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.

[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.

[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

[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

[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.