The Secretary of State for Health states doctors can use other thyroid hormones other than levothyroxine-only; they can prescribe unlicensed drugs; they can follow whatever guidelines they wish even if they are from another country.
Because I could not find the definitive source within the Department of Health for the statements below, on the 2 February 2013, I wrote direct to The Rt. Hon Sir Jeremy Hunt MP (Secretary of State for Health in the UK): Please keep the DoH response safe.
Show it to your GP/Endocrinologist if they insist they cannot prescribe anything other than levothyroxine-only and/or cannot prescribe unlicenced drugs.
Show it to those doctors who state they are not allowed to follow other thyroid guidelines other than the RCP's policy statement.
Show it to those doctors who claim they are not allowed to diagnose if blood results are within the reference range - and help further their education.
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Dear Jeremy Hunt
I am founder/Chair of Thyroid Patient Advocacy (TPA) tpauk.com . There are no official guidelines for the diagnosis and treatment of hypothyroidism or guidelines for those suffering from peripheral thyroid hormone deficiency and I wondered what the situation is for medical practitioners when all they have as guidance is a policy statement issued by the Royal College of Physicians.
Are doctors allowed to follow guidance/guidelines of their choice, whoever has written them, and choose guidelines even if they are from a different country? TPA has over 4000 members of the Internet Thyroid Support Forum, many saying their doctor has told them that they are not allowed to diagnose or treat outside of the RCP policy statement. I would be grateful for a definitive answer to this question please.
Kind regards
Sheila Turner (Chair)
_______________________
DEPARTMENT OF HEALTH RESPONSE:
Our ref: DE00000756922
Dear Mrs Turner,
Thank you for your email of 4 February to Jeremy Hunt about hypothyroidism treatment. I have been asked to reply.
I should explain that the Royal College of Physicians (RCP) and the British Thyroid Association (BTA) are independent of the Government. The Department of Health has no plans to ask the RCP to withdraw its clinical guidelines for the treatment of this medical condition. Nor does the Department have any plans to produce guidance on the diagnosis or treatment of hypothyroidism. ‘UK Guidelines for the use of Thyroid Function Tests’ are published jointly by the Association for Clinical Biochemistry and the BTA.
Doctors are encouraged not to rely too heavily on the results of blood tests, but to use their clinical knowledge and an assessment of the symptoms experienced by individual patients in making a diagnosis for thyroid treatment. Doctors are free to use whatever guidance they feel is appropriate when making a diagnosis. This includes guidance published in other countries.
I should add that under their terms of service, GPs are allowed to prescribe any product, including any unlicensed product or product not licensed for a particular indication, that they consider to be a medicine necessary for the treatment of their patients under the NHS. This is subject to two provisos, which are:
- the product is not included in Schedules 1 or 2 of the ‘NHS General Medical Services Contracts (Prescription of Drugs etc) Regulations 2004’, otherwise known as the Selected List Scheme; and
- GPs are prepared to justify any challenges to their prescribing by their primary care trust.
It is the responsibility of health professionals to decide on the most appropriate treatment for their patients. If a person has any concerns over their treatment or the drugs they are prescribed, they should raise these concerns with their GP or consultant.
I hope this reply is helpful in clarifying the Department’s position.
Yours sincerely,
Peter Wozniak
Ministerial Correspondence and Public Enquiries
Department of Health
Written by
julieknight
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You can see this text, close to word-for-word as in the response, by simply searching the web. With minor variations it has been the government line for quite a number of years.
The RCP/ACB document says within it that it is due for review in 2009. I argue that continuing to use it is inappropriate for that reason alone. [I was in communication with the author very recently and it appears that the BTA and BTF simply are ignoring the issue.]
fantastic bit of information, bloody docs, I went private and paid over a thousand pound to be diagnosed. then I was told I couldnt have a trial of thyroxine, so I paid again and insisted a trial, lol cost me altogether, 1, 350 for a trial. how bizzare, quite cross actually reading this. I could of got Eltoxin for a couple of pounds. lesson learnt.
It looks wonderful but my GP practice has never allowed me to have my armour on a script even though it has been proved ( 4 times) that I am allergic to synthetic thyroxine They also frequently refuse to prescribe various drugs requested,often by 3 consultants ,if they think they are too expensive! Even worse, I have to test my anti coagulation daily. The strips cost about £3 a time. NICE and my local health authority say they must prescribe them . They will not, too expensive!!! Every time I order 2 boxes from the company even they tell me I can get them free on a script!! I could go on, they have done far worse !
Hi that is the least of the problems with them. if i make the slightest complaint to them or any one or even point out their mistakes then have to leave the practice.,been told often! Too ill! Told my husband , if that happens he will have to leave me in my wheel chair outside the practice, with a banner but as no support from him, in fact he makes things worse, cannot do anything! Believe me I have tried every thing else! Unfortunately doctors drum up excuses to get rid of unwanted patients and in the end nothing can be done. My brilliant ,lovely consultants and doctor friends all know this!! It was well known that I had a major cardiac arrest due to a doctor`s wrong and treatment. My consultant insisted I reported it. It was all in the notes, life saved by the CCU nurses, I should have been in the car but late leaving the hospital. Very lucky, all in the notes. Went as far as ombusman as case to answer, all the evidence, case dismissed after 3 years of fighting! That is just one example, moral do not keep any rotten doctors and diagnose yourself!!
Patients must complain about this poor medicine from doctors that Jackie describes. A doctor has a duty to discuss treatment and agree that treatment with the patient. The NHS Constitution says that. Its a legal duty .nhs.uk/choiceintheNHS/Right...
The investigations or treatment you (the doctor) provide or arrange must be based on the assessment you and the patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options.
if you present evidence as to why you need armour and show him/her the letter above, then your doctor "should" prescribe it. If s/he doesn't, demand that the doctor provides you with his/her evidence why s/he wont prescribe. That also is a legal duty under the NHS Constitution.Prescribing a medicine that a patient is allergic to when there is a safer alternative could be negligent and call into question the doctor's fitness to practise.
if s/he doesn't, complain to the PCT (Clinical Commissioning Group after April) and the
If this is the case, shoud the alternative medicine also be free (as Levo is when prescribed).In other words is it the medicine or the condition that gets free treatment on the NHS?
Your story is appalling. it looks to me that you need some sort of legal help. Have you tried the Citizens Advice Bureau or some similar organisation?
Fear of being "de-listed" is often cited. Some bullying doctors use the threat to stop complaints about them. This is unethical and contrary to Good Medical Practice which states at paragraph 38:
In rare circumstances, the trust between you and a patient may break down, and you may find it necessary to end the professional relationship. For example, this may occur if a patient has been violent to you or a colleague, has stolen from the premises, or has persistently acted inconsiderately or unreasonably. You should not end a relationship with a patient solely because of a complaint the patient has made about you or your team, or because of the resource implications* of the patient’s care or treatment.
You have the right to choose your GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse, in which case you will be informed of those reasons.
You have the right to express a preference for using a particular doctor within your GP practice, and for the practice to try to comply.
Access to health services:
You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.
You have the right to access NHS services. You will not be refused access on unreasonable grounds.
You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets
So, the threats of de listing are hollow and only work when a patient doesn't know his/her rights. Knowledge is power as someone famous once said
if a doctor uses this threat, report them to the PCT. If the bullying doctor refuses to treat you, you may be better off at another surgery anyway, unless you cant access another one because there isn't one in travelling distance, in which case, stand your ground.
it sounds like you need more intensive help than I can provide on this forum, but I hope that we have given you a starting point and some positive help
Thanks for your thoughts but tried this and lots more. 3 doctors in the past have wanted me to report consultants who have messed up, common problem with me as very complicated medical conditions. I will not do that but I have tried every thing else.I always write and tell them off in the hope this is not perpetuate My son is a lawyer and I have known a lovely psychiatrist. for 20 years. Lovely great man and a legal expert. He is expert witness all over the world. He has also advised me but knows as I do it is impossible with a GP as they are termed"Self employed" They have to have done some thing appalling to be struck off, usually involving sex.Consultants are different, they have made the most lethal mistakes for me. mostly cardiac arrests ( withdrawing medicine , against advice ) and acute kidney failure twice by increasing my dosage much too quickly . without allowing repeat tests etc. A lot of my heart problems could/ should have been treated many, many years ago. Even when seeing a Prof. inadequately treated. In 1999 , After knowing about my thyroid and not telling me, since 1982 also my heart problems for years. My GP referred me to a neurologist for falls, caused by these not being treated. Consequently I did not see an endo or cardiologist and was in a mental hospital for falls for 6 months Later my psychiatrist wrote to every one concerned and told them the facts of life. Finally taken off my records but still GP phones hospitals to tell them " I am mad", whose sanity is in question here? Of course, it strongly effects my treatment and also endangers my life! My best hospital has more sense! When Let out I took matters into my own hands and am very proactive about treatment , especially wrong treatment. Although, when in hospital, every few months and I am in a coma, I cannot control the docs.! I actually only go in if at deaths door with all the drama that entails! The hospital I am meant to go to which is not my neighbourhood understand I know best but if in a coma,I end up at local H, such bullying etc etc not to mention them causing 3 cardiac arrests. Ah well, I am still here and still fighting!
Thanks any way, I could say a lot more ! life is not fair but we just have to do the best we can. That is why I am so keen at giving what answers I know abut on the site.If I can help some one with these complicated issues, there is more point to it all.
If you do not click on "Reply to this" only the first posting receives your answer. I looked back and found this. Thanks any way.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
OMG Read this reply from the Health Minister - ironically it ended up in my junk
Do doctors have to follow Guidance?
READ THIS! CCG's are stopping docs and endos's prescribing T3 by using bits from this that suit them. T3 is a possible treatment etc AGH!!!
