GP refusing to prescribe phosphate binders

[Cazpi2]

Hi everyone, my account on here got frozen, but I've just re-registered with an extra number 2 on my username!

I've been taking phosphate binders for a good ten years or so (at least) currently I'm taking Renvela (Sevelamer Carbonate).
My GP has announced that she will no longer prescribe it, she tells me that this drug may only be prescribed by hospitals, and not by GP's, and that she had previously been prescribing it "by mistake".

My local pharmacy always have it in stock, and have never queried a Renvela prescription from the GP, which, I would have assumed they would do, if it was, as she says "a hospital only drug".

When I told my consultant, he rolled his eyes, and said he had seen a couple of instances of this recently from certain GP's, and that he presumes they are doing it as a cost cutting measure. He happily wrote me a prescription to be going on with, but the clinic don't do repeat prescriptions, so for me to keep getting my phosphate binders from my renal unit will involve a monthly 25 mile round trip to hospital, clogging up their clinic to see a doctor, then another hour waiting in the hospital pharmacy, all involving time off work, and lots of hassle, instead of a five minute walk to my local pharmacy.

Anybody else having trouble getting their drugs.

[wagolynn]

I have come across similar problems, I think it is a matter of moving costs around, GP prescribing costs are monitored, and I would not be surprised if they do not get a bonus for being under a certain amount.

If you tell your consultant about your logistic problems perhaps he may be able to prescribe sufficient to get you from one routine appointment to the next. Do not be surprised if he cannot do this, there are restrictions on GPs on how much they can prescribe at a time, I do not know if these applies to hospital prescriptions.

The bean counters don't live in the real world.

[JMan]

Had a similar problem in the past before I moved.

More recently my GP changed my Renagel (Sevelamer hydrochloride) to the generic carbonate (which I don't tolerate). Had to get a stiff letter from consultant to GP to resolve the problem. Local pharmacy, at the moment, don't have issues with the prescription and it actually states, 'do not prescribe generic' when I get the meds.

[Cazpi2]

It goes on.
Returned to the GP today, armed with a letter from my consultant. She still refuses point blank to prescribe the sevelamer, she became quite angry and accused me of wasting her time with my persistent demands for phosphate binders.
I spoke to the pharmacy, who say they do have other patients who are receiving gp prescriptions for it.

I've now called the local clinical commissioning group, who were very pleasant and helpful, but tell me that my GP is correct, and that the Renvela may only be prescribed by the hospital, which has taken the wind out of my sails somewhat. I'm surprised that my consultant isn't aware of this, as he must have loads of patients on the same drug.

The only reason I can think of for the difference of opinion between GP and consultant is that the two of them are in different health trusts, and are maybe working from different guidelines. Whatever the reason, this leaves me stuck in the middle with both ends telling me the other is responsible for the prescription. My GP got really stroppy, and refuses to discuss the matter further. I even had grief getting iron tablets out of her this morning ffs. At least the consultant is sympathetic and approachable.

It's a nightmare.

[SKM23435]

GP’s can’t prescribe Sevelamar in Surrey either.
I’m told it’s because GP’s don’t have the experience in using it or the expertise to monitor it. As responsibility of safety and monitoring remain with the prescriber - the consultant needs to prescribe.

It’s interesting though - my consultant monitors my tacrolimus, my GPprescribes it??!

[SKM23435]

Just looked up Tacrolimus on line. Apparently GP,S are not to prescribe for new transplant patients. Those patients whose GP’s do prescribe are to be “repatriated” back to consultant prescribing in the future. I know that not all GP’s have been prescribing anyway.
Again it’s quoted as a safety issue.

[Cazpi2]

I dread to think of the drug hassles I'll have post transplant.

My GP has never voluntarily given me a prescription for anything. Every single one has involved a battle. She changed one of my drugs without telling either me or my consultant, she just sent an amended prescription to the pharmacy electronically. I didn't realise until I went to pick it up.

When I first joined the practice after moving house she ran through the list of meds, and said "you shouldn't be taking this" about three or four of them. She has tried to reduce my bicarb, stop my quinine, stop my diuretics,etc and each time I need to get a letter from the consultant before she'll accept it. Each time I go I make an attempt to get off to a fresh start with her, but she's wearing me down.

[wagolynn]

Hi Cazpi2,

Is there only one GP in the practice?

Just see another one if there are several, I have come across this behaviour, and that was my solution.

The other way is to ask her to look at the correspondence between the GP and your Consultant each time she wants to make changes.
Copies of all the correspondence will be on the computer system, your Consultant sends a report to your GP every time you visit the Consultant, and/or when the Consultant changes your medication.

[Cazpi2]

There are one and a half GP's in the practice. The other one is part time, semi retired, and married to the other one!
I'm hoping that the one I've been seeing will retire soon as well.
The practice was put into Special Measures recently following an inspection, it's just been taken off the Special Measures last week. Apparently they also lost their licence to administer injections, don't know if they got that back.

I usually take hard copies of my correspondence with me when I visit, as she has claimed not to have received it in the past. I generally find ways to get things done without involving her, it's easier, but these phosphate binders have been a bit of a hurdle. Oh well. I'll get it sorted eventually.

[SKM23435]

In this case I don’t think it’s the GP. It’s a dictat from a higher authority.
It’s your consultant you need to talk to. He/she wants you to have a precpsciption, they should prescribe it.

[Chris Wright]

Cazpi,

Change your GP surgery.

I did about 7 years ago to one which has about 20 Doctors. I have one allocated to me who is very reasonable. Also as the practice is so big, they can create a list of their patients who are at risk of hospitalisation which means if you phone and want to speak to someone, you will be phoned back that morning.

It was easy for me as i am in SW London, i can understand if you are in the country it is trickier.

Hope it works out for you.

Chris