Medical ranting

[triskellian]

About four years ago, I had a series of asthma attacks which ended with a few days in hospital, and a lot of meetings with doctors to discuss different medicines.

Since then, my asthma's been stable, so although I've seen doctors for other things in the meantime, no one's looked at my asthma. The surgery I go to has been getting increasingly insistent that I have to see the asthma nurse for a checkup, so I finally gave in and went yesterday.

And it made me angry...
I demonstrated that I know how to use my inhaler properly. I explained that my asthma was giving me no trouble at the moment. Against my wishes, I was weighed and measured (I have a deliberate policy of not knowing how much I weigh as part of my "trying to be sane about my body image" plan. Yes, I could have not looked. And, no, I haven't got either taller or shorter since my last checkup four years ago).

Apparently I am supposed to do this every year. Show up, be weighed and measured, breathe in from one tube (inhaler) and out into another (peak flow meter), and answer a bunch of dumb questions. I've had asthma my whole life, and it seems I can't be trusted to just get on with it on my own. If it changes, I'm perfectly capable of making an appointment with the doctor to talk about it then.

Next, I discover that the rules about prescriptions have changed and I'm now only allowed to have a prescription for one month's worth of medicine at a time (ie one inhaler, when I'm used to getting three). This means it costs me three times as much (the prescription fee is per medicine, not per item), and it means that every single month I have to go through the rigmarole of getting more medicine. I'm horribly disorganised about getting my medicine anyway; I don't fancy having a running-out-need-to-get-more crisis every month.

All of this is particularly galling in light of two facts. The first is that some chronic diseases entitle their sufferers to free prescriptions, but chronic asthma, despite its potentially life-threatening nature, isn't one of them.

And the second fact is that the big thing in asthma treatment is for sufferers to learn to manage their condition themselves so that it doesn't affect their lives. Which I was getting on with quite nicely until I started being forced to jump through bureaucratic hoops. Monthly prescriptions (and associated fees) and yearly checkups have much more of an impact on my life than my asthma itself does :-(

Comments

[onebyone.livejournal.com]

Exercise patient choice - phone up a bunch of doctors until you find one willing to prescribe you three inhalers at a time, and then see what kind of deal you can get on the checkups.

[onebyone.livejournal.com]

Or, if the rule is "one prescription covers enough inhalers for a month" rather than "one prescription per inhaler", abuse it by claiming you're using three times as much inhaler than you really are, stock up on three inhalers a month for six months, then you don't have to worry about it for another year.

[triskellian]

Won't work. In the case of the preventative inhaler, they know how many times I'm taking it (cos it's prescribed that way), and in the case of the reliever, if I start taking lots of it, they'll want to see me more often to faff about with my medicine to "allow me manage my asthma properly".

[bibliogirl.livejournal.com]

You might want to look at the prescription "season tickets"; I don't know how they would work out in regard to one prescription a month, but my dad used to have one before he turned 65, I think.

[triskellian]

Yep, I need to investigate those - it'll probably mean it costs me double rather than triple :-(

[bibliogirl.livejournal.com]

I thank my lucky stars that the only medicine I take regularly is (a) free to its users, (b) comes in six-month sets (usually), and (c), since I started going to one of the local clinics rather than my GP, is handed out at the clinic rather than me having to remember to go to a chemist...

[uitlander]

I was going to suggest the same. I've just renewed mine - worked out just over £90 for the year. Having said that, of course it covers you for everything in the year, not just inhalers.

The surgery are probably following NHS guidelines to monitor asthma sufferes. Yeah, its a pain as it seems to be all nicely under control, but some sort of regular health check could also catch other problems early - which is no bad thing. Weight thing is annoying, but sadly there are health issues associated with weight. I tend to ignore my weight now, but I've managed to lose a lot. Occassionally venturing near the scales helps remind me to curb my enthusiasm for 'nice things' every so often - but that is a personal choice. Of course, the manner in which 'helpful advice' is issued by any medical staff is key here, so if they are actually being pleasant and vaguely supportive I'd grit my teeth and try and see it as a positive, annoying as it may be.

[lanfykins.livejournal.com]

People who have to pay for more than 5 prescription items in 4 months, or 14 items in 12 months, could save money by buying a PPC. From 1 April 2004, the charge for a single prescription item is £6.40, whereas a 4-month PPC will cost you £33.40 and a 12-month PPC £91.80

So in triskellian's case it might or might not help, but it still doesn't deal with the problem of having to get hold of a new prescription every month. I used to end up regularly managing to put myself in anti-depressant withdrawal with the correct application of just a little incompetence.

Have you pointed out all of these issues to your doctor? In so many words?

[triskellian]

Have you pointed out all of these issues to your doctor? In so many words?
No, 'cause it was the nurse I saw yesterday. My plan is, indeed, to explain all of this to an actual doctor, and see if I can get classed as some sort of exemption to the month-at-a-time rule. I'm tempted to try secretrebel's suggestion that I claim bureaucratic hoops exacerbate my asthma ;-)

[lanfykins.livejournal.com]

I believe kharin managed to thwart a similar rule using sarcasm alone*, so it's possible.

I believe the phrase was, 'So when are you going to install the revolving door in the surgery?'

[ex-kharin447.livejournal.com]

That did work for a while. Unfortunately, the events triskellian has just described have also happened to me. The phrase 'So I'm expected to asphyxiate myself to save you money?' failed to do the trick.

[lanfykins.livejournal.com]

Hmm.

Fortunately my doctor doesn't seem to have clocked the fact that I'm asthmatic and haven't had a new prescription in over a year, or I'd undoubtedly be called in too...

[ex-kharin447.livejournal.com]

"but it still doesn't deal with the problem of having to get hold of a new prescription every month."

You might want to look at electronic prescriptions schemes - I get my inhalers mailed to me from these people: http://www.pharmacy2u.co.uk.

Not all doctors are using this but there is a surgey in Summertown that is signed up.

[triskellian]

Thanks for the link - I'll investigate.

[elethiomel.livejournal.com]

I was going to suggest the same. My Mum has one and IIRC it's about £40 (although it may have gone up) and covers you for a year, so it'd work out about half-price, give or take.

I agree with you about the fact the asthmatics should be exempt from prescription charges. Interestingly I believe that thyroid condition sufferers do get free medication although I believe those conditions are rarely, if ever, fatal.

[triskellian]

Yep, thyroid conditions are my favourite comparison. Much more debilitating than asthma, but they ain't gonna kill you.

[onebyone.livejournal.com]

I find it difficult to conceive of any ethical argument which doesn't result in either almost everyone or almost no-one getting free prescriptions.

So I conclude that the purpose of charging some people but not others is almost entirely to do with budget management. Given this, there's probably not much mileage to be got from considering particular examples of it being flagrantly unfair.

[triskellian]

You're right, of course. Doesn't stop it making me angry, though.

[bateleur.livejournal.com]

I dunno, because if you seem angry about the lack of fairness, that might result in "discretion" being used where this is permissible.

[uitlander]

As with amny others, I find it insane that asthmatics do not get free prescriptions. Its a life-long medical condition, and presenting any barriers to people who need ventolin and the like to breathe is insane. One instance where I don;t mind paying a bit more tax & NI to cover this sort of thing. I don't want asmatics 'rationed' on number of inhalers - I want them to have plenty lying around so if they lose/misplace them there's no problem. One of my friends regulalry leaves one over at my place as he knows he's forgetful - 'caching behaviour' in archaeological parlance, and something I thoroughly approve of.

[ex-kharin447.livejournal.com]

Exactly the same thing has happened to me; presumably this is a general policy from the Thames Valley health authority. When I complained I was told that my 'inhalers are very expensive.' I have since been forced to take out a prepay certificate.

"the big thing in asthma treatment is for sufferers to learn to manage their condition themselves so that it doesn't affect their lives."

They really are a load of condescending twerps, aren't they? They seem to think we're quaffing seretide and ventolin

(cont)

[ex-kharin447.livejournal.com]

They seem to think we're quaffing seretide and ventolin just to maliciously drain their budgets.

Re: (cont)

[angua.livejournal.com]

But that's the only reason I do it!

I just enjoy the breathlessness and feeling that I'm about to die most of the time ;)

Re: (cont)

[ex-kharin447.livejournal.com]

Smirks...

[triskellian]

seretide and ventolin
Hey, snap!

Yes, I enjoy being permanently on medication, having to remember to take an inhaler with me everywhere I go and so on. Lots of fun, just to spite the NHS/taxpayers/policymakers/whoever.

The excuse they gave me yesterday was "It's about waste. <insert story of some care home stockpiling medicines which were then thrown away>" This didn't seem a particularly compelling argument since I'm not a care home, and I only want to stockpile a couple of spare inhalers at a time, and my life is more likely to be wasted if I'm only allowed one inhaler at a time.

OK, I'm going to stop abusing italics now.

[onebyone.livejournal.com]

seretide and ventolin

That's Margaret Atwood's latest, isn't it?

[triskellian]

:-P

[ex-kharin447.livejournal.com]

The point is that it is a very good idea to stockpile inhalers to some extent. Otherwise, if an inhaler runs out sooner than you thought, you forgot to order a new inhaler or if you lose an inhaler, you're stuck without a spare.

[lathany.livejournal.com]

That's just cr*p.

I hope you manage to find a cheaper way of getting the treatment through one of the various methods suggested by other people.

[adamsmithjr.livejournal.com]

Could be worse. You could live in the USA. Our health-care costs $1000 a month for insurance, plus 20% of much of our treatment costs.

So, you have my sympathy - but also, look on the bright side! x

[lathany.livejournal.com]

Why do some people ruin perfectly good offers of sympathy with things like "Could be worse..."?

[adamsmithjr.livejournal.com]

Aw, don't be like that. The sympathy is perfectly genuine. I just thought... well, who cares what I thought. Did I mention that

adamsmithjr is happy.

You're a rosy-cheeked ray of f'ing sunshine 24/7. I bet you smile a lot and little things don't get you down. Must be nice. Fuchsia's definitely your color.

brought to you by interim32. wanna know your lj's moodring color? enter your user name and hit the button. (discussion thread)

?

[lathany.livejournal.com]

Fuchsia?!

[adamsmithjr.livejournal.com]

I think it's pronounced 'Fyoosha' rather than ... well, anything else.

[triskellian]

Sympathy accepted, and, yes, I'm aware this whinge is tiny compared to the equivalent situation in the US.

[adamsmithjr.livejournal.com]

Yes - nevertheless, good luck in your quest for a cheap and hassle-free way to 'manage your own condition' (barf - sounds like being potty-trained). x

[cuthbertcross.livejournal.com]

Right.
This may not make you feel better, triskellian, but it may explain things a little.

The reason you've been jumped on is to do with the changes the Government made last year in the way GP services are funded. There was a "new contract" brought in that altered the way they work out how to pay GPs. There are a certain number of "quality measures" (very management speak) which doctors have to show they're doing, and then they get payment based on how many they have managed. The government decided several hundred things that "matter", like "diabetes care" and "asthma care and "cervical smears", and then drew up a list of things to do to earn "points". And , you've guessed it, points mean prizes.

There are *many* far more important things, like good communication, compassion when a relative or patient is dying, holistic support, good team support, which are not "pointsworthy", but that's another matter and to do with politics of healthcare provision.

What's important here, is that you have been (rightly) identified by your GP as an asthmatic and put on their "asthma register". This means your GP practice depends on you being checked annually to see if you're OK and happy with your treatment for part of their funding. OK, a waste of time from your point of view, but it funds the service, and they have no choice, they *have* to see you annually to get the money. (Some practices do a phone review, but most places don't have time to implement this) The other thing is that people from age 18-35 are notorious for not seeking help regarding their asthma treament until they're really poorly, and thus far too many of 'em still end up in ITU or the morgue. Again, clearly not you, but you can't tell the well non-attender from the ill non-attender, can you?

And about the prescriptions thing; the problem here, believe it or not, is not your GP. The actual bugdet that provides payment for prescriptions on the NHS isn't your GP anymore, it's a seperate management-led authority called the Primary Care Trust. Each PCT covers about 100,000 population or so, and they tell the GPs about which drugs they aren't "allowed" to prescribe (like the really expensive MS and Alzheimer's drugs) and also they dictate the amount of medicine allowed per perscription. The PCTs get their funding from the Government, and - you've guessed it- the govt haven't given them enough money to do what they want. So many PCTs are in dire financial straights with big deficits, the PCT managers have to decide how to make their pursestrings tighter, and one way to do it is to reduce the per-perscription length from 56 days to 28 days. So that's what they've done. After all, who'll notice???!!!

So, that may or may not explain things a little. Whatever happens, I hope your asthma stays well-behaved.

[smiorgan.livejournal.com]

Interesting. One question: why if the per-prescription length is 56 days do I get 100 days worth of medication every time I ask for it?

[onebyone.livejournal.com]

I guess: because PCTs aren't required to allow 28 day prescriptions only, that's just one tool at their disposal, and they can choose which kinds of prescriptions it applies to. Your kind of prescription is so rare compared with asthma that there's far less incentive to gouge more money out of your kind of prescription than out of asthma prescriptions.

This also explains how triskellian needs to negotiate in order to get what she wants:

your GP practice depends on you being ... happy with your treatment for part of their funding

So the question is how much of their funding, and what concessions it is worth your GP's while to make in order to keep it. OK, so GPs don't make the rules, they just enforces them, so it's a little unfair to give them grief. But you don't make the rules either, you just suffer at the pointy end of them, and this is your only means of feeding back to the person who did make them.

[cuthbertcross.livejournal.com]

Actually, if you did want to feed back, it's worth considering writing to the PCT to point out your dilemma and the inconvenience it causes you having to get scripts each month. Asking your GP nicely if you can have 2 inhalers at a time might work if you go in and discuss it with them face to face during a proper appointment (rather than requesting on the repeat script, with lacks a personal factor and may just get turned down.).

[triskellian]

Yep, I'm planning on talking to my GP about it the next time I go in.

And thanks for the background info - much appreciated!