T3 prescription from GP

[Andie222]

Hello everyone. I was prescribed a trial of T3 by an NHS endo last year. My GP took over prescribing in January. She did 2 prescriptions of one months each. She has now left and her replacement (not new to the surgery) has texted me to say “Liothyronine is a tablet which can only be prescribed by your endocrinologist. If you are running out you need to get I touch with them”.

I’m sure she is talking nonsense, but I’m not sure how to tackle this. Any suggestions please?

Is there an official document which says GP’s are alllowed to prescribe?

[TiggerMe Ambassador]

Hi, there should be a letter from your Endo to you and your GP telling them what they should be prescribing, if you have online access to your records you will be able to see it, you'll need to point it out to them as they rarely like to go and look for themselves!

If you have a rottweiler receptionist to get past print a copy of the letter out to hand over for the GP's attention or using the direct messaging on their website paste it to a message for the Dr

It might be the 'trial' word they are picking up on?

I was told 'you will have to continue buying liothyronine from the internet as you have been doing'.... this was true whilst waiting to see the NHS Endo but they happily ignored the letter of instruction.

You might need to get your big bossy knickers on 😅 you have to fight to get it and keep fighting to keep it 🤼

[Andie222 in reply to TiggerMe]

Hello Eeyore100. Thank you for your speedy reply. I do have a letter from the endo to the GP. It specifies my current dose, but unfortunately it does not ask the GP to prescribe it. Maybe I will have to ask the endo to write again and be more precise.

[TiggerMe Ambassador in reply to Andie222]

Is that the one to you or on your records? They will differ… The fact they have done 2 months means there must have be some request?

[Andie222 in reply to TiggerMe]

It was written to my GP and I was copied in.

[TiggerMe Ambassador in reply to Andie222]

How did you manage to get the first two months? They started supplying so they can’t just stop

[Andie222 in reply to TiggerMe]

I asked my GP and she said yes. I explained that my endo would be writing to her, but in the meantime could she prescribe as I was running out. To my amazement she said yes!

[TiggerMe Ambassador in reply to Andie222]

Excellent 👏👏👏 well done, it is daunting isn't it but once you get the hang of it 🙃

[Jaydee1507 Administrator]

You need to find the shared care agreement for your local ICB. Google should be able to help you out there, it will look something like this. eastkentformulary.nhs.uk/me...

On this particular one it does say that GP's aren't obliged to take over prescribing if the GP doesn't feel happy to do so and then you should remain under the care of your Endo.

Could you speak to a different doctor at the same practice who might be happy to continue the prescription. Also contact the practice manager and tell them you have had a successful trial with an Endo and question why your prescription has been stopped now.

[Andie222 in reply to Jaydee1507]

thank you. I am going to hunt for that document now. I could try the practice manager if other routes fail. Good idea.

[Jaydee1507 Administrator in reply to Andie222]

Actually your GP cannot stop your thyroid prescription. The say so would have to come from an Endo so do point that out to the practice manager.

[Andie222 in reply to Jaydee1507]

I’ve found the document you suggested. It confirms that after a successful trial the GP can prescribe if they are happy to do so. I’m going to print it out and pop in tomorrow. I will try and explain it to the receptionist.

[Star13]

Are you sure it’s the GP that is stopping it and not a practice pharmacist? These people are being entrenched in surgeries now and taking over prescribing. They like nothing better than over riding on something like this. I’d check who is calling the shots before you go all guns blazing. If it is the pharmacist then you can be more insistent that they not stop your prescription without the advice of the Endo.

[Andie222 in reply to Star13]

Good point. The text message appeared to come from the GP, but I don’t really know who sent it.

[Star13 in reply to Andie222]

I’d ring the surgery and check.

[Babette]

The GP notebook (gpnotebook.com/en-gb/simple... includes:

Where liothyronine is prescribed, GP repeat prescribing would be reasonable after completion of a 3 month or longer review by an NHS consultant endocrinologist

I was in a similar situation when I first started on T3 but that was to do with CCG guidelines being misinterpreted by my GP. I contacted the hospital and the endo and GP argued for months (the endo kindly gave me the emails) which meant I had to find my own meds. If you are stuck, the endo might be helpful.

Good luck.

[Andie222 in reply to Babette]

Thank you. The link doesn’t seem to work, but the wording sounds good. Fortunately I have some spare tablets to tide me over if the argument takes a while.

[Babette in reply to Andie222]

I've gone to the site again. Let's see if this works: gpnotebook.com/en-gb/simple...

If not, you can search for the text and GP notebook should come up in the results.

[TaraJR]

Which area (ICB) are you under? I may be able to help a bit.

National guidance says that T3 can be used as if T4 doesn't work. It has to be initiated by an endo but GP can then prescribe.

If you're on Facebook, do join us on ITT Improve Thyroid Group as we have template letters and documents that detail all national guidance and parliamentary statements on T3. You can download them and send them to whoever you need to.

[Andie222 in reply to TaraJR]

thanks TaraJR, I am in Bristol. I have found the Liothyronine prescribing guidelines and I’m planning to visit the GP this afternoon and talk to whoever will listen!

[TaraJR]

Ok, I can only see a basic statement on their formulary, which doesn't mention GPs.

They do reference the NHSE RMOC guidance which says no changes should be made by a GP, only an endo. So your GP should really be helping it to continue!