089/thy.2021.0304. Epub 2021 Dec 31.
Extended Absorption of Liothyronine from Poly-Zinc-Liothyronine: Results from a Phase 1, Double-Blind, Randomized, and Controlled Study in Humans
pubmed.ncbi.nlm.nih.gov/346...
Phase 1 Clinical Trial of Poly-Zinc-Liothyronine Demonstrates Slow-Release Serum T3 Kinetics
liebertpub.com/doi/full/10....
METAL COORDINATED POLY-ZINC-LIOTHYRONINE PROVIDES STABLE CIRCULATING T3 LEVELS IN HYPOTHYROID RATS
can somone tell me why labs don't do as GPs ask, re T3? Who owns the labs? Who is responsible for making such a decision and how can we complain?
Most labs are part of NHS hospitals - though some are private. (Some private labs do some NHS work.)
Doctors don't appreciate the importance of T3 testing so rarely request it.
Labs often don't do T3 testing even when requested. (Though quite a few do sometimes progress to it depending on the results of TSH and FT4 tests. Cascade or reflex.) This appears to be because they do not appreciate its importance and cannot see a justifiable cost-benefit.
Labs virtually never report back to the person who requested the T3 test.
As I see it:
Every test request should end up being reported back to the requester. Which could be the result or why it wasn't done. (Including sample spoiled or dropped on the floor!) It should be transactional. If a test is added (e.g. T3 because TSH and FT4 were strongly indicating an issue), that too should be specifically reported.
Labs should take full responsibility for tests they refuse. If they do not understand why a test is required for a certain patient, they should not just refuse it. They should contact the requester.
The system should allow test requests to include an explanation (even if just a tick box) to reduce inappropriate tests AND ensure those that are appropriate are actually done.
(I've referred to T3 as some labs/hospitals do TT3 rather than FT3 and my point applies whichever they offer.)
thanks. I don't understand why GPs dont chase up labs for information. Any business which requests any service from anyone would automatically find out what has happened to their request.
I think they don't have the time to do so.
That's why it needs to change.
With patient-focus, every test requested on your behalf should appear on your records. And every lab response (whether a result, a refusal, a "sorry, we can't do that test", "no budget left", or anything else) should also appear there.
The GP would then see these on your records. The system should also report back to the GP ("Today, you have had six tests refused by the lab." + full details). Hopefully the number of such issues would reduce over time due to mutual understanding.
If the lab refused and patient came to harm, the GP would be able to point out what they had requested - but would also have it pointed out against them that they didn't follow it up.
I'm expressing it in very simplistic terms. Obviously things like GP holidays, illnesses, changes of job, etc. need to be understood and factored in.
I doubt that many GPs know what FT3 or FT4 mean. One of the GPs phoned to tell me that T3 converted to T4.
Years ago, I was so incensed at the hospital path lab ignoring my GP's request for my FT3 test and him not being given an adequate explanation as to why, that we agreed that I would go in to the department and ask to see the consultant in charge of blood tests. I'd been paying to have them done privately for quite a while before this but now the NHS had taken over my treatment and my GP wanted to be informed.
The consultant saw me (!) and apologised profusely, citing them being constantly asked to do tests that weren't necessary so they just didn't do them unless the GP added an extra explanatory note. He then organised for me to have it done.
I see now, because I went to a satellite unit for blood tests earlier this year, where they print off your forms as you arrive and give them to you to pass to the phlebotomist, that there is a notes section on there for each test requested to explain the rationale behind it. Progress? Who knows?!
Do people actually 'see' a GP? I must tell my GP practice that this is happening. Only phone consultations are offered but only if someone unknown decides that you can.
The last GP appointments I’ve had were regarding shingles.
Initial diagnosis was remote - I sent photos by email. Doctor I had never seen but she was quite good.
A few days later, it looked like I might be getting a bacterial infection, and saw her in person. She added antibiotics.
Since then, I have simply used email to get prescriptions. (Not all things have appeared on repeats so could not be ordered that way.)
In some ways, remote can be easier. But we need to be able to express what we want, and think we need. Not just pushed whichever way “they” dictate.
I have found remote consultations very good and less disruptive to work so I’m quite a fan of them.
Definitely keep on ranting if we, hypo patients, are going to be treated as if we are idiots and no clinical symptoms being considered.
One of the GPs in my surgery phoned to tell me "your TSH is too low. Your T3 is too high. Your T4 is too low. My response "TSH is low because I take T3 only. T4 is low because I take none! GP "but T3 converts to T4".
NO doctor that's not correct!
The majority of hypo patients on this forum have found that few GPs are knowledgeable about dysfunctional thyroid glands. I have also read a Last Testament from a woman who could no longer continue living due to continuous symptoms not being relieved.
It's bad enough to be told by a GP that 'TSH is too low, Free T3 too high and T4 too low.'
Response to GP - "T3 is high as I take T3 only. T4 is low because I take none".
GP's response 'but T3 converts to T4.
No doctor, that's wrong!
I believe the basic blood test should be:-
TSH, T4, T3, Free T4, Free T3 and thyroid antbodies.
It's no wonder that we tire as the 'knowledgeable experts' seem not to be experts in any way at all.
Those experts have made decisions to stop NDTs - safety well proven and with no need for blood tests - as there would have been none when NDTs were first introduced in the 1892 and it saved lives from then on.
Then T3s were stopped for a short time.
Dr John Lowe stated that doctors/endos in USA were paid to prescribe certain medications. I assume mainly new introductions.
I think the medical professionals fail to understand patients' worries that doctors - Dr Gordon Skinner and Dr Peatfield - in particular who knew how best to treat those who had dysfunctional thyroid glands were hounded as if they were the enemy,
Doctor P resigned his licence so that he couldn't be struck off but was still able to give advice - I was one who consulted with him and also Dr Skinner. Two caring doctors and I would say they had a 'vocation' rather than job.
Both Dr Peatfield and Dr Skinner have died but Dr Skinner's staff have collated all of their scientific findings over the years and are hoping to publish if they can find sufficient monies.
We are well ahead of them with people like diogenes posting important reasearch here and educating us on how everything really works. The currently accepted mainstream model of the thyroid and how it works, and how to treat it is plain and simple wrong. If only they could get it!
helvella, I think we could all rant all day on this topic. Silo thinking rules everywhere.
Thanks Helvella for bringing it to our attention. I wonder if the ‘cheaper’ staff is an option a lot of gp surgeries are using now. I know my friend never seems to see a doctor. She feels lucky to get an appt but over the last few years sees a nurse or a paramedic instead. I suppose this is classed as progress but my friends care has been poor because of it.
I have been referred to a pharmacist when GP unavailable during the pandemic. They ordered tests and prescribed medicine. I have to say it was a positive experience, the pharmacist knew more about the medicine and its' possible interactions and the test and was able to tell me more from that standpoint than I would have received from the GP.
I think a pharmacist could well prescribe levo or Liothyronine with some background support, no problem.
We hear of pharmacists prescribing instead of GPs.
We hear of paramedics prescribing instead of GPs.
We hear of nurse practitioners prescribing instead of GPs.
Each of these is understandable.
Who then does the rest of the work pharmacists/paramedics/nurse practitioners are expected to do?
What happens when the treatment (whether a medicine or something else) reaches the limits of the non-GP to handle? There surely will be a tendency to prescribe the medicine they are allowed to, rather than escalate to a "real" GP to get the best (or right) medicine for the patient.
Yes, very valid observations! My conclusion is that GP training needs to be better as well as more holistic and there needs to be more GP's.
I think all of those things are unlikely to happen anytime soon. It's rather glum.
And many GPs are doing these ad hoc remote doctor jobs... the NHS is changing and not so far in the best interests of patients.
Today it has been announced that pharmacists will start referring for cancer.
Pharmacists to assess cancer symptoms and refer patients to specialists
NHS scheme aims to speed up diagnosis process and take workload off GPs
theguardian.com/society/202...
They say:
They will be able to refer people whose symptoms they believe may be signs of cancer to have diagnostic tests, such as a scan or endoscopy.
Of course, the flip side, they will be in the position of reassuring people that they do not have cancer (because they are not exhibiting the list the pharmacists will work to). Or simply suggest they go to a GP if they have any real doubt.
'Pharmacists to assess cancer symptoms and refer patients to specialists'
Based on the rubbish we've seen reported here about pharmacists knowledge, I find this more than a little worrying.
I think I'd have a lot more faith in the ability of dogs to detect cancer. As here for example the-scientist.com/news-opin...
I'm not a "dog person" but the dog faces in that article look as if they are saying "Please can we help you?"
There are reports of cats as well: dailypaws.com/pet-news-ente...
And WHAT does a GP do?? They are doing less and less since lockdowns.
I’m glad you had a positive experience. Good to hear. It does sort of beg the question of job security for gp’s then. Do we actually need them if they aren’t really doing the job now? Does this present a case for AI?
Oh god please no. It reminds me of that dystopian film - can't remember the name - starring Matt Damon and Jodie Foster where the super-wealthy live in a Ring World system up in space, with super advanced healthcare capable of curing almost any illness...and the down and outs live on earth and get basic healthcare administered by cold, unempathetic -AI.
The film was so obviously an exaggerated critique of the American healthcare system.
We're going that way already with the trend for healthcare apps, featuring programmable avatar 'doctors' or therapists. Merely a piece of programming code not capable of responding outside of defined parameters...
Lol yes. I remember!!
We are getting there though and when you say… ‘and the down and outs live on earth and get basic healthcare administered by cold, unempathetic -AI’ that is most doctors I’ve seen. Ever. The exception is Maxillo Facial. They are such lovely people. But the rest? 🤷♀️
Helvella, I watched it and thought how similar it is to my GP practice: No appointments in person, no phone appointments available for weeks, perhaps one or two emergency appointments - rarely available, triaged by unknown unqualified persons, advertising for new patients all the time, no doctors on Friday afternoon or at various other times, one full-time doctor ....... this is in Central London.
Interesting, but not surprising, sad too. Here in France everything is regulated to the last penny. Although it's better in some ways, i.e. same day GP appointments etc. etc.Dentists are mostly useless, trying to get eyes tested difficult, So as long as you can manage with no teeth and a guild dog, fine. NDT illegal most chiropractors don't exist and alternative medicine is frowned upon.
I'm continually surprised to hear this is the situation in France. I used to meet so many people who would travel there for treatment because it was supposedly of an excellent standard.
France has one of the best health systems in the world. Apart from Dentistry, Eyes Testslack of Chiropractors. Every system has failures. The cost is very little here most costs are refunded by the C.P.A.M. My niece who is AM Labour for Wales knows that it was her party that started the Privatisation of NHS services some years ago. Back in the UK
Southampton ENT was privatised years ago and put out to tender. All of this erodes a system which was not broken, but is now. In my own family my Nephew is a consultant
stroke doctor. He knew that choosing this was good for the NHS, he is dedicated to helping patients. He has nothing to do with the private sector.
Brightness14 , you are funny
But the food is excellent according to Rick Stein 🤣 Although perhaps not so good if you need it liquidised!
Are these medical people they are talking about physician assistance?
I just did some poking around in the Companies House website.
If I've understood what I'm seeing correctly...
Operose Health Ltd used to be named Centene Corporation (which is no longer in operation, at least in the UK, but has been renamed) which was based in Delaware in the USA.
find-and-update.company-inf...
If you look here :
find-and-update.company-inf...
3 out of 4 of the officers of the company are American.
So, the Americanisation of the NHS and the American takeover of our health services is charging along as planned.
Very shocking, wasn’t it.
whoops- told off by GP
Off topic advice please
Off topic: methyl B12 helps autism.
