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[dazned]

Apologies this might get a bit rambling ,did debate whether to post or not but here goes bear with me...

Last week I met up and spent an afternoon with my old (now deceased) doctors wife ,she lives in next road. She was the practice nurse there. They both built,literally but not personally,a new medical practice on our estate which he owned. He was the family doctor for years until his early death about 7 years ago. His wife sold the practice but owns the land and building which the new medical business rents from her anyway I digress but thats the background !
Anyway after an hour of chit chat,catching up I obviously turned the chat around to menopause and how how felt that I had no choice to go private and how gp there said he didn't have to perscribe what consultant perscribed,or any hrt despite the new Nice guidelines !
What she said was .....
1) Ultimately they are only guidelines and gps dont have to abide by them
2) Practices are very much run to a budget nowadays they are a business so you will always be given the cheapest at first.
3)Each practice is given a set list of medication that they are allowed to perscribe from,if we or they want something not on that list they have to present a case for it before a panel before they can perscribe.
4)A gp doesnt have to perscribe what a consultant perscribes,especially if it isnt on said list.

I must point out that she didn't agree with these statements !

Her son is a consultant in big London hospital and his wife is a gyne.

If I think of anything else I will add it . Sorry if it was garbled Ive been very busy 

This might go someway to explaining how some people get what they want and some dont alot depends on that list and how much they have in the kitty,or if they have other patients on really expensive drugs draining it.
Its all wrong but how the NHS is going.

[Evelyn63]

Very interesting Dazned, funny enough, I remember my GP saying about prescribing for my VA, she said " we used to always prescribe Replens but not on list now " I didn't really know what she was referring to.

I have Medics in my extended family, and totally agree that GP practices are run totally like a business .  The partners have to buy into the practice and take out mortgages to cover their share . 

[dazned]

I personally don't think that it can 

As more are living longer and new super drugs are found thank goodness ,theres no denying they tend to be super expensive too !

If a practice only has x amount of money you can see that if they have to choose who gets what the most seriously ill person would get the lions share,unfair definitely,but its harsh economics unfortunately now.

[Pennyfarthing]

I personally don't think that it can 

As more are living longer and new super drugs are found thank goodness ,theres no denying they tend to be super expensive too !

If a practice only has x amount of money you can see that if they have to choose who gets what the most seriously ill person would get the lions share,unfair definitely,but its harsh economics unfortunately now.

But did you know they can top up their incomes fantastically by earning QOF points for things like prescribing statins, doing diabetic checks etc.  ITs BIG money!!

[walking the dog]

My fab GP always consults her bnf before prescribes me anything she wanted to give me some natural melatonin on prescription last week for my sleep issues but bnf says only for over age 55 so couldn't. I have read  a lot recently about NICE guidelines and I was beginning to come to conclusion that's all they are , guidelines /recommendations, not actual rules gp must follow.
So thank you dazned you have confirmed what was on my mind and I thank my lucky stars I have such a fantastic gp practice

[CLKD]

What's 'bnf' 

There is no loyalty anymore.  Charities, GP Practices, Pharmacies are all big business these days.  Makes it difficult for those GPs who want to do a good job for their patients.

[walking the dog]

British National Formulary its that book they look in to see what to prescribe sometimes.your right clkd its all about profit before people

[CLKD]

   was called "MIMMS" in my day 

[Janice68]

Thanks interesting thread here!!!

[ellie]

 Recently  at the pain clinic, the specialist  asked me if I had ever tried Verstatis pain patches. I said I had and they did help somewhat,but I didnt like asking for them as my doctor told me they where very expensive......He raised his voice and said......If I say you have to have them, then you HAVE to have them......
      So I asked my doctor again, and he started to tell me the expense etc and even when he knew it was the specialist who had prescribed them, he still said.....I will give you them but only if you feel they are helping a lot.
        It makes you feel so guilty for draining the practice money.....NOT a nice feeling at all 

[walking the dog]

I was like that when i had to go on continuous utrogestran Ellie as I'm on sixty pills a month but my gp was fine just said to me don't worry about cost but it def depends on your gp

[Pennyfarthing]

Recently  at the pain clinic, the specialist  asked me if I had ever tried Verstatis pain patches. I said I had and they did help somewhat,but I didnt like asking for them as my doctor told me they where very expensive......He raised his voice and said......If I say you have to have them, then you HAVE to have them......
      So I asked my doctor again, and he started to tell me the expense etc and even when he knew it was the specialist who had prescribed them, he still said.....I will give you them but only if you feel they are helping a lot.
        It makes you feel so guilty for draining the practice money.....NOT a nice feeling at all 

THis happened to me a few years ago.  A female GP prescribed me high dosage Evening Primrose capsules which really helped. I went to collect my prescription one day and the snooty receptionist/dispenser said "you do realise these cost an absolute fortune don't you?"  I said I didn't but I couldn't see that it was any of her business anyway what my GP had prescribed for me.

[Janice68]

I'm a bit curious about vagifem? To buy this privately it wld of cost me about £16 and told to get it on NHS as it's cheaper. Just thinking about the cost as alot of women use it. I know the ovestin is alot cheaper than vagifem because of the prep of vagifem hence only being given one box per prescription I guess.  Just wondering that's all!!

[walking the dog]

How many vagifem do most people get in a box ? 12/24 ? How much utrogestran are people getting per prescription and patches pills gel ? I'm just wondering if there's a standard issue or if its up to gps ?

[Janice68]

I will be interested to know too! All docs are different and more generous than others!
 I get 24 vagifem  per prescription ! With the ovestin when I did get it just one tube and it didn't go that far and I think it is cheaper privately.
Because   they are expensive maybe thats why the 24 only of vagifem
It's so interesting!!