Cycling UK Forum

simonineaston wrote: ↑18 Jun 2024, 8:37pm

Jdsk wrote: ↑18 Jun 2024, 6:17pm Was that an NHS referral to the private provider?

I don't know. The conversations I had both with the gp and the surgeon included no discussion on the topic of sector or payment. As far as I recall, the focus of both interactions was solely clinical. Soon after the gp appointment, I did receive in the post a parcel of papers which included, in helpfully enormous print, a list of sites that I could choose from to attend to see the specialist. It's entirely possible that amongst the sheaf of papers was an explanation of the way the referral might be dealt with, with respect to private and nhs locations. I simply selected on the basis of a) inspection grading and b) geographical convenience.

That sounds like an NHS referral to a private provider.

There's a lot of it in the system in England. At one time in the Choose and Book programme there was a requirement to offer the patient at least one option of a private provider. And there have been targets for NHS purchasers in England to meet some targets for use of private providers.

Apart from the flow of money (and the wider effects) it's very different from the situation where the patient selects and pays the private provider: roughly speaking from the patient's point of view it's the same as NHS provision.

Jonathan

Psamathe wrote: ↑18 Jun 2024, 6:38pm ...
Not cooperating I was describing was when private consultant I arranged and paid for independently from GP, consultant writes to GP reporting results fof consultation "I saw this patient, carried out examination finding x, y and z indicating patient is suffering a, b and c. I have privately prescribed <x> at a dose of <y>. I would ask you continue this prescription after the 2 week private prescription to continue the treatment for the diagnosed condition" and GP decides despite the trivial cost of the prescription he'll only prescribe half the requested dose!

Did the GP say why?

Problems of this type are not uncommon. Of course the second prescriber is responsible for their own actions whatever anyone else requests them to do.

And staff providing NHS care have requirements for guidance and governance that may not apply to a private practitioner.

Jonathan

Jdsk wrote: ↑19 Jun 2024, 8:42am

Psamathe wrote: ↑18 Jun 2024, 6:38pm ...
Not cooperating I was describing was when private consultant I arranged and paid for independently from GP, consultant writes to GP reporting results fof consultation "I saw this patient, carried out examination finding x, y and z indicating patient is suffering a, b and c. I have privately prescribed <x> at a dose of <y>. I would ask you continue this prescription after the 2 week private prescription to continue the treatment for the diagnosed condition" and GP decides despite the trivial cost of the prescription he'll only prescribe half the requested dose!

Did the GP say why?

Problems of this type are not uncommon. Of course the second prescriber is responsible for their own actions whatever anyone else requests them to do.

And staff providing NHS care have requirements for guidance and governance that may not apply to a private practitioner.

Jonathan

Didn't get to speak to GP about it. I checked with the consultant and he said half dose is useless and only used when psychologically weaning people off the medication (they find it has massively helped them so when consultant says they can stop they get worried so consultant says drop to a half dose and it in effect becomes a placebo). Apparently very safe and I suffered no side effects from the initial private prescription.

Earlier in investigations same consultant had written to GP asking for 24 hr heart monitoring (as it's something they need to eliminate in early stages of diagnosis). GP just ignored it so I ended-up using my own blood pressure and taking readings every 30 mins during waking hours and consultant said better than nothing but if we can't get GP to do it properly we can't force them ("we can only do what we can do").

I don't know if it's private requests GP doesn't like or consultants because same condition I managed to get GP to refer me to Tropical Medicine infectious diseases specialist @UCLH (as it's very likely my condition related to an infection from South American travels) and the NHS consultant said "Yes .. we need to test for <x>, <y> and <z>". Eventually after a lot of repeated requests from me I managed to get 2 of the 3 tests done but one never managed to get one done (and not available privately). If it is one of the conditions the consultant wanted tested it's now too late for realistic treatment.

Ian

Thankyou

Jonathan

Re: OP's Question about Private Consultations
As OP's condition sounds complex and has a significant history (previous consultations, hospital attendances, etc.) if considering a private consultation it might easily be that tests are needed. Do check with the consultant or their PA if all possible tests can also be carried out privately or what can and what can't (should the consultant need them). With the 1st private consultant I saw (a useless one) I did (paid for) a couple of standard tests (eg CT scan) but then the next tests he revealed "were not available privately anywhere nearby so he could write to my GP asking I be referred to NHS who would need to have a consultant appointment to identify the tests were needed ..." so basically he did the 1st couple of small steps then passed back to NHS having made no progress.

Fortunately 2nd consultant (some distance away) had a proper specialist clinic and was able to do those tests to progress the diagnosis.

So thought for OP is try and see what tests might be needed and if those tests are also available privately (maybe check costs as some testing could get expensive eg MRI).

(Note about my situation with regard to diagnoses and condition to clarify other my posts and discussions in this thread: My own condition is diagnosed as far as a grouping of symptoms that can be treated but the underlying cause is not diagnosed eg You have a broken leg, they have diagnosed your leg is broken and they can treat the condition but they have maybe not been able to identify what caused your leg to break).

Ian

gbnz wrote: ↑18 Jun 2024, 3:20pm Wish to keep cycling etc, etc. Have found the NHS a joke

In what way, do you NEED to see a doctor to cycle ?

I have never had anything but amazing NHS treatment.

You say you have found the NHS a joke, as bad a generalisation as ever there was, like a woman saying all men are a joke !

Pinhead wrote: ↑19 Jun 2024, 2:56pm

gbnz wrote: ↑18 Jun 2024, 3:20pm Wish to keep cycling etc, etc. Have found the NHS a joke

In what way, do you NEED to see a doctor to cycle ?

I have never had anything but amazing NHS treatment.

You say you have found the NHS a joke, as bad a generalisation as ever there was, like a woman saying all men are a joke !

If one has a debilitating condition that prevents cycling that can be medically alleviated, then you need treatment, and thus a doctor, to cycle.

As for a woman saying all men are a joke, yes, it's a sweeping generalisation but truth be told you can see where they're coming from at least some of the time, and the same with NHS treatment. It's not exactly news that especially in England the NHS is near/at/arguably past breaking point, and in those conditions some examples of terrible treatment are practically certain.
A pal is an A&E consultant in Wales, he recently experienced A&E in Liverpool accompanying a relative and he was pretty shocked at the state of things. That's not a comment on the people, you can only do what you can do with what you have, and they just didn't have enough staff.

Pete.

Pinhead wrote: ↑19 Jun 2024, 2:56pm

gbnz wrote: ↑18 Jun 2024, 3:20pm Wish to keep cycling etc, etc. Have found the NHS a joke

In what way, do you NEED to see a doctor to cycle ?

I have never had anything but amazing NHS treatment.

You say you have found the NHS a joke, as bad a generalisation as ever there was, like a woman saying all men are a joke !

Once you get into seeing consultants they can start telling you what not to do and that can go on your medical records which, if you ignore it can cause problems later. eg I have been told by two consultants that I should not be cycling but I have "discussed" the issue with them (before it got into my medical records) and they changed their views.

NHS can be very challenging. I've just been through several months repeated tests when I kept telling them nothing was wrong. Started because a nurse practitioner referred me for the wrong test also asking for a blood test that no other medics can understand why. Minor anomaly in the unnecessary blood test so a GP registrar (trainee GP) decided I needed a full body CT scan and urgent referral to specialist consultant! Consultant had to see me and investigate and eventually agreed "Nothing wrong, no further follow-up tests" but GP registrar seemed to know better and continued more tests, even wanted to refer me to 2ndry healthcare again but decided they'd probably refuse the referral - all with me asking "please stop this I'm not ill!" so testing continued until I requested a 2nd opinion from a fully qualified GP who tactfully agreed but asked me just do the urine test she has put in a request for and we'll call it all done (and the one urine test became two urine tests because I cycle ...). And final conclusion - what I said when it all started was "I'm not ill, nothing wrong".

Trouble is that from a travel insurance perspective if you refuse tests or a referral, should you claim on the medical cover it can void your insurance (several GPs have independently explained what happens and confirmed this).

Ian

Pinhead wrote: ↑19 Jun 2024, 2:56pm I have never had anything but amazing NHS treatment.

Many people do. The problem with them is that they have no conception that there are others who don't.

You should consider yourself lucky you aren't one of those instead.

axel_knutt wrote: ↑19 Jun 2024, 4:59pm

Pinhead wrote: ↑19 Jun 2024, 2:56pm I have never had anything but amazing NHS treatment.

Many people do. The problem with them is that they have no conception that there are others who don't.

You should consider yourself lucky you aren't one of those instead.

When you have had a negative experience have you followed it up with your health board ?

Retired NHS

Pinhead wrote: ↑19 Jun 2024, 5:25pm

axel_knutt wrote: ↑19 Jun 2024, 4:59pm

Pinhead wrote: ↑19 Jun 2024, 2:56pm I have never had anything but amazing NHS treatment.

Many people do. The problem with them is that they have no conception that there are others who don't.

You should consider yourself lucky you aren't one of those instead.

When you have had a negative experience have you followed it up with your health board ?

Retired NHS

It depends what it is. If I complain that e.g. it's too hard to get a quick physio appointment it won't help: reason is not enough resources and complaining will just take more resources away from care and all I'll get is "sorry".

If someone has clearly dropped the ball then that's often worth following up because reviewing what went wrong can stop it happening again.
Having said that, if part of the problem is a culture of backside-covering then it's very hard to make headway. I don't see that as endemic where I work, but my department is a very small cog in a very big machine and it would be naïve to think it doesn't happen anywhere or that some of our seven figure list of employees aren't as competent as they would ideally be.

Pete.

pjclinch wrote: ↑19 Jun 2024, 9:20pm

Pinhead wrote: ↑19 Jun 2024, 5:25pm

axel_knutt wrote: ↑19 Jun 2024, 4:59pm

Many people do. The problem with them is that they have no conception that there are others who don't.

You should consider yourself lucky you aren't one of those instead.

When you have had a negative experience have you followed it up with your health board ?

Retired NHS

It depends what it is. If I complain that e.g. it's too hard to get a quick physio appointment it won't help: reason is not enough resources and complaining will just take more resources away from care and all I'll get is "sorry".

If someone has clearly dropped the ball then that's often worth following up because reviewing what went wrong can stop it happening again.
Having said that, if part of the problem is a culture of backside-covering then it's very hard to make headway. I don't see that as endemic where I work, but my department is a very small cog in a very big machine and it would be naïve to think it doesn't happen anywhere or that some of our seven figure list of employees aren't as competent as they would ideally be.

Pete.

Pinhead wrote: ↑19 Jun 2024, 5:25pm

axel_knutt wrote: ↑19 Jun 2024, 4:59pm

Pinhead wrote: ↑19 Jun 2024, 2:56pm I have never had anything but amazing NHS treatment.

Many people do. The problem with them is that they have no conception that there are others who don't.

You should consider yourself lucky you aren't one of those instead.

When you have had a negative experience have you followed it up with your health board ?

Retired NHS

I've done a lot more than follow it up, I've been drawn into a battle that's lasted for the best part of a decade, and resulted in nothing but deliberate harm to me.

pjclinch wrote: ↑19 Jun 2024, 9:20pmit would be naïve to think it doesn't happen anywhere or that some of our seven figure list of employees aren't as competent as they would ideally be.

The problem isn't the minority who aren't competent, it's those who witness it, then cover up, close ranks, and look the other way. Only last night BBC news was reporting how the two doctors who suspected Letby was a murderer kept quiet about it. That problem's endemic.

Jdsk wrote: ↑18 Jun 2024, 3:39pm

Jdsk wrote: ↑18 Jun 2024, 3:25pm I strongly recommend checking in advance if there will be any costs in addition to that quoted for the consultation.

gbnz wrote: ↑18 Jun 2024, 3:31pm Oh,thanks. It'll be a £200 for attending etc, etc, with travel costs
...

I was thinking of their billable costs rather than your consequent costs: clinical investigations, prescriptions, medical supplies and consumables etc.

Do say if you have any more questions or concerns about private consultations.

Jonathan