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

[Bulletguy]

PeteH - 2015-10-28 7:39 PM

 

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

 

Interesting post......especially as i too once had dreams of 'fulltiming' US though eventually realised it would not be quite so simple!

 

With respect to your first 'para' and 'stashing', i cannot do that. My GP's practice knows exactly what amount prescriptions i have, how many used and how many left. I've tried it before.

 

Slightly o/topic here though it does relate to the '3 month rule' (which i didn't know about then).....when i was looking into fulltiming US i spent some time on ex-pat American motorhome forums asking questions, one of which concerned the Visa. I wanted to stop in US for 18mth - 2yrs but soon found a Visa wouldn't cover me for that length. One guy who had been living there posted that "all you have to do is nip over the border into Mexico or Canada, then return a few days later and you get another 6mths on your Visa". But it wasn't long before another poster came along and said "no chance, they stopped that a while back and if i tried that, got caught, i could easily end up getting deported!"

 

I gave up on it in the end! *-)

[derek pringle]

Bulletguy - 2015-10-28 7:05 PM

 

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!

 

Hi,

I would worry with this method depending on the mess and how you could manage if somehow they didn't, arrive as you expect.Much sooner sort out different way of ensuring what I needed BEFOREHAND I left.

Speak to an alternative local G.P before switching perhaps,no good moving for more of the same treatment.

Cheers

Derek

 

 

[PeteH]

Bulletguy - 2015-10-29 12:54 AM

 

PeteH - 2015-10-28 7:39 PM

 

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

 

Interesting post......especially as i too once had dreams of 'fulltiming' US though eventually realised it would not be quite so simple!

 

With respect to your first 'para' and 'stashing', i cannot do that. My GP's practice knows exactly what amount prescriptions i have, how many used and how many left. I've tried it before.

 

Slightly o/topic here though it does relate to the '3 month rule' (which i didn't know about then).....when i was looking into fulltiming US i spent some time on ex-pat American motorhome forums asking questions, one of which concerned the Visa. I wanted to stop in US for 18mth - 2yrs but soon found a Visa wouldn't cover me for that length. One guy who had been living there posted that "all you have to do is nip over the border into Mexico or Canada, then return a few days later and you get another 6mths on your Visa". But it wasn't long before another poster came along and said "no chance, they stopped that a while back and if i tried that, got caught, i could easily end up getting deported!"

 

I gave up on it in the end! *-)

 

We had an American bank account, (Chase) with a debit and Credit card. That we used for all our US purchases.. Transferred money into the account periodically to keep it above $1500. which means NO charges. Transfer fees are not unreasonable, and if you do it in under $10000--00 tranches it does not get delayed under the homeland security rules! (had to make 3 transfers when we bought the Winne).

 

The old trick of Ducking into Canada or Mexico, has got very dodgy in recent times. Even the Canadian "snow-birds" are being given a hard time by Homeland Security!!, which was unknown even just a few years back. (US Paranoia? OR just Typical Civil Service Bloody Mindedness?). One (UK) guy we bumped into had just come back from The Yukon and had been given the real 3rd degree by H-S He though he was going to have to go back to Blighty from Canada at one point!!. and leave his 5th wheel rig behind!.

 

Pete

[Bulletguy]

derek pringle - 2015-10-29 5:39 AM

 

Bulletguy - 2015-10-28 7:05 PM

 

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!

 

Hi,

I would worry with this method depending on the mess and how you could manage if somehow they didn't, arrive as you expect.Much sooner sort out different way of ensuring what I needed BEFOREHAND I left.

Speak to an alternative local G.P before switching perhaps,no good moving for more of the same treatment.

Cheers

Derek

 

Derek i should have said it's one option i'm seriously considering. I know it's not the most ideal but i certainly aren't ruling it out. Ideally i would prefer to go away with (eg) a 4 month supply, but under my present GP it's highly unlikely that i can persuade him to budge. I'm going to make an appointment to speak to his partner, but sceptical about the outcome of that......not to mention he's not a particularly pleasant chap either!

 

[Bulletguy]

PeteH - 2015-10-29 8:09 AM

 

Bulletguy - 2015-10-29 12:54 AM

 

PeteH - 2015-10-28 7:39 PM

 

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

 

Interesting post......especially as i too once had dreams of 'fulltiming' US though eventually realised it would not be quite so simple!

 

With respect to your first 'para' and 'stashing', i cannot do that. My GP's practice knows exactly what amount prescriptions i have, how many used and how many left. I've tried it before.

 

Slightly o/topic here though it does relate to the '3 month rule' (which i didn't know about then).....when i was looking into fulltiming US i spent some time on ex-pat American motorhome forums asking questions, one of which concerned the Visa. I wanted to stop in US for 18mth - 2yrs but soon found a Visa wouldn't cover me for that length. One guy who had been living there posted that "all you have to do is nip over the border into Mexico or Canada, then return a few days later and you get another 6mths on your Visa". But it wasn't long before another poster came along and said "no chance, they stopped that a while back and if i tried that, got caught, i could easily end up getting deported!"

 

I gave up on it in the end! *-)

 

We had an American bank account, (Chase) with a debit and Credit card. That we used for all our US purchases.. Transferred money into the account periodically to keep it above $1500. which means NO charges. Transfer fees are not unreasonable, and if you do it in under $10000--00 tranches it does not get delayed under the homeland security rules! (had to make 3 transfers when we bought the Winne).

 

The old trick of Ducking into Canada or Mexico, has got very dodgy in recent times. Even the Canadian "snow-birds" are being given a hard time by Homeland Security!!, which was unknown even just a few years back. (US Paranoia? OR just Typical Civil Service Bloody Mindedness?). One (UK) guy we bumped into had just come back from The Yukon and had been given the real 3rd degree by H-S He though he was going to have to go back to Blighty from Canada at one point!!. and leave his 5th wheel rig behind!.

 

Pete

 

I think a case of both (bib). A cousin of mine lived and worked in the US for a few years and his job meant a regular commute between there and UK. He often got stopped on entering the US by one of the 'jobsworths' in a uniform and questioned over his citizenship. That he had a home in Texas and was in full time employment with one of the largest oil companies there didn't seem to 'gel' despite having all his papers in order.

 

He's glad to be back in UK now!

 

They've always been a tad paranoid......the madness of McCarthyism being a prime example where anyone like me not conforming and daring to question 'the state' would be deemed a subversive and dragged in for questioning!

 

Yanks don't take kindly to anyone having the audacity to criticise their country and aren't very good at self deprecating humour, but during the early 70's a cracking series of cartoons came out called "Wait Till Your Father gets Home", and that really does poke fun at the batty side of America. If you haven't seen it, it's well worth buying the DVD set (plentiful and cheap anywhere US) as it's one of the few Hanna-Barbera cartoons which has never been repeated on UK tv.

[pepe63xnotuse]

BG

Wouldn't you have exhausted all available avenues with your current GP Practice, prior to reaching the stage of contacting your MP (who in turn contacted the Health Secretary)? :-S

 

You've stated umpteen times, and in no uncertain terms, that your GP is sticking very much to "the rules", that he clearly won't budge and that it is highly unlikely that his partner(who allegedly is "not a very pleasant chap") will "go against him" anyway on such matters?...

 

So is there any point?

 

Have you made any enquiries with any these of other GPs that you were referring to earlier? (primarily the one who gives out 4-5 months worth to your friends).?

 

Because at the moment, you appear to be hell bent on continuing going around in circles.. ;-)

[Brian Kirby]

Paul, I think you are caught by regulation 25 of the The National Health Service (General Medical Services Contracts) Regulations 2004, which states:

Removals from the list of patients absent from the United Kingdom etc.

25.—(1) The Primary Care Trust shall remove a patient from the contractor’s list of patients where it

receives notification that that patient—

(a) intends to be away from the United Kingdom for a period of at least three months;

(b) is in Her Majesty’s Forces;

© is serving a prison sentence of more than two years or sentences totalling in the aggregate more

than that period;

(d) has been absent from the United Kingdom for a period of more than three months; or

(e) has died.

 

So, as soon as the GP becomes aware that you intend being, or have been, absent from the UK for "at least three months", he is contractually obliged to notify his Local Primary Care Trust of that fact, and the PCT is instructed under the regulations to remove your name from your GP's list of patients. I cannot find any exception to that rule. It seems to be accepted that there is no means for either GP or PCT to become aware of such absences unless told, and there seems to be no general obligation upon patients to tell. Make of that what you will.

 

Obviously, if you cannot be retained as an NHS patient once absent for more than three months, you cannot be prescribed medication on the NHS for more than three months. However, it may be possible to make a private arrangement with the GP since it seems private patients, if accepted, can be treated outside the Regulations.

 

The National Health Service (General Medical Services Contracts) Regulations 2004 is a 90 page doucument that forms the contract of employment between the NHS, GP's, out of hours service providers, and prescribing chemists. Any change to the terms has to be notified to all contracting parties by way of a written variation to the contract.

 

I think trying to get formal agreement to a variation to allow patients to remain on PCT lists when absent for longer than three months would need to centre around in regulation 25 (a) and (d) above. As drafted, there is little scope to argue that you haven't really left the country, as in emigrated, since it is mere absence that provides the trigger: i.e. being "away from the United Kingdom" or having been "absent from the United Kingdom". The best I can see is if (a) and (b) were qualified to exclude people absent only for pleasure purposes, but I can see great resistance to such a change from within DH.

 

So, on balance, I think your best bet would be to find a diplomatic excuse for moving to a different GP, explaining that you take extended breaks of maybe 10 - 12 weeks from time to time, and would like an arrangement that would allow you to do this while still being to maintain a "safe" stock of medication for the period immediately before, and after, your trip. That way the alarm bells don't get rung, and the GP is not put into a position in which he has to decide whether or not to breach the terms of his contract of employment - for which the penalties are intentionally unattractive!

 

I suspect those GP's who ignore this regulation are either unaware of its existence (not surprising in 90 pages), or haven't been told, in terms they are obliged to recognise, of their patient's intentions.

[PeteH]

Bulletguy - 2015-10-29 4:29 PM

 

PeteH - 2015-10-29 8:09 AM

 

Bulletguy - 2015-10-29 12:54 AM

 

PeteH - 2015-10-28 7:39 PM

 

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

 

Interesting post......especially as i too once had dreams of 'fulltiming' US though eventually realised it would not be quite so simple!

 

With respect to your first 'para' and 'stashing', i cannot do that. My GP's practice knows exactly what amount prescriptions i have, how many used and how many left. I've tried it before.

 

Slightly o/topic here though it does relate to the '3 month rule' (which i didn't know about then).....when i was looking into fulltiming US i spent some time on ex-pat American motorhome forums asking questions, one of which concerned the Visa. I wanted to stop in US for 18mth - 2yrs but soon found a Visa wouldn't cover me for that length. One guy who had been living there posted that "all you have to do is nip over the border into Mexico or Canada, then return a few days later and you get another 6mths on your Visa". But it wasn't long before another poster came along and said "no chance, they stopped that a while back and if i tried that, got caught, i could easily end up getting deported!"

 

I gave up on it in the end! *-)

 

We had an American bank account, (Chase) with a debit and Credit card. That we used for all our US purchases.. Transferred money into the account periodically to keep it above $1500. which means NO charges. Transfer fees are not unreasonable, and if you do it in under $10000--00 tranches it does not get delayed under the homeland security rules! (had to make 3 transfers when we bought the Winne).

 

The old trick of Ducking into Canada or Mexico, has got very dodgy in recent times. Even the Canadian "snow-birds" are being given a hard time by Homeland Security!!, which was unknown even just a few years back. (US Paranoia? OR just Typical Civil Service Bloody Mindedness?). One (UK) guy we bumped into had just come back from The Yukon and had been given the real 3rd degree by H-S He though he was going to have to go back to Blighty from Canada at one point!!. and leave his 5th wheel rig behind!.

 

Pete

 

I think a case of both (bib). A cousin of mine lived and worked in the US for a few years and his job meant a regular commute between there and UK. He often got stopped on entering the US by one of the 'jobsworths' in a uniform and questioned over his citizenship. That he had a home in Texas and was in full time employment with one of the largest oil companies there didn't seem to 'gel' despite having all his papers in order.

 

He's glad to be back in UK now!

 

They've always been a tad paranoid......the madness of McCarthyism being a prime example where anyone like me not conforming and daring to question 'the state' would be deemed a subversive and dragged in for questioning!

 

Yanks don't take kindly to anyone having the audacity to criticise their country and aren't very good at self deprecating humour, but during the early 70's a cracking series of cartoons came out called "Wait Till Your Father gets Home", and that really does poke fun at the batty side of America. If you haven't seen it, it's well worth buying the DVD set (plentiful and cheap anywhere US) as it's one of the few Hanna-Barbera cartoons which has never been repeated on UK tv.

 

Yes.

 

My Son Lives in Texas, Has American Citizenship, and two Passports!. Works for a Texan Oil Company. They still give him the 3rd degree. Maybe it`s his (Still) Yorkshire accent? Despite the fact that at least 4 possibly 6 Yorkshireman are on the Plaque of the Deceased Killed at the ALAMO!.

 

Pete

[derek pringle]

hi,

Brian,

I f the logic of this 3 mth rule is is taken to its full conclusion, do you not agree there are an awful lot of Brits [motorhomers and otherwise] who "technically" should not have a registered G.P Head down and find a way around the wall rather than running in to it is my phylosophy. This rule will not imo be relaxed by pursuing through the Dept of Health, but rather reinforced.

cheers

derek

[Aly]

As I read it, having a 'registered gp' isn't the problem. You re-register on return.

 

But, it means you are subject to 'partial exemptions'. No free hospital treatment for pre-existing conditions.

 

Thank goodness, as Brian tells us, it doesn't seem that we are obliged to tell our doctor we will be away for more than three months.

 

If I've got that wrong, please advise.

[Brian Kirby]

derek pringle - 2015-10-31 9:03 AM

 

hi,

Brian,

I f the logic of this 3 mth rule is is taken to its full conclusion, do you not agree there are an awful lot of Brits [motorhomers and otherwise] who "technically" should not have a registered G.P Head down and find a way around the wall rather than running in to it is my phylosophy. This rule will not imo be relaxed by pursuing through the Dept of Health, but rather reinforced.

cheers

derek

Yes Derek, I do agree. Clearly those with no repeat medication requirements, of whom I would guess the very great majority are completely unaware of this rule in their GP's contracts of employment, will come and go from UK without anyone being any the wiser. It also seems some GPs may have overlooked, or forgotten, this provision, so are happy to prescribe on the basis of their judgement of the patient's health, and the safety of providing more than three month's medication. For the others, like Paul, however, the (presumed) unintended consequence of this is to discriminate, rather unfairly IMO, against their ability to travel for longer periods.

 

The snag with your philosophy, IMO, is that one first has to know the wall is there. If you innocently breeze into your GP's surgery and announce that you intend going off for longer than three months, so could they please give you a prescription for that longer period, the GP is contractually obliged to enquire when you propose to leave, and then notify the PCT of the date, from which point you will be summarily removed from your GP's regsiter. So, far from being able to get medication to cover your trip, the GP would only be able to prescribe up to your departure date, because from that date will no longer be your GP. If you think about it, that is a classic Catch 22.

 

I assume that Paul's GP is concerned that he intends to travel for longer, so offers him one of two options. Either he will prescribe three months supply of his medication, or he will issue dated prescriptions so that Paul has to keep visiting his pharmacist at monthly intervals. In that way the GP does not allow Paul to build up stock before a trip, and then take off for longer. Seems a strange relationship to me, but I don't know what has passed between Paul and his GP, and I have no idea what Paul's medication is for, nor what it is. Nor, in the nicest possible way, do I want to know!

 

So, don't shoot me, I'm just the messenger! :-D

[Bulletguy]

Apols but i've not had time to get back to the thread until now.......but there is more 'info'. I'll try and keep it brief to the point.

 

Brian Kirby - 2015-10-29 6:51 PM

 

Paul, I think you are caught by regulation 25 of the The National Health Service (General Medical Services Contracts) Regulations 2004, which states:

Removals from the list of patients absent from the United Kingdom etc.

25.—(1) The Primary Care Trust shall remove a patient from the contractor’s list of patients where it

receives notification that that patient—

(a) intends to be away from the United Kingdom for a period of at least three months;

 

(b) is in Her Majesty’s Forces;

 

© is serving a prison sentence of more than two years or sentences totalling in the aggregate more

than that period;

 

(d) has been absent from the United Kingdom for a period of more than three months; or

 

(e) has died.

 

In ref to the emboldened (a,b and d). We already know, or at least more aware now of what should happen, but not so aware of what actually does happen.

 

"Intending to be away from UK" or "absent from UK" for more than 3 months, which, according to the DoH 'that person is removed from the doctors list and as a consequence ceases to be eligible for NHS treatment', as you yourself mentioned Brian, a pretty crazy regulation given the amount of people not on 'meds' who regularly exit the UK for long periods. In my opinion it's also unworkable.

 

However in relation to (para b) yesterday i was talking with my son who spent 18 years in the Armed Forces and i asked him what happened over GP registration/de-registering. This was his 'track record' during those 18 years; 6 months Canada, 6 month duty in Bosnia, two 6 mth duty Iraq, one 6 month duty Afghanistan. He then spent almost 5 years based in Germany.

 

During all that time out of UK he remained on a local GP's list here in the UK and also had access to the NHS. The only point at which he transferred to another GP was when he left the Forces, moved from this area, and went to live in London.

 

Interesting eh? So much for Regulations!

 

 

So, as soon as the GP becomes aware that you intend being, or have been, absent from the UK for "at least three months", he is contractually obliged to notify his Local Primary Care Trust of that fact, and the PCT is instructed under the regulations to remove your name from your GP's list of patients.

 

Seems more a case of 'some do, some don't'!! My sons GP never told him he'd need to scrub him from his list. Never told him he wouldn't be eligible for NHS treatment. Never told him about any 'regulations'!

 

 

So, on balance, I think your best bet would be to find a diplomatic excuse for moving to a different GP, explaining that you take extended breaks of maybe 10 - 12 weeks from time to time, and would like an arrangement that would allow you to do this while still being to maintain a "safe" stock of medication for the period immediately before, and after, your trip. That way the alarm bells don't get rung, and the GP is not put into a position in which he has to decide whether or not to breach the terms of his contract of employment - for which the penalties are intentionally unattractive!

 

That's what i'm considering since pepe63 posted that link about the recent change to allow people to choose an out of area GP......particularly as i know the GP my friend uses will write up a prescription to cover me for whatever i want.

 

I suspect those GP's who ignore this regulation are either unaware of its existence (not surprising in 90 pages), or haven't been told, in terms they are obliged to recognise, of their patient's intentions.

 

This may be so Brian but imo a poor excuse. GP's would be made aware of any new regulations and they have a responsibility to ensure they familiarise themselves with any changes etc. I expect someone earning the higher end of a five figure salary into six figures to cope with this task. If they can't then quite frankly they shouldn't be in the job.

[Bulletguy]

Aly - 2015-10-31 11:06 AM

 

As I read it, having a 'registered gp' isn't the problem. You re-register on return.

 

But, it means you are subject to 'partial exemptions'. No free hospital treatment for pre-existing conditions.

 

Thank goodness, as Brian tells us, it doesn't seem that we are obliged to tell our doctor we will be away for more than three months.

 

If I've got that wrong, please advise.

 

Not 'obliged' no though as Derek has said 'technically' you shouldn't be registered, and as the DoH have made clear to me in their letter, "that person is removed from the doctors list and as a consequence, cease to be eligible for NHS treatment". But as you can see from my sons experience, that simply isn't the case.

 

Ask yourself this, or better still ask friends you know who do this.......just how many people who regularly 'winter over' in Spain call their GP to tell them they are leaving UK for 4 months? Those not needing 'meds' could be out of the UK 12 months at a time and just return when they need the NHS or their GP. Those on regular 'meds' need a sympathetic GP!

[Bulletguy]

Brian Kirby - 2015-10-31 11:07 AM

 

I assume that Paul's GP is concerned that he intends to travel for longer, so offers him one of two options. Either he will prescribe three months supply of his medication, or he will issue dated prescriptions so that Paul has to keep visiting his pharmacist at monthly intervals. In that way the GP does not allow Paul to build up stock before a trip, and then take off for longer. Seems a strange relationship to me, but I don't know what has passed between Paul and his GP, and I have no idea what Paul's medication is for, nor what it is. Nor, in the nicest possible way, do I want to know!

 

Nothing has 'passed' between us other than my frustration at him cocking up the prescription earlier this year. Bearing in mind i was already on an unexpected 'time limit' over this crazy 3 month allowance.

 

I don't mind telling anyone what 'meds' i'm on, just that i'm not fond of dwelling on it as though i'm some kind of 'special' person or something! I've suffered with epilepsy since the age of seven so had to learn to live with it most of my life. Thankfully no longer serious but need regular medication and i'd never risk driving without, which would be like playing Russian roulette.....not just with my own life, but other peoples too.

 

Not addictive, not a dangerous drug, and pretty much useless to anyone else but myself!

[derek pringle]

Hi,

I am a little confused so will put a scenario forward :-

If a person is away over 3mths they are technically off the GP list. Does this mean they are off the N.H.S. and if so could there be repercussions re the E111 and reimbursement of charges?

Any thoughts

 

cheers

derek

[Brian Kirby]

Derek, you are asking technical (though interesting) questions that no-one can really answer. You need to read the NHS Constitution, and the accompanying Handbook (both downloadable in response to a "Google" search). Seemingly, all full time residents (very much simplified, but roughly anyone who spends more than 185 days in any year in UK) of whichever part of the UK (some exceptions for recent arrivals, whether immigrating or visiting) are eligible for NHS treatment at all times, at no cost to themselves, (saving the known exceptions of prescriptions, dental work, opticians etc).

 

What is officially denied under the regulations (which are, in effect, the contracts of employment for doctors, pharmacists, some nurses, and dentists) is access to the GP and, through that, access to prescription medicines when de-registered. The three months definition seems to me out of step with any other concept of residency or domicile in common use, all of which that I have been able to find point to the 185 days residency test.

 

So, I don't understand where the three months came from, or what it is intended to achieve, or how the Minister can make it stick. However, I think bringing a challenge risks a long and difficult fight against entrenched views, and would need parliamentary support to bring it about. It seems to me that the impact of that rule, intentionally or not, is to discriminate against a group of people who, through no fault of their own, fall into a group who are not so ill that long term travel is out of the question for them, but not so healthy that they can get by without any medication at all.

 

Whether the interests of that group represents a sufficiently persuasive argument for changing the regulation to say 185 days, or even abolishing the time based limitations, is an open question. Is it worth opening the can of worms in the interests of equality, or better to just accept the uneven operation of the current rules?

[Brian Kirby]

Aly - 2015-10-31 11:06 AM

 

As I read it, having a 'registered gp' isn't the problem. You re-register on return.

Yes, you you can re-register, but it is the initial de-registration that causes the problem. Once de-registered, you have no GP. A GP can only prescribe long term medication for someone who will remain their patient for the duration of the treatment. So, if you intend travelling for more than three months, this means you cannot leave the UK in possession of any NHS provided medication.

 

But, it means you are subject to 'partial exemptions'. No free hospital treatment for pre-existing conditions.

You could not get "free hospital treatment for pre-existing conditions" when abroad in any case. That is only available on NHS while in UK. This is just about those who are on long-term medication and who want to travel outside UK for more than three months.

 

Thank goodness, as Brian tells us, it doesn't seem that we are obliged to tell our doctor we will be away for more than three months.

 

If I've got that wrong, please advise.

What I actually said was: "there seems to be no general obligation upon patients to tell." I haven't made an exhaustive check, I have merely looked for evidence of such an obligation, including in the NHS Constitution and Handbook, and cannot find any.

 

The Handbook quotes the Constitution (Section 3b), “Please provide accurate information about your health, condition and status.” and then adds:

"(Section 3b of the NHS Constitution) What this means in practice.

The delivery of safe and effective care is reliant on good quality information. Patients are responsible for ensuring that information about them is accurate and up to date. (My italics) So, what does that obligation imply? Nothing is quite black and white.

[Brian Kirby]

Bulletguy - 2015-10-31 11:57 PM.......................GP's would be made aware of any new regulations and they have a responsibility to ensure they familiarise themselves with any changes etc. I expect someone earning the higher end of a five figure salary into six figures to cope with this task. If they can't then quite frankly they shouldn't be in the job.

Now I'm getting confused Paul! :-D Your doctor is being punctilious - almost over zealous - in following the regulations, but you portray him as the "bad guy". Yet those who are being less so, and are either "turning a blind eye", or have failed to read properly what the Regulations say, are the ones you criticise above, but are actually those who are prescribing the way you want - so would appear to be your "good guys". You can't have it both ways. :-) They can either stick to the rules (good/bad?), or bend them in favour of their patients (good/bad?).

 

As I said further up, it is the Regulations you are caught by, and neither you, nor I, nor the doctors, have much influence over them. Individual doctors will interpret them as they see fit (they are doctors after all, not rule slaves) but the results will inevitably vary from one to another - because ultimately they are individuals.

 

FWIW, I think your decision to change is by far the most sensible one for your circumstances, and (providing you are careful what you say) should achieved what you want with the least grief and loss of time. So, happy travels.

[Brian Kirby]

Bulletguy - 2015-10-31 11:57 PM........................

 

"Intending to be away from UK" or "absent from UK" for more than 3 months, which, according to the DoH 'that person is removed from the doctors list and as a consequence ceases to be eligible for NHS treatment', ..................................

Yes, I'd forgotten that bit but, FWIW, I think that statement is very probably incorrect. The only test for eligibility to receive NHS treatment seems to be that you are a UK tax payer (resident, domiciled, whatever) in UK.

 

Leaving the UK for more than three months should, under the Regulations, deny you access to a GP (if the GP was aware of your absence) until re-registered, but you could always go to accident and emergency, in which you would receive NHS treatment. They don't first ask where you've been for the past three months when you're wheeled, or even walk, in!

 

This three month thing really bugs me, I simply can't work out what it is usefully intended to achieve, nor where they got the three months from. It doesn't seem to coincide with any other recognised residency test and, since residency seems to be the key to accessing the NHS, I can't understand where/how the DoH has authority to deny access. I'm tempted to think that it may have no actual, legal, validity at all, at least insofar as it affects what a UK taxpayer is entitled to expect under the NHS Constitution. No question that it affects what the doctor is supposed to do, but that seems to conflict directly with what the public are entitled to receive. Bewildered, I am. :-D

[Bulletguy]

Brian Kirby - 2015-11-01 11:34 AM

 

Aly - 2015-10-31 11:06 AM

 

As I read it, having a 'registered gp' isn't the problem. You re-register on return.

Yes, you you can re-register, but it is the initial de-registration that causes the problem. Once de-registered, you have no GP. A GP can only prescribe long term medication for someone who will remain their patient for the duration of the treatment. So, if you intend travelling for more than three months, this means you cannot leave the UK in possession of any NHS provided medication.

 

Brian you must surely have realised by now this just is not the case?!!

 

In theory yes......in practice, no!

 

Poster Davec.....4 months supply. Poster Tiggy......9 months supply. Both exiting the UK , both in possession of meds provided by the NHS. Some friends of mine already in Spain until March end who have theirs posted on by their daughter, but remain on their GP's practice list here in UK. Another friend of mine who will be leaving shortly for winter in Spain.....4 months supply. All without question. Even my own son, serving in the Forces for 18 years, five of which he was based in Germany, the rest of the time in other countries, continued to remain on a GP's list in the UK.

 

The '3 month rule' is a technicality as is the removal from a GP's list.

 

 

Brian Kirby - 2015-11-01 12:01 PM

 

Bulletguy - 2015-10-31 11:57 PM.......................GP's would be made aware of any new regulations and they have a responsibility to ensure they familiarise themselves with any changes etc. I expect someone earning the higher end of a five figure salary into six figures to cope with this task. If they can't then quite frankly they shouldn't be in the job.

Now I'm getting confused Paul! :-D Your doctor is being punctilious - almost over zealous - in following the regulations, but you portray him as the "bad guy". Yet those who are being less so, and are either "turning a blind eye", or have failed to read properly what the Regulations say, are the ones you criticise above, but are actually those who are prescribing the way you want - so would appear to be your "good guys". You can't have it both ways. :-) They can either stick to the rules (good/bad?), or bend them in favour of their patients (good/bad?).

 

No. I was responding to your remark "that GP's are either unaware or haven't been told", that in my opinion would be a very lame manner of excusing it! GP's have a professional duty to familiarise themselves with the law and medication otherwise we'd have doctors dishing out unsuitable medication to patients!

 

It's not a matter of me 'wanting it both ways' at all and you are just clouding the issue with that.

 

As I said further up, it is the Regulations you are caught by, and neither you, nor I, nor the doctors, have much influence over them. Individual doctors will interpret them as they see fit (they are doctors after all, not rule slaves) but the results will inevitably vary from one to another - because ultimately they are individuals.

 

I know that......that's what i've said all along and can be clearly seen by other posters experiences.......which effectively makes the Regulations 2004 a complete waste of paper!

 

 

[Brian Kirby]

Bulletguy - 2015-11-01 7:47 PM..........................Brian you must surely have realised by now this just is not the case?!!

 

In theory yes......in practice, no!

 

Poster Davec.....4 months supply. Poster Tiggy......9 months supply. Both exiting the UK , both in possession of meds provided by the NHS. Some friends of mine already in Spain until March end who have theirs posted on by their daughter, but remain on their GP's practice list here in UK. Another friend of mine who will be leaving shortly for winter in Spain.....4 months supply. All without question. Even my own son, serving in the Forces for 18 years, five of which he was based in Germany, the rest of the time in other countries, continued to remain on a GP's list in the UK.

 

The '3 month rule' is a technicality as is the removal from a GP's list.

Nevertheless, it is a "technicality" that is catching you out! :-) We have no way of knowing whether the cases you cite (of GPs ignoring the rule, bending the rule, not having read the rule, or whatever), are a minority, a majority, or in either case, how large. All we presently know is that some do, and yours doesn't. My point to Davec was to state what the Regulations say should actually happen, because he seemed to have missed the point that if de-registered, one cannot (within the Regs) get medication for more than 3 months. That is the position you are in so, from your perspective, it seems it is rather more than a mere technicality. That is what I wanted to emphasise.

 

Beyond that, I don't think the experiences of others, with other GPs, in other places, create a valid argument for your GP to do likewise - because those other GPs are breaking the Regulations. It's a bit like arguing that one shouldn't be fined for speeding, because an unknown number of other drivers, in other parts of the country, were also speeding at the same time, but weren't fined. One rule breaker doesn't entitle, or oblige, others to also break that rule.

 

..........................................................It's not a matter of me 'wanting it both ways' at all and you are just clouding the issue with that.

You are unhappy that your GP won't break the rules for you. OTOH, you are complaining that other GPs are breaking the rules for other people. That looks to me like wanting it both ways. Surely, in logic, they should all treat everyone as your GP treats you - within the rules?

 

................Individual doctors will interpret them as they see fit (they are doctors after all, not rule slaves) but the results will inevitably vary from one to another - because ultimately they are individuals.

 

I know that......that's what i've said all along and can be clearly seen by other posters experiences.......which effectively makes the Regulations 2004 a complete waste of paper!

But if people break the law and get away with it, it doesn't mean the law is wrong. It only means that breaking that law, for whatever reason, is not being detected or penalised.

 

This doesn't mean I think the Regs are perfect - far from it. But they are what they are, they have the force of law, and those who are taking liberties with Regulation 25 are taking risks. There is no gain to the GP from doing this, so whether one sees them as heroes, knaves, or fools is rather a matter if personal stance.

 

Personally, as I've said before, I can't understand what a) and d) of Regulation 25 are intended to achieve, I don't understand where the DoH gets its authority to issue regulations that appear to significantly alter Acts of Parliament, and I don't understand where they got the three months timescale. Best solution to me, until someone can explain the above, is that a) and d) of Regulation 25 should be struck out, leaving GPs to make the judgement on purely clinical grounds.

 

But, this all now seems a bit of a dead duck! You've decided to change GP, which I hope will prove a success, and will enable you to enjoy your extended travels.

[derek pringle]

hi,

I think this situation should stand a reasonability test. In this day and age it is not unusual for people to take an extended holiday on occasions, the days of 2 weeks and that's it are far gone. Given this doctors should give a reasonable amount of medication to cover the circumstance, the problem is what is reasonable,even I think the guy who gets 9 mths worth should be declared ex pat.

It is common knowledge that people winter away [ you just have to look at the holiday ads for long stays in Spain etc] all seem based at about 3 months.

On moving G.P's I would be wondering if the present G.P has to send a report to the new G.P about your health and lifestyle. Don't know.

cheers

derek

[Aly]

I'll be honest, I haven't read through any of the NHS documents that Brian has. I find things like that difficult to follow, and get confused. The document I have read is the Essex one linked by Cliffy on the first page.

 

Having looked at that, I think 9 month away Tiggy would be covered by the 'one-off' rule. As I commented before, I think one of the problems is the 'blurring' of what is 'holiday' and what is 'living'. I spend up to three months in Spain. I am 'living' there. But am I on 'holiday'?

 

Brian, I mentioned before about partial exemptions, I wasn't referring to treatment abroad. Page 5 of the Essex document, if I have understood it correctly, explains about NHS hospital exemptions if you have been out of the country for more than 3 months. It specifically talks about those who 'winter' in another country.

 

I think the 'three month' idea stems from 90 day rules, as certainly in Spain, if you are staying for more than 90 days, but less than 183, you are supposed to temporarily sign on the EU foreigners register. But I don't know anyone who does

 

Also if you had 'de-registered', and when back went to a hospital for treatment, surely the computerised systems we have would alert the staff to your status? At, least, I thought that was the idea behind all this expensive computerisation of the NHS records.

 

I certainly don't know any long termer in Spain who tells their doc they are out of the country for more than three months. I know people who live full time in Spain but are not Spanish residents and go back to Britain for their healthcare. I came across one the other day who is a full time Spanish resident, has paid into the

system and therefore has a Spanish health card and uses the Spanish system for medications. BUT is still registered with a UK doctor via their daughter's address. I think the vast majority-90%? - of those who long stay or tour, are unaware of these NHS 'rules'.

 

But none of this helps BulletGuy. I have to agree that it is not fair that he cannot be out of the country for more than 3 months, whereas others just do as they please. I do hope he is able to join the other practice and get what he wants. I could be wrong, but I don't think he has to notify the current doctor, they would just get asked to transfer his records to the new practice.

 

 

[Brian Kirby]

The first time I tried Cliffy's link it didn't open, and I assumed it had become corrupted and moved on. However, having read what Aly says above, I tried again, and lo-and-behold, it worked! :-) Interesting document.

 

So, I tried finding a similar document on our local CCG website, but could only come up with a guidance note on excessive prescribing, which referred to the same 3 months time limit, but did not quote the source. So, I rang them and asked and, surprise, surprise, they confirmed that it comes from the NHS (General Medical Services Contracts) Regulations 2004; i.e. those which underlie Paul's problem. It seems the whole NHS has picked up on this limit and it has become the established line, although very few people indeed seem to have read the regs for themselves. It has just become received wisdom and pops up willy-nilly.

 

The very nice lady I spoke to said it had affected her six months trip in her motorhome, because her doctor had given her a prescription for three months (even though he knew she was off for six), didn't de-list her, and gave her a copy prescription so she could buy her medication while abroad - which she was able to do at a pharmacy. And she works for the CCG in the medicines management department! Beat that! :-D

 

But, back to the "Essex" document, which includes this.

 

"Anyone who is deemed to be ordinarily resident in the UK is entitled to free NHS hospital treatment in England. “Ordinarily resident” is a common law concept interpreted by the House of Lords in 1982 as someone who is living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, with an identifiable purpose for their residence here which has a sufficient degree of continuity to be properly described as settled. It is unlikely that anyone coming to live in the UK, intending to stay for less than 6 months, will fulfil these criteria." (Which has been lifted from the DoH website)

 

It also includes this:

 

"Going abroad for more than three months.

 

If you are no longer resident in the UK and are living abroad, the NHS normally won't pay for any treatment or services. This includes people who are in receipt of UK state retirement pensions.

No longer resident, means that you have left the country for more than three months. Therefore, you will have to obtain healthcare cover in the country you are in, or get private medical insurance."

 

Anyone spot the rather obvious contradiction between the two statements?

 

The National Heath Service Act 2006 states:

 

1 Secretary of State's duty to promote health service

 

(1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

 

(a) in the physical and mental health of the people of England, and

 

(b) in the prevention, diagnosis and treatment of illness.

 

(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.

 

(3) The services so provided must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.

 

No wonder there is some confusion in a number of quarters as to what the rules, actually, are.

[Bulletguy]

Brian Kirby - 2015-11-02 4:14 PM

 

Bulletguy - 2015-11-01 7:47 PM..........................Brian you must surely have realised by now this just is not the case?!!

 

In theory yes......in practice, no!

 

Poster Davec.....4 months supply. Poster Tiggy......9 months supply. Both exiting the UK , both in possession of meds provided by the NHS. Some friends of mine already in Spain until March end who have theirs posted on by their daughter, but remain on their GP's practice list here in UK. Another friend of mine who will be leaving shortly for winter in Spain.....4 months supply. All without question. Even my own son, serving in the Forces for 18 years, five of which he was based in Germany, the rest of the time in other countries, continued to remain on a GP's list in the UK.

 

The '3 month rule' is a technicality as is the removal from a GP's list.

Nevertheless, it is a "technicality" that is catching you out! :-) We have no way of knowing whether the cases you cite (of GPs ignoring the rule, bending the rule, not having read the rule, or whatever), are a minority, a majority, or in either case, how large.

 

I would have thought that's patently clear just from the few postings in this thread. I posed the same question on another forum (non-motorhome related) and got pretty much the same kind of response, with one person saying how she is issued with a six month prescription for insulin in one lot. She explained that insulin is dangerous if you don't know what you are doing and just one weeks supply can kill.

 

It's certainly not a tiny minority.

 

 

derek pringle - 2015-11-03 8:39 AM

 

I think this situation should stand a reasonability test. In this day and age it is not unusual for people to take an extended holiday on occasions, the days of 2 weeks and that's it are far gone. Given this doctors should give a reasonable amount of medication to cover the circumstance, the problem is what is reasonable,even I think the guy who gets 9 mths worth should be declared ex pat.

 

Myself personally i'd say it would depend much on the type of drug. Hence the reason i was astonished the diabetic who told me she gets 6mths supply of insulin in one go. The medication i take is neither addictive nor dangerous. Insulin can kill.

 

It is common knowledge that people winter away (you just have to look at the holiday ads for long stays in Spain etc) all seem based at about 3 months.

 

My friends spend four month there over winter and been going for the past five years. It's that simple they don't even book anything. Collect their 'meds' before leaving, drive down, find a location they like, then go to an Estate Agent with short term rental properties and rent an apartment/flat. It costs them less than what they would spend on heating here in UK.

 

Aly - 2015-11-03 11:24 AM

 

I certainly don't know any long termer in Spain who tells their doc they are out of the country for more than three months.

 

I doubt anyone does! About the only exceptions i can think of would be those going to countries requiring vaccinations against malaria etc.

 

I know people who live full time in Spain but are not Spanish residents and go back to Britain for their healthcare.

 

I came across one the other day who is a full time Spanish resident, has paid into the

system and therefore has a Spanish health card and uses the Spanish system for medications. BUT is still registered with a UK doctor via their daughter's address.

 

Which makes you wonder why someone would feel it necessary to remain on a GP's list in the UK. That they are doing it via their daughters address suggests to me they do know 'the rules'! I think you will find ex-pat brits are very aware of the rules. I'm a member on this forum here; http://www.expatforum.com/expats/spain-expat-forum-expats-living-spain/ and a quick read through some of the threads there will soon tell you.

 

I think the vast majority-90%? - of those who long stay or tour, are unaware of these NHS 'rules'.

 

UK residents are certainly less aware and those not in need of prescribed medication will probably never know. However the thread question specifically asking about those on medication and how long they remain out of UK for, has been answered.