Putting off the inevitable

By | 21 May, 2010

I must be brave. I must face my fears. I can’t keep avoiding it. I’ve been busy at work. Its the wrong phase of the moon and the dog ate my homework. All good excuses but I’ve run out of road. I have to take the giant leap.

GP studying hard to learn about diabetes

GP studying hard to learn about diabetes

My GP surgery have been harassing me for months. One of their chaps has now read his full quota of articles about diabetes in Womans Weekly, Men & Motors and Fishing Today and is now kindly going to share that knowledge via the medium of a diabetic clinic. (Note: all speculation on the potential qualifications of said GP to deliver diabetes care is based on nothing more than too many bad experiences with Dr’s who like to pretend they know more than they do which have led me to be very wary of people claiming to know about diabetes).

I’ve been stalked by the Drs receptionist for the last 2 months, begging and pleading for me to make an appointment. This naturally makes me wonder quite how much money the GP gets paid for every patient who uses this clinic because I haven’t felt so wanted since a spotty 13 year old had a bit of a scary crush on me in high school.

Previous experience of GP diabetes care hasn’t been good. Anyone who starts a conversation with a young woman with “do you take tablets for it” is off my list. “Diabetics can’t have their tonsils taken out” and “you should expect to have complications if you’ve had diabetes over 20 years” were also uttered by GP’s who supposedly had their Brownie badge in diabetes. The highlight was definitely the incredibly useful “if your blood sugar is high, you need to take more insulin” . Proof indeed that they’d read the first chapter of “Diabetes: The blindingly obvious” but sadly hadn’t progressed to “Diabetes: It’s not quite as simple as it may first appear”.  Little gems like that tend to undermine your faith in the system.

I already attend a great hospital diabetic clinic. I’m struggling to see what I’ll get out of this – all my numerous test results are up to date, I’m muddling along quite happily and I really don’t need any more help. Sadly, I’ve put this off long enough. I know from previous avoidance tactics that eventually my dealer will start withholding my insulin fix until I go and see them.

Ironically, I am quite a supporter of GP based diabetes care. I’ve met incredibly knowledgeable GPs delivering top class diabetes care to (mostly) type 2’s. I just haven’t been lucky enough to experience it personally and seem to have spent every diabetes related GP appointment over the years providing free education on living with type 1. I’m quite happy to do that and even throw in a free insulin pump tutorial at the same time, just let’s not pretend its you doing me the favour by letting me be there!

So, now I’ve delayed the inevitable a bit longer by blogging rather than making an appointment, I’d better get on with it. Although my office is looking very messy, I might just give it a bit of a tidy first.

20 thoughts on “Putting off the inevitable

  1. Annette A

    Oh, I’m with you on that one, @Alison. Last time I gave in, the nurse (that’s practice nurse) said ‘We needed you to come in because we haven’t had any test results from the hospital in a long time so we dont know you’re being seen.’ Whilst on her screen, in full view, were my last set of tests from the hospital. Taken 3 weeks previously. And they wonder why I cancel the appointments they make for me without asking…

  2. Alison Post author

    I’m very happy with one free Toe Tickle, it’s when I’m expected to take time off work for duplicate Toe Tickles because the hospital and the GP aren’t working together that I get a little irritated.

  3. Tim

    @alison – ‘zactly!

    Sometimes I thing that GPs / hospitals, etc., forget that quite a lot of us do actually have demanding, professional jobs and that, while we do want to have regular checks, appointments that duplicate something that’s already been done and is half way through the day aren’t ideal.

  4. Cecile

    You should feel cosseted for being passed through both a colander and a sieve. But how come the colander is in charge of your prescription? Isn’t it something you get from the specialist you consult for your 3monthlies?

  5. Alison Post author

    I don’t want to be cosseted, I just want an efficient service! In the UK the colander, or the GP as we normally call them, is in charge of prescribing. I agree what type of insulin I want to use with the specialist who I see once or twice a year and he writes to the GP, the holder of the prescription pad, to tell him to prescribe it. The GP then issues repeats as requested until he gets overexcited about running diabetes care himself, hence the current situation.

    1. Mike

      I’ve been through the same loop myself. My surgery got themselves all excited about an in-house Specialist Nurse and began insisting I went there for annual review. After a year of double review fun, with all that jolly pottering off for blood tests (what larks!) I asked the my Consultant at the hospital if I could stop attending – the surgery weren’t taking no for an answer. He agreed since they were pretty happy with what I was doing.

      A couple of years later I had an actual question to ask (I wanted to change insulin). Cue blank faces and terror behind the eyes all round at the surgery. I got referred to the ‘GP with interest’ who, 2 minutes in to the appointment, said something like, “This is a bit out of my league really. You’ll need to go to see a consultant at the hospital…”.

      So now I’m back where I started, and much happier for it. I don’t think the surgery will ask me back too soon. I probably have a ‘troublemaker’ flag on my file.

  6. Alison Post author

    I don’t really mind who delivers my care as long as they’re competent and linked in with the rest of the system. They’re the two bits that are causing me issues at the moment.

  7. Annette A

    Actually @Tim, my pharmacist does. They look at how often I go for repeats of the various stuff on my repeat, then adjust the numbers of each thing so that I only have to go every couple of months (rather than every 3 weeks).
    I think it might have somehing to do with it being classed as a ‘rural practice’ so the GP surgery has its own attached pharmacy who have slightly more powers than your standard town centre one (or something?). But it suits me, cos I dont have to go back so often.

  8. Hairy Gnome

    I’m just a lucky old T2 I guess… I don’t even bother to see my GP nowadays, unless my DSN tells me I need to that is, let alone visit a hospital diabetes clinic. As long as I get my Hb1Ac (or whatever the feck it’s called) every three to six months my repeat prescriptions just keep on and on and I avoid the people that know absolutely nothing about my diabetes. Just thankful for small mercies, me! 😉

    1. Hairy Gnome

      @Tim Of course I frequent Shoot Up! A lunatic fringe of eddicated and informed T1s is far preferable to NHS professionals who have far more important things to worry about than an insulin resistant gnome! I’ve learned a lot about diabetes from this site, and thoroughly enjoyed doing it! 😉

  9. Gillian

    What’s a ‘toe tickle’? I thought I was the only one who had problems with appointments interfering with everyday life. I don’t understand why the doctors surgery wants to take blood samples for my HbA1c when the diabetic clinic at hospital has just taken it a month earlier. The blood renews itself every 3 months doesn’t it? The nurse in the doctor’s surgery can’t answer any queries I have either. However she is VERY good at making me feel like I’m not controlling my diabetes properly. Didn’t medical staff ever learn that diabetes isn’t one of those simple things in life? Also, do they perhaps want to do our HbA1c checks at the doc surgery because they have a quota to fill to recieve money? I know from my time spent with practice nurses they get their salary and then extra money for doing things such as taking bloods for individuals on methotrexate etc (excuse the poor word choice – engrossed in TV at the same time. Despite what people think, not all women can multi-task efficiently!). So maybe they’re taking our bloods for this extra cash as well?

  10. Alison Post author

    @gillian – the toe tickle is the diabetic foot check up, where they prod and poke to check you can feel it and I can’t help but giggle when they do the tuning fork thing and it vibrates through my foot.

  11. lee cornish

    I know I’m a bit late to this but found it doing a Google search on Gp’s and how much they get paid for forcing these appointments on us. A friend who is a district nurse said the GP get’s nine quid for each diabetes appointment he makes.

    My GP has a very bad habit of calling me in every time I have been to my hospital clinic to see how things are going. The first time he did this he asked what my job was (it is something to do with looking after oil and gas pipelines), he then went on tell me that my bloodstream was very much like a pipeline and in the same way it needed looking after and this is what insulin does. Having been diabetic for over twenty years I really did not need this patronising and condescending attitude from him!

    Now, every time I go to the proper clinic at the hospital he sends me the letter or I find I have to see him first so that he can re-authorise my repeat prescription, even if this has only just been done as part of his yearly review. Last time I went to get it renewed I saw another GP hoping it would just be re-authorised and I could go on my way, but oh no, he gave the Hbac1 form and said to get a blood test from the surgery nurse and come back to see my own GP when the results were in!

    So yes, seeing his dedication to see me at least three times a year I do believe he is getting that nine quid a time, money which I’m sure the NHS could be spending on developing even better care for diabetics.

  12. Tim

    Hi Lee – welcome to Shoot Up!

    I agree – one does wonder if there’s sometimes a slight conflict between health care provision and the benefits doctors can receive (either through meeting arbitrary targets or receiving cold hard cash for the surgery budget).

  13. lee cornish

    I honestly don’t mind the surgery receiving extra money for providing this care but it is a complete duplication of service. The care I receive from the hospital is very good and comprehensive, and then to have to go so shortly after to my GP who really is just repeating what the hospital have told him (which I already know as I get a copy of the letter) is a real nuisance and if I try to avoid it I am the one marked down as difficult or not caring about my diabetes. Effectively by stopping my repeat prescription until I’ve had a review with my GP he’s wasteing everybodys time and money (the NHS, lost time at work etc.) and really, having just been to the hospital this is the last time I need a prescription review! Anyway, glad to hear it’s not just me.

  14. Alison Post author

    It’s almost as if we need to put the patient (customer??) at the centre of the whole process, rather than artificially segmenting care between GP and hosptial. That way, what’s important is whether I’ve had the relevant checks, and not whether each part of an inefficient system has stuck their oar in to justify their pay.

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