Medication.....How long are you out of the UK?

[Aly]

Bulletguy, I totally understand your frustration. It does indeed seem to be a postcode lottery.

 

I have a property in Spain and have no difficulty getting three months medication from my doctor. But she doesn't remove me from her list, which Cliffy's very interesting link suggests she should be. I have found though, that I can purchase my medication over the counter in Spain (but not in UK - I found this out when I had 'lost' one of the packets - it turned up later).

 

Up until now, I have spent no more than 100 days in Spain, as this is the maximum on my insurance. But I am considering joining the MH community and hence why I am reading these forums. Health cover was one of the queries on my list.

 

As I own a Spanish property, I know about '90 day rule' and 183 day residency rule etc. (And well aware of those that ignore these).

 

I agree with you that the residency bit is bonkers. If you spend 5 months touring outside of the UK, and 7 months in the UK, you will have exceeded the 183 day requirement to be UK resident, so how can they remove your NHS entitlement? Especially when, as you say, you own property and pay taxes.

 

And reading that document, there seems to be a lot of 'blurring', with the word, 'holiday' and 'living'.

And when exactly did I sign a document stating that 'I understand that I am only allowed a one-off extended holiday once in my lifetime'?

 

I would be interested to know if anyone, such as jupe, has had any difficulty using the NHS after their 4-6 months away?

 

 

 

[Klyne]

On a more general point about advance prescriptions more and more surgeries are using online ordering which seems to be set up to implement the rules on how much medication can be ordered. Our latest version allows you the option of ordering three months supply at a time and you can order this one moth before you are due to use the last of your previous prescription. So cleaver timing could mean you have a maximum of 4 months supply but you would be lucky if that coincided with your holiday. Most basic medications for things little hypertension and diabetes are available over the counter abroad if you can produce evidence that they have been prescribed. We certainly found this in Italy. Whether that would work with the more advanced medications I don't know. With automatic ordering systems becoming increasingly common the option for doctors to prescribe more that what is allowed by the regulations might well diminish anyway?

 

David

[Bulletguy]

pepe63 - 2015-10-25 10:24 AM

 

BG..

Sorry, but It's starting to sound as if it's about being "envious" of what some others may/may not get as anything else...

 

I realised that was bound to rear it's head sooner or later. It's a shame but i find the "i'm alright jack so sod you" is becoming increasingly widespread in today's selfish society.

 

Envy? No.

 

Angry/bitter/infuriated/frustrated? You bet i am.

 

 

When renewing your prescription at 3 months,I'm assuming that you need to attend for a consultation?..

 

No......every 6 months.

 

..if not, is there nobody who could collect it and just forward it on to a given point for?...

 

Not really though it is worth pointing that out to my MP to show the craziness of all this....but then the Dept of Health would simply wave their Regulations 2004 at me to remind me that i'd be taken off my GP's list should i dare to stay out of the UK for over 3 months.

 

Also the logistics involved of trying to arrange a pick up and post on wouldn't be that straightforward. When i plan a tour the only date 'set in stone' is when i board the ferry. Everything after that is 'as and when' basis ie, i don't know which country i'm going to be in on what date or even what place in a particular country. Of course i couldn't do that when i was working.....my life was ruled by the clock. But i've been retired five years and tour now how i'd always wanted to, or how i'd always hoped/expected to.

 

 

(..if a van needs a spare part from the UK, it seems that folk don't think twice about getting them sent on...)

 

Not in my case as most Ford parts come from Germany which is the largest supplier of Mk5 Transit parts. Poland also has huge supply of Transit spares.

 

 

Aly - 2015-10-25 10:45 AM

 

Bulletguy, I totally understand your frustration. It does indeed seem to be a postcode lottery.

 

I have a property in Spain and have no difficulty getting three months medication from my doctor. But she doesn't remove me from her list, which Cliffy's very interesting link suggests she should be. I have found though, that I can purchase my medication over the counter in Spain (but not in UK - I found this out when I had 'lost' one of the packets - it turned up later).

 

Up until now, I have spent no more than 100 days in Spain, as this is the maximum on my insurance. But I am considering joining the MH community and hence why I am reading these forums. Health cover was one of the queries on my list.

 

As I own a Spanish property, I know about '90 day rule' and 183 day residency rule etc. (And well aware of those that ignore these).

 

I believe you will find it's quite a lot. Not just a handful, but tens of thousands.After all, Spain has long been the favoured destination of Brits, particularly 'retirees' spending winters there.....as a couple of my friends do....with an unlimited supply of medication courtesy of an understanding GP....or a GP who 'bends the rules (depends on what view you prefer to take).

 

I agree with you that the residency bit is bonkers. If you spend 5 months touring outside of the UK, and 7 months in the UK, you will have exceeded the 183 day requirement to be UK resident, so how can they remove your NHS entitlement? Especially when, as you say, you own property and pay taxes.

 

And reading that document, there seems to be a lot of 'blurring', with the word, 'holiday' and 'living'.

 

It is completely bonkers. I know all about 'health tourism' and the manner in which the NHS has been abused for years and as i've said, to a point i can understand this has been designed to stop that......but it's not worked as the NHS is still being abused.

 

 

And when exactly did I sign a document stating that 'I understand that I am only allowed a one-off extended holiday once in my lifetime'?

 

You didn't......The State tells you your 'allowance'! Freedom of movement and right to travel is a basic human right, yet UK Gov are restricting that. Other political parties in this country are just a smoke screen to dupe folk into a pretence of democracy. UK behaves more as a Totalitarian state.

 

 

I would be interested to know if anyone, such as jupe, has had any difficulty using the NHS after their 4-6 months away?

 

And so would i too!

[Brian Kirby]

If I understand correctly, your GP is giving you pre-dated prescriptions for one months supply of your medication, in batches of six. Do you know why s/he is doing this? It seems a very inefficient way to proceed.

 

It seems it is quite legal to issue two month prescriptions, so only three such would be required to cover the same period, and it is acceptable - subject to the GP's clinical judgement - to issue three month prescriptions, in which case only two such would be required. It seems the GP is, in effect, saying s/he wants to see you every six months, to review your condition and decide if the medication remains appropriate.

 

Also, you said above that the pharmacist refused to supply more than one months supply at a time. Do you know on what ground he did this? Broadly, if the doctor prescribes, the pharmacist should supply, with the sole proviso that the prescription does not contain an error. So, he acts as a safety backstop, but should not otherwise question the GPS's prescribing decision. It sounds to me as though he is somewhat exceeding his authority. Is there perhaps a problem between GP and pharmacist that is underlying your problems?

 

Final question: for how long do you want to be able to travel? As a group, we are a minority and, in a country of some 60 million, a small one at that. Expecting legislation/regulation to be changed to suit our preferences, no matter how reasonable we think our preferences, is likely to lead to disappointment, IMO. You won't achieve much more by going at this head-on than a re-statement of the current rules, and possibly a crack down that will restrict the freedom of GPs to interpret the existing guidelines in the interests, as they see it, of their patients. In short, an own goal. It takes doctors a long time to qualify, and they are unlikely to respond well to attempts to push them around.

 

You say your friend, whose GP is inclined to a more flexible approach, lives only about 15 miles from you. I assume his GP is not that far distant either? So, change doctor. Surely simpler and less time consuming than writing to MPs and looking for ammunition on here to assist your campaign which, I'm sorry to say, does seem to be a little reminiscent of tilting at windmills. I assume you don't see your GP that often, so would the journey not be worth the benefit to you of his/her more, shall we say informed, approach? If necessary, also change pharmacy to the one your friend uses. When you cease travelling you can always change back, if necessary. Surely better to discreetly exit than to alienate those you may have to rely on in future. If the gap between changing and returning is several years, they will probably have forgotten who you are in any case! It's that thing about not slamming the door as you leave.

[Bulletguy]

Brian Kirby - 2015-10-25 7:21 PM

 

If I understand correctly, your GP is giving you pre-dated prescriptions for one months supply of your medication, in batches of six. Do you know why s/he is doing this? It seems a very inefficient way to proceed.

 

It seems it is quite legal to issue two month prescriptions, so only three such would be required to cover the same period, and it is acceptable - subject to the GP's clinical judgement - to issue three month prescriptions, in which case only two such would be required. It seems the GP is, in effect, saying s/he wants to see you every six months, to review your condition and decide if the medication remains appropriate.

 

Pre-dated as per month. Eg; Nov, Dec, Jan, Feb, Mar, Apr would be a full 6 x 1 monthly supply but the Pharmacist will only dispense that, ONE month supply at a time, unless instructed otherwise by the GP ie requiring the whole amount to be put on a SINGLE prescription. Eg if 3 months then it must be 3 months amount on the ONE prescription.

 

Also, you said above that the pharmacist refused to supply more than one months supply at a time. Do you know on what ground he did this?

 

Because like my GP he sticks firmly to 'the rules'. By law he cannot (or isn't supposed to) dispense pre-dated prescriptions as a batch. The young lady who previously ran the Pharmacy would do this, hence why i never had this issue until a couple of years ago, but then she left and that's how i eventually found discovered what i was up against.

 

The other point i mentioned is Pharmacists receive payment PER prescription so for obvious reasons, prefer lots of separate prescriptions rather than one. I know this is a fact as one of the women who work there let it slip during conversation. No idea if it was intentional or not. Whether GP's receive payment too i've no idea but it wouldn't surprise me in the least.

 

Broadly, if the doctor prescribes, the pharmacist should supply, with the sole proviso that the prescription does not contain an error. So, he acts as a safety backstop, but should not otherwise question the GPS's prescribing decision. It sounds to me as though he is somewhat exceeding his authority. Is there perhaps a problem between GP and pharmacist that is underlying your problems?

 

He does......but when it comes to 'the rules' he and my GP are like flypaper. When i eventually caved in to defeat by my GP this year and grudgingly accepted the 3 month prescription in order to get away, he cocked it up three times until one of the Pharmacy assts stepped in and went to my GP's surgery himself to get the prescription written out correctly.

 

Final question: for how long do you want to be able to travel?

 

Ideally 15 - 18 weeks. Hardly asking for the earth is it? Anyone would think i'm attempting to defect to Russia!

 

As a group, we are a minority and, in a country of some 60 million, a small one at that. Expecting legislation/regulation to be changed to suit our preferences, no matter how reasonable we think our preferences, is likely to lead to disappointment, IMO. You won't achieve much more by going at this head-on than a re-statement of the current rules, and possibly a crack down that will restrict the freedom of GPs to interpret the existing guidelines in the interests, as they see it, of their patients. In short, an own goal. It takes doctors a long time to qualify, and they are unlikely to respond well to attempts to push them around.

 

And i'm going to achieve absolutely zilch by keeping my trap shut and head down. Oh i know some people don't like folk like me who they see as 'trouble makers' or 'rocking the boat', but then they aren't facing the same issues. If they were, they'd have a very different view and singing from the same hymn sheet as mine. Back to what i said earlier about the "i'm alright jack, sod you" which is all too common with folk today.

 

You say your friend, whose GP is inclined to a more flexible approach, lives only about 15 miles from you. I assume his GP is not that far distant either? So, change doctor.

 

Impossible.

 

The GP's surgery you are a patient of is dictated by geographics. You cannot simply decide you want to go to a GP practice 15 miles away as they can't take you on as a patient unless you live within the area they cover.

 

Where i live now is just 5 miles away from where i used to live, yet when i moved here the GP i used told me he wouldn't be able to keep me on his list and had my files transferred over to the surgery i'm with now. My friend might only live 15 miles away, but we both live in entirely separate counties let alone city,town or village.

[Tiggy]

Wow, what a can of worms! Looks like I was lucky. Interesting point is that the main reason given is that the doctor actually reviews the prescription every month. That's laughable, he probably doesn't even read it, normally the chemist just phones up and a new one is issued. The only time it gets reviewed is when I see a consultant, once every six months, as at that point they do the bloods that tell them what is happening. So Mr Hunt's arguments don't hold any water. Further, we paid for our little Aussie trip by renting out our house, which was taxable income as far as HMRC was concerned, although technically we should have struck off the NHS register while we were away. Seems like madness to me, but I can also see why they are trying to do something, as I'm not sure about UK citizens living permanently overseas being still entitled to the NHS. It all seems a bit strange to me, as I' sure the idea of UK Nationals being overseas for months on end is not a new one,so it's weird that the don't have a better system for coping with it.

[StuartO]

The NHS delivers service to UK citizens which is free at the point of service in UK, except of course for prescription charges. It souldnt be surprising that the central NHS policy aims to limit its obligations outside these parameters when it can - but equally it should not be surprising that some GPs will help by ignoring the rules, especially if you are nice to them. Presumably the rule about only two months prescription at a time (or whatever it is) is aimed at limiting cost of drugs and the one about de-registering with your GP if you leave the country for more than 3 months will be aimed at stopping the capitation payment to the GP. The NHS administration would like all GP practices to follow all the rules all the time but of course they don't do that.

 

I suggest that it's no use banging the table in your efforts to get a bigger allowance of travel medication, that will do no good at all: the NHS system will dig its heels in and so will GPs if you start trying to criticise or bully them. The last thing they want to listen to in their surgery is a lecture about how unfair the NHS is.

 

You will always get the best out of the NHS by avoiding making a fuss except as a last resort and by cultivating friendly relationshsips with those who deliver the service to you. So be nice to the reception staff as well as to the GPs and ask especially nicely if, in effect, you want them to break the rules for you. Most doctors want to be helpful, especially to nice, respectful patients and that can work in your favour if you let it.

 

Plan ahead and try to build up your stock of medication by asking for next month's repeat early on some pretext and then do it again a while later. Then ask for three months supply just before you go away and settle for two months without complaint if that's all they will issue. You could try looking crestfallen and upset because you dont think you will be able to cope with going to a foreign doctor and explaining your problems and perhaps even bursting into tears at the prospect, but whatever you do, don't start banging the table. Take the trouble to pick a quieter time at the Surgery to go in and make your request rather than when it's busy.

 

If you have already blown it by making yourself a complaining nuisance to your GP Practice, change to a different one and don't make the same mistake twice.

[Brian Kirby]

Bulletguy - 2015-10-25 8:46 PM

 

Pre-dated as per month. Eg; Nov, Dec, Jan, Feb, Mar, Apr would be a full 6 x 1 monthly supply but the Pharmacist will only dispense that, ONE month supply at a time, unless instructed otherwise by the GP ie requiring the whole amount to be put on a SINGLE prescription. Eg if 3 months then it must be 3 months amount on the ONE prescription.

Then it seems the pharmacist is doing what I would expect, and following the doctor's directions. So, the root source of the problem is the way the doctor is prescribing. You didn't answer my question as to why the doctor is doing this. Do you know why this slightly bizarre practice is being followed?

 

The other point i mentioned is Pharmacists receive payment PER prescription so for obvious reasons, prefer lots of separate prescriptions rather than one. I know this is a fact as one of the women who work there let it slip during conversation. No idea if it was intentional or not. Whether GP's receive payment too i've no idea but it wouldn't surprise me in the least.

I think this is largely irrelevant, somewhat speculative, and is clouding your main issue: i.e. the way the GP prescribes.

 

He (the pharmacist) does......but when it comes to 'the rules' he and my GP are like flypaper.

Which, again, is as it should be. There seems little point criticising people for following the instructions of their employer.....................................

 

Final question: for how long do you want to be able to travel?

 

Ideally 15 - 18 weeks.

Ah, so over three months. Even so, this does not seem to lie at the heart of your problem. If you admit that to the doctor, they will possibly respond by advising that by doing this you will remove yourself from their register. However, if you can win the doctor over to prescribing three months supply on a single prescription, you could then argue (meaning ask nicely :-)) that you would need a further "buffer supply", possibly to be drawn shortly before you leave, so that you have medication when you return (maybe in case of unavoidable delay), rather than coming back on your last pill. So, two prescriptions to be fulfilled with an overlap between them, allowing you to return with medication in hand, while not exceeding the permitted amount on any single prescription, so no eyebrows raised. This seems to be an arrangement others have arrived at, and no-one's backside is put in the firing line.

 

As a group, we are a minority and, in a country of some 60 million, a small one at that.....................

 

And i'm going to achieve absolutely zilch by keeping my trap shut and head down.

.

And I think you will achieve zilch, except perhaps a DfH crackdown on prescribing practice, by being confrontational. As Klyne and Stuart and I have all suggested, the best approach is likely to be to work with the system, rather then trying to change it. It just requires a bit of compromise.

 

.............................................................You say your friend, whose GP is inclined to a more flexible approach, lives only about 15 miles from you. I assume his GP is not that far distant either? So, change doctor.

 

Impossible.

 

The GP's surgery you are a patient of is dictated by geographics. You cannot simply decide you want to go to a GP practice 15 miles away as they can't take you on as a patient unless you live within the area they cover.

 

So, are you literally restricted to this one practice, or is there another, nearer, with which you could register?

 

If not, what about a chat to whichever bit of health authority you/the GP comes under, to see if a reasonable compromise can be reached?

 

What you want to be able to do is not that unusual, though for obvious reasons it is not commonplace.

 

There seems no question of excess prescribing, as you would consume the same amount of medication over the same timespan, however it is prescribed. It is just finding a workaround solution that allows everyone to stay within their working frameworks.

 

If your condition is broadly stable, it seems the periods you propose travelling would not leave you at risk - unless the doctor is supposed to check your condition periodically, and your absences would exceed that timescale. However, the supply of six months prescriptions at a time suggests this is not the case.

 

I assume all the medication is viable for 3 - 4 months at a time, or could this be the stumbling block?

 

I'm still puzzling why, if issuing prescriptions for a total period of six months, the GP is doing so one months at a time, and is so dating the prescriptions that only that single month can be fulfilled by the pharmacist. This sounds to me as though the GP is deliberately restricting either you, or the pharmacist, from exercising any initiative that would allow either of you to accommodate "life".

 

So, we circle back to the GP, and why this particular practice is being adopted. Do you know why?

[pepe63xnotuse]

I haven't read it in depth but this states that you can sign up to a GP practice,even if you are outside of their "boundary" (..capacity permitting).

 

http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/patient-choice-GP-practices.aspx

 

I know for a fact that I have family members who are signed up to, and use, GP practices near to where they work, as opposed near to where they live. :-S

 

(Having said that, GPs in our area don't cover "call-outs" anyway, so the fact you don't live just around the corner, probably doesn't matter to them.)

 

 

[Bulletguy]

Brian Kirby - 2015-10-26 12:09 PM

 

Then it seems the pharmacist is doing what I would expect, and following the doctor's directions. So, the root source of the problem is the way the doctor is prescribing. You didn't answer my question as to why the doctor is doing this. Do you know why this slightly bizarre practice is being followed?

 

I think you've misunderstood or misinterpreting what i wrote Brian and am not sure how much more clarity i can provide..

 

My GP issues me with 6 prescriptions at a time. Each covers a ONE month supply, so prescription 'A' (as we will call it) will give me November. Prescription 'B' December, prescription 'C' January......and so on until all six have been used. But the Pharmacist cannot dispense A B C D E and F in ONE LOT together as it's actually illegal and a Pharmacist doing this can get into trouble. However, if the GP issues ONE SINGLE prescription for ABCDE and F amounts, in other words SIX MONTH TOTAL amount then the Pharmacist is legally able to dispense. In the case of poster Tiggy, that is what her GP must have given her for a 9 month supply. Her GP is 'bending the rules'......according to the Dept of Health. That's what i'm asking for and i would have thought it fairly clear to see from other posters that it is done.

 

 

I think this is largely irrelevant, somewhat speculative, and is clouding your main issue: i.e. the way the GP prescribes.

 

Far from speculation that point is a fact Brian regarding Pharmacists. As for GP's i don't know but i said that in the previous post.

 

Which, again, is as it should be. There seems little point criticising people for following the instructions of their employer................

 

Except some GP's and Pharmacist's are obviously not and that's what i'm critical of. Can you not see the points i've been making all along? Have you read other posts where one is being given a 9 month supply and another 4 months? Are you telling me those GP's are 'following the instructions of their employer'?

 

 

Ah, so over three months. Even so, this does not seem to lie at the heart of your problem. If you admit that to the doctor, they will possibly respond by advising that by doing this you will remove yourself from their register.

 

Read the above ^^

 

And I think you will achieve zilch, except perhaps a DfH crackdown on prescribing practice, by being confrontational. As Klyne and Stuart and I have all suggested, the best approach is likely to be to work with the system, rather then trying to change it.

 

I hardly think a retired bullet maker is likely to pose a threat to Government or change NHS regulations! But why would anyone worry or concern themselves over that?

 

......It just requires a bit of compromise.

 

Hallelujah.....if only i could get some of that!!

 

 

So, are you literally restricted to this one practice, or is there another, nearer, with which you could register?

 

If not, what about a chat to whichever bit of health authority you/the GP comes under, to see if a reasonable compromise can be reached? What you want to be able to do is not that unusual, though for obvious reasons it is not commonplace.

 

As far as i know, yes. Precisely what GP practices fall into my area i've no idea. If i do approach another then i'm going to have to tell them the reason why and i want a GP who will give me above the 3 month norm.

 

 

If your condition is broadly stable, it seems the periods you propose travelling would not leave you at risk - unless the doctor is supposed to check your condition periodically, and your absences would exceed that timescale. However, the supply of six months prescriptions at a time suggests this is not the case.

 

Very, (to the bib) but let me just say this. One of the meds i take is essential and would be extremely high risk to drive without it. Though i've already found i can purchase it online from a company in the US, i'm reluctant to go down that path......not because of cost, but using 'worst case scenario' i collapse at the wheel or run someone over and kill them, the sh*t would hit the fan big time as questions would be asked as to what medication i'm on and who prescribed it. Once it was found i'd bought it from an online supplier, my GP would be absolved of any negligence and i'd be standing in the dock. So i've ruled that out as i'm not prepared to take that risk.

 

I assume all the medication is viable for 3 - 4 months at a time, or could this be the stumbling block?

 

Not sure what you mean by this? If the 'use by' date, then it's three years.

 

I'm still puzzling why, if issuing prescriptions for a total period of six months, the GP is doing so one months at a time, and is so dating the prescriptions that only that single month can be fulfilled by the pharmacist. This sounds to me as though the GP is deliberately restricting either you, or the pharmacist, from exercising any initiative that would allow either of you to accommodate "life".

 

So, we circle back to the GP, and why this particular practice is being adopted. Do you know why?

 

Because legally that's how they are supposed to issue and legally how the Pharmacist is supposed to dispense.

 

To get a 3 month supply the GP needed to issue ONE SINGLE prescription with the whole 3 months meds on before the Pharmacist will dispense.

[Bulletguy]

StuartO - 2015-10-26 9:30 AM

 

The NHS delivers service to UK citizens which is free at the point of service in UK, except of course for prescription charges. It souldnt be surprising that the central NHS policy aims to limit its obligations outside these parameters when it can - but equally it should not be surprising that some GPs will help by ignoring the rules, especially if you are nice to them……..

 

Well I'm not on a PR exercise. I'm simply asking for a little leeway……just as many other people benefit from year in year out.

 

 

Plan ahead and try to build up your stock of medication by asking for next month's repeat early on some pretext and then do it again a while later. Then ask for three months supply just before you go away and settle for two months without complaint if that's all they will issue.

 

I already explained in other posts Stuart that i've made previous attempts at 'stocking up' on meds by earlier prescriptions but my Surgery keep a very tight rein and i'm simply told "you still have another months prescription left so we won't issue until that's being used". I know the reasons for this as people 'stockpiling' medication is rampant and costs the NHS a fortune, though it would seem from what you and others say, the practice is widespread. I'm well aware of it..

 

[Bulletguy]

pepe63 - 2015-10-26 12:33 PM

 

I haven't read it in depth but this states that you can sign up to a GP practice,even if you are outside of their "boundary" (..capacity permitting).

 

http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/patient-choice-GP-practices.aspx

 

 

Interesting link. I see it only came in in January 2015.

 

According to that i could actually register at the same GP practice my friend uses who would give me whatever amount meds i needed to go away with.

 

Hhhmmmm.........i wonder what my GP would have to say about transferring out?!!

[Brian Kirby]

Bulletguy - 2015-10-26 6:55 PM

 

Be patient, Paul, I'm trying to help! :-)

 

I think you've misunderstood or misinterpreting what i wrote Brian and am not sure how much more clarity i can provide..........

I had understood that, and that is what I thought I had set out in my para. My point is that it is the GP's prescribing practice that is tying the pharmacist's hand, rather that the pharmacist being uncooperative as you had seemed to infer, and it is that which underlies your problem. So yes, it is a fact that the pharmacist must comply with the GP's prescription instructions. No misunderstanding there...........................

 

Except some GP's and Pharmacist's are obviously not and that's what i'm critical of. Can you not see the points i've been making all along? Have you read other posts where one is being given a 9 month supply and another 4 months? Are you telling me those GP's are 'following the instructions of their employer'?

Yes I have read, and have understood. However, your central argument is, IMO, flawed. What you are arguing is one of two things. Either that because others breach guidelines, regulations, or whatever, your GP should be coerced into doing the same, or that the rules should be changed to allow all GPs the same latitude. What I'm saying is that, IMO, that tack simply won't bear fruit. I just think you're wasting your time pursuing it....................................

 

I hardly think a retired bullet maker is likely to pose a threat to Government or change NHS regulations! But why would anyone worry or concern themselves over that?

Because that is exactly what you appear to be asking the DoH to do................................

 

As far as i know, yes. Precisely what GP practices fall into my area i've no idea. If i do approach another then i'm going to have to tell them the reason why and i want a GP who will give me above the 3 month norm.

If you put it in those terms, then any GP would be cautious about taking you onto their book, or giving you the required dose. You need to present your problem in a way that doesn't start alarm bells ringing, that allows the GP to get you what you want without putting a noose round his own neck..............................

 

So, it isn't that you need to see the GP more frequently, or that your medications have a short shelf life or complex storage requirements. It is, purely and simply, that the way your GP is issuing prescriptions is causing the problem. This is not the way prescriptions are "legally" supposed to be issued. Read again your reproduced the extract from Hunt/DoH, in which it is accepted that there is latitude to issue prescriptions for longer periods, subject to the GP's clinical judgement.

 

The point about being de-registered from NHS eligibility after three months need not be an insurmountable barrier. Your GP would be within his accepted prescribing latitude to give you one prescription for three months supply of your medication without specifying particular months within which the medication must be supplied. From this string, and my own experience, this seems quite commonplace. You then present the prescription to the pharmacist when you see fit, and get the whole three months supply in one hit. If you were later to present a request for a further three months prescription, so that you are assured of having an adequate supply when you return, you get your four months supply and, if you don't make an issue over how long you are going to be away, the GP is not put into a difficult position. That is what I and others have been trying to suggest to you. How you arrive at that position will require a bit of carefully discreet diplomacy.

[Bulletguy]

Brian Kirby - 2015-10-27 12:26 AM

 

I had understood that, and that is what I thought I had set out in my para. My point is that it is the GP's prescribing practice that is tying the pharmacist's hand, rather that the pharmacist being uncooperative as you had seemed to infer, and it is that which underlies your problem. So yes, it is a fact that the pharmacist must comply with the GP's prescription instructions. No misunderstanding there................

 

Just as GP's should be fully complying to the regulations......but some aren't and we both know that is a fact.

 

Yes I have read, and have understood. However, your central argument is, IMO, flawed. What you are arguing is one of two things. Either that because others breach guidelines, regulations, or whatever, your GP should be coerced into doing the same, or that the rules should be changed to allow all GPs the same latitude. What I'm saying is that, IMO, that tack simply won't bear fruit. I just think you're wasting your time pursuing it.......................

 

I probably am. I would prefer some sound logical reasoning to take place but it seems i'm p*ssing in the wind when it comes to expecting that and will have to revert to underhanded, unscrupulous, devious methods which i didn't want to do. Not because i'm some holy joe on a mission from God but purely peace of mind more than anything.

 

I've just had email from another friend who regularly spends winters in Spain which is where both he and his wife currently are. They have their meds posted on by a family relative, but were completely unaware about the possibility of being removed from a GP's list. They use their relatives address so i advised them to keep quiet about that as well as how long they spend out of the UK.

 

Because that is exactly what you appear to be asking the DoH to do.

 

Take more than an ex-bullet maker to become law maker.

 

If you put it in those terms, then any GP would be cautious about taking you onto their book, or giving you the required dose. You need to present your problem in a way that doesn't start alarm bells ringing, that allows the GP to get you what you want without putting a noose round his own neck.

 

Before moving to another practice i'd need to know if any of the GP's would issue me with a 4 or 4+mth prescription, otherwise there'd be no point in changing. And there's only one way to find that out........ask them.

 

So, it isn't that you need to see the GP more frequently, or that your medications have a short shelf life or complex storage requirements. It is, purely and simply, that the way your GP is issuing prescriptions is causing the problem. This is not the way prescriptions are "legally" supposed to be issued. Read again your reproduced the extract from Hunt/DoH, in which it is accepted that there is latitude to issue prescriptions for longer periods, subject to the GP's clinical judgement.

 

I know there is (bib). 3 months. I want longer.

 

The point about being de-registered from NHS eligibility after three months need not be an insurmountable barrier. Your GP would be within his accepted prescribing latitude to give you one prescription for three months supply of your medication without specifying particular months within which the medication must be supplied. From this string, and my own experience, this seems quite commonplace. You then present the prescription to the pharmacist when you see fit, and get the whole three months supply in one hit. If you were later to present a request for a further three months prescription, so that you are assured of having an adequate supply when you return, you get your four months supply and, if you don't make an issue over how long you are going to be away, the GP is not put into a difficult position. That is what I and others have been trying to suggest to you. How you arrive at that position will require a bit of carefully discreet diplomacy.

 

That might work with your GP but mine wouldn't wear it. He'd issue me ONE SINGLE three month prescription to go away with. Now........if i phone five or six weeks later and ask for another ONE SINGLE 3 month, i wouldn't even get past the receptionist in trying to pull that. They'd tell me within seconds i'd already had an issue and wouldn't get another.

 

[pepe63xnotuse]

BG(Paul?)

 

You posted not so long back that it was "impossible" to change to a different GP(out of your area)

 

That link that I posted, took all of a minute to find ( I searched something like " Can I sign up to a GP Practice not in my immediate area?"), and it was only the second NHS link down, so hardly buried away.

 

Now, if I found that, why couldn't you? :-S (too wrapped up contacting MPs and getting wound up about it posting on here, maybe? ;-) )

 

You say that you have friends who say that they are able to get 4-5 months worth of meds from their GP(for when in Spain), so you know that it is possible..and even if it is strictly speaking against the "rules" and/or that people should really be un-registering etc, as long as the GP is happy to allow such leeway, what does it matter?.......

 

Better to look for a real-world solution, rather than wasting your time campaigning/complaining, based just on the fact that some people are able to break rules that you aren't. ;-)

[Brian Kirby]

Bulletguy - 2015-10-27 2:52 AM..........................That might work with your GP but mine wouldn't wear it. He'd issue me ONE SINGLE three month prescription to go away with. Now........if i phone five or six weeks later and ask for another ONE SINGLE 3 month, i wouldn't even get past the receptionist in trying to pull that. They'd tell me within seconds i'd already had an issue and wouldn't get another.

Obviously, you must do what you find reasonable, and what you are comfortable with. I seem to remember that these restrictions were introduced, at least in part, to prevent abuses of the system where people were able to obtain large quantities of drugs on repeat prescriptions, take them abroad, and sell them. So, if my memory is right, they were a bit of a blunt instrument to prevent a considerable fraud being carried out by a small group of people.

 

Looking at what you've said above, it seems speculative. You say "wouldn't", not don't, you say "they'd tell me", not they have told you. So (and I don't expect an answer to this), have you put your problem to the GP in terms of how he can help you achieve your goal?

 

It would be unwise to go away for three months with just three months supply of medication to last you. You would come back with nothing to take, and if delayed you'd be in the poo! It seems there is nothing in your condition that requires the doctor to see you at more frequent intervals than six months, and your medication will comfortably last the duration you propose travelling. Your only obstacle is the way the prescriptions are being written, which is not, in my experience, and it seems the experience of others, "normal".

 

We both need some regular medication. We are both with the same group practice, but are registered with different GPs. We don't actually exceed three months away at a time, but we both have repeat prescriptions for three months supply at a time, that we request via the standard repeat prescription requests. The prescriptions are then passed to the nearby pharmacy by the practice, where they are completed ready for one or other of us to collect. Occasionally, a prescription will be annotated for one or other of us to see the GP, or make an appointment for a blood test. We decide when we need the repeats, and arrange these to give adequate cover for a while both before we leave, and after we have returned, as well as for the trip itself. We usually request the prescriptions about a fortnight before we will leave, in case the GP wants to see either of us in the meantime. We depart with a full three moths supply in the van (in case of delays) plus at minimum a week's supply at home to await our return. So, in total, we will at minimum have a stock of medication of about 15 weeks, that we will, as would you, consume in due course. Both GPs are aware that we travel for several weeks at a time, but have never made a point about how long. We are left to manage the supply of the medications we need to suit our requirements - though I'm pretty sure questions would be asked if they thought we were taking liberties!

 

This is the kind of arrangement I think you would ideally like. It is a question of getting there without the pharmacist or the GP having to have your requirements spelled out to them in full detail. It is just one of those arrangements that works around restrictions which exist to prevent abuses, when there is unspoken acceptance that such abuses will not arise, without anyone being put on the spot in an embarrassing way.

 

I don't consider this to be "underhanded, unscrupulous, devious". I see this as the way reasonable people circumvent restrictions that were never designed to prevent what they propose doing, but would unreasonably restrict them from so doing if applied to the letter.

 

After all, you are not proposing to flee the country with a pile of drugs to sell on the black market, just to be cut a little slack. I really think a little discreet negotiation and enquiry will get you there, but that tackling the problem head on, by trying to exert direct pressure, will not. Good luck with whatever course you follow.

[Bulletguy]

pepe63 - 2015-10-27 8:53 AM

 

BG(Paul?)

 

You posted not so long back that it was "impossible" to change to a different GP(out of your area)

 

That link that I posted, took all of a minute to find ( I searched something like " Can I sign up to a GP Practice not in my immediate area?"), and it was only the second NHS link down, so hardly buried away.

 

I had already responded to your post, but you seem not to have noticed. New legislation which came in this year hence the reason i didn't know about it. Interesting that the Dept of Health didn't inform me of that as an option isn't it?

[Bulletguy]

Brian Kirby - 2015-10-27 1:29 PM

 

Bulletguy - 2015-10-27 2:52 AM..........................That might work with your GP but mine wouldn't wear it. He'd issue me ONE SINGLE three month prescription to go away with. Now........if i phone five or six weeks later and ask for another ONE SINGLE 3 month, i wouldn't even get past the receptionist in trying to pull that. They'd tell me within seconds i'd already had an issue and wouldn't get another.

 

I seem to remember that these restrictions were introduced, at least in part, to prevent abuses of the system where people were able to obtain large quantities of drugs on repeat prescriptions, take them abroad, and sell them. So, if my memory is right, they were a bit of a blunt instrument to prevent a considerable fraud being carried out by a small group of people.

 

Looking at what you've said above, it seems speculative. You say "wouldn't", not don't, you say "they'd tell me", not they have told you. So (and I don't expect an answer to this), have you put your problem to the GP in terms of how he can help you achieve your goal?

 

You are indulging semantics to try making a point Brian.

 

Look......i've lived here for 21 years now and being a person on regular prescribed medication, i reckon in that time i've found how my GP practice 'works'. Far from 'speculative' what i wrote is fact over how my GP's practice works. I'm not really bothered that you doubt me as you don't attend the practice......i do. Yes obviously the GP knows i'm not happy and yes, i asked if there is any other way. His reply was a firm flat resounding 'no....3 month max take it or leave it'. He will not budge one millimetre.

 

I've never heard of anyone selling their medication. Seems a bit counter productive to me. However i have heard of people 'stockpiling' large quantities, some because they can't be ars*d to call in at a Pharmacy each month, others to enable lengthy stays away from the UK.

 

 

Your only obstacle is the way the prescriptions are being written, which is not, in my experience, and it seems the experience of others, "normal".

 

We both need some regular medication. We are both with the same group practice, but are registered with different GPs. We don't actually exceed three months away at a time, but we both have repeat prescriptions for three months supply at a time, that we request via the standard repeat prescription requests.

 

My GP will not do that (bib) even when i'm at home. I've asked and he told me he will only issue me with the 3 month single prescription for purpose of going out of UK. To quote his words verbatim, "the NHS guideline maximum is 2 months but we will go to ONE extra month making out a 3 months prescription". He will NOT do that on a regular basis.

 

What you must accept Brian as can be very clearly seen by other posts, is not all GP's work to the same criteria. Now, whether we term this as 'bending the rules' or simply being more flexible is a matter of how one chooses to define it, but the bottom line is some GP's are more than others. Despite the NHS regulations 2004 the DoH are so keen to wave at me, there is no consistency.

 

 

I don't consider this to be "underhanded, unscrupulous, devious". I see this as the way reasonable people circumvent restrictions that were never designed to prevent what they propose doing, but would unreasonably restrict them from so doing if applied to the letter.

 

After all, you are not proposing to flee the country with a pile of drugs to sell on the black market, just to be cut a little slack. I really think a little discreet negotiation and enquiry will get you there, but that tackling the problem head on, by trying to exert direct pressure, will not. Good luck with whatever course you follow.

 

Given the hoops 'n hurdles they have me jumping through and over i think the 'powers that be' are probably more afraid of me fleeing the damn country than flogging drugs which i need myself. Drugs which are neither dangerous nor addictive and won't even give you 'a high'.

 

Cutting some slack would be nice and all i want. As said before, 15 -18 weeks is hardly asking for the earth though anyone would think i'm about to suck up the entire NHS budget.

[Brian Kirby]

Bulletguy - 2015-10-27 5:13 PM

 

Brian Kirby - 2015-10-27 1:29 PM..........................Looking at what you've said above, it seems speculative. You say "wouldn't", not don't, you say "they'd tell me", not they have told you. So (and I don't expect an answer to this), have you put your problem to the GP in terms of how he can help you achieve your goal?

 

You are indulging semantics to try making a point Brian.

 

No, and I wasn't seeking to make a point: just to explain my reason for asking the question.

 

I am not doubting what you say (or your very evident frustration!), rather I have been trying to suggest ways in which you may be able to get around what sounds like a very narrow, and unhelpful, interpretation of the rules by your GP. I wonder if he's been disciplined for careless prescribing in the past?

 

The fraud, IIRC, had nothing to do with the perpetrators selling their own medication, but encouraging anyone that knew who was on saleable drugs to use their repeat prescriptions to build up stockpiles, which they would then take to third world countries and sell. Those stockpiling got a cut from the profits.

 

My GP will not do that (bib) even when i'm at home. I've asked and he told me he will only issue me with the 3 month single prescription for purpose of going out of UK. To quote his words verbatim, "the NHS guideline maximum is 2 months but we will go to ONE extra month making out a 3 months prescription". He will NOT do that on a regular basis.

Then, I personally think he is being unreasonable, and is not using his professional judgement when assessing how to facilitate your reasonable wishes. Other than keeping his own backside clean, I can't see any good reason for him being so restrictive. You will use the drugs in due course, so how many he prescribes at once has no bearing on the quantity you will use, so no impact on the bill to the NHS. In fact, he seems to me almost to be using his position to punish you. Those not on medication can push off for as long as they wish, and I doubt many pop into their GP before they go and say "I'm off for six months, please take me off your register, I'll re-register when I get back!" How many people in that position even know about this rule? It is discriminatory in its impact.

 

What you must accept Brian as can be very clearly seen by other posts, is not all GP's work to the same criteria. Now, whether we term this as 'bending the rules' or simply being more flexible is a matter of how one chooses to define it, but the bottom line is some GP's are more than others. Despite the NHS regulations 2004 the DoH are so keen to wave at me, there is no consistency.

The lack of consistency has long been evident, and is implicit in my description of how it works for us. If you take a bunch of professionally trained and qualified people, and confront them with a set of rules, most will interpret the rules in the manner they judge best: in the case of GPs, best for their patient's overall wellbeing. However, they will never be consistent, because they will each use their own judgement. Your guy seems to me to have become hidebound by the letter of the rules, and to have lost sight of the circumstances they are designed to prevent. The DoH will, of course back him in this, they are their rules. Someone needs to have a quiet chat, rather than putting things in writing.

 

However, it seems plain to me he is your problem, and it is him you seem to me to need to get around. After all, with a maximum of only three months supply, you could not realistically travel for even three months - unless you were to collect the drugs the day you leave, and have another supply waiting the day you get back. So, my conclusion is that to get where you want to be, you have to change GP, which will mean changing the practice you are registered with.

 

A reasonable GP would understand what you want to do and, providing you don't make an issue of four months, would accept the procedure of running two three month prescriptions in parallel as the logical solution. An unreasonable one would not, so a talk before registering would seem wise, leaving you free to try elsewhere without gathering a trail of rejected GP's in your wake.

[derek pringle]

hi all,

I agree with trying to legally work within and around the system, however, it will be very hard for Bulletguy as he would need some flexibility from his G.P which seems not forthcoming especially enough to cover the length of time he likes to be away for. I really sympathize when obviously others can receive prescriptions for as long as necessary.

Does the G.P surgery not have a Practice Manager you could have a chat with as it doesn't seem you will get far face to face with the G.P.

The only thing that does worry me is when things are pursued to the nth degree it can end up with a 'dumbing down' or reversion to the lowest common denominator where everybody who is getting satisfaction now could lose out.

good luck Bulletguy and hope you find a resolution to your problem.

derek

[Bulletguy]

Brian Kirby - 2015-10-27 7:07 PM

 

I am not doubting what you say (or your very evident frustration!), rather I have been trying to suggest ways in which you may be able to get around what sounds like a very narrow, and unhelpful, interpretation of the rules by your GP. I wonder if he's been disciplined for careless prescribing in the past?

 

Not to my knowledge. He's the longest serving there and know from what neighbours have said, is well respected.

 

 

Then, I personally think he is being unreasonable....

 

So do i.

 

....and is not using his professional judgement when assessing how to facilitate your reasonable wishes. Other than keeping his own backside clean, I can't see any good reason for him being so restrictive. You will use the drugs in due course, so how many he prescribes at once has no bearing on the quantity you will use, so no impact on the bill to the NHS. In fact, he seems to me almost to be using his position to punish you.

 

Those not on medication can push off for as long as they wish, and I doubt many pop into their GP before they go and say "I'm off for six months, please take me off your register, I'll re-register when I get back!" How many people in that position even know about this rule? It is discriminatory in its impact.

 

Precisely how i put it over to my MP.

 

In their efforts to stem the flow of 'health tourism' (which i agree with), Government legislation has inadvertently penalised those on regular prescribed medication. The letter i received from my local NHS group suggesting that i should register with a doctor in the country of my travel is completely impractical as anyone who tours will know.

 

 

Your guy seems to me to have become hidebound by the letter of the rules, and to have lost sight of the circumstances they are designed to prevent. The DoH will, of course back him in this, they are their rules. Someone needs to have a quiet chat, rather than putting things in writing.

 

I think it's probably a bit late in the day for 'quiet chats'. At a 'guesstimate' I'd say he's now in his early 50's so will be planning retirement before long. He's a pleasant enough bloke, just bloody stubborn. I'm not prepared to roll over and kowtow.

[Bulletguy]

derek pringle - 2015-10-28 9:33 AM

 

hi all,

I agree with trying to legally work within and around the system, however, it will be very hard for Bulletguy as he would need some flexibility from his G.P which seems not forthcoming especially enough to cover the length of time he likes to be away for. I really sympathize when obviously others can receive prescriptions for as long as necessary.

 

Does the G.P surgery not have a Practice Manager you could have a chat with as it doesn't seem you will get far face to face with the G.P.

 

The only thing that does worry me is when things are pursued to the nth degree it can end up with a 'dumbing down' or reversion to the lowest common denominator where everybody who is getting satisfaction now could lose out.

good luck Bulletguy and hope you find a resolution to your problem.

derek

 

No there isn't a Practice Manager, just two senior GP's of which he is one who own and run the practice. I could ask to see his partner, but he's very unlikely to go against him. They run the place. They are 'God'!!

 

I wouldn't worry too much about your final para. As i've said before, who the hell is going to take any notice of me? I'm just a retired bullet maker who can be a bit of a nuisance that authority hopes will shut up and go away.

 

Thanks for the wishes.....i will resolve the problem one way or another.

[Tea Cup]

My local practice offers online repeat prescriptions, to be collected at chosen pharmacy. It has occurred to me that this could be collected for me and posted on by a friend or relative. I don't see why this wouldn't work (customs not being an issue in the EU?)

[Bulletguy]

Tea Cup - 2015-10-28 6:19 PM

 

My local practice offers online repeat prescriptions, to be collected at chosen pharmacy. It has occurred to me that this could be collected for me and posted on by a friend or relative. I don't see why this wouldn't work (customs not being an issue in the EU?)

 

That is what i'm looking at doing.

 

My current batch of prescriptions run out end of March 2016 so i need to renew during that month. However, that will be close to when i want to go away so am hoping i can persuade my GP to give me a 3 month single prescription plus 3 x 1 single prescriptions. If he won't.....then i'm stuffed.

 

If i can get that, then i will ask my friends wife if she would 'do the business' for me and send a months supply on. Just a matter of jiggling around with logistics as i move from one place to another as well as country.....after all, i am touring!

[PeteH]

I thought long and hard about posting this, when we where travelling the USA. we had similar issues, in as much as we too where away over 5 Months. the "trick" in my case was pre planning, I have one med that I cannot get in the US, this I have always ordered every 18 days, and get a months supply. by the time I am about to go "foreign" Parts. I have enough "stashed". which added to the 3 months I can get in one hit. to keep me going for the period of being out of Country.

 

The other issue is the "3 month rule" viz being removed from a GP "list". By carefully manipulating dates and times, this can be avoided One factor is to use the "online" prescription system to order drugs, which then "flag up" as being still "active", done towards the end of our travels means that I have a small back log to collect on my return. The Pharmacy already think I have "memory" issues so they do not seem to think twice about it. It was only questioned once and I just said "oh dear! must have forgotten and done it twice!.

 

Sometimes being an "old fart" has it`s uses?

 

Pete