Post by dizzydumpling on Jun 16, 2020 16:33:28 GMT
Dear fellow ADDers,
It's a long time since I've visited these boards (real life got in the way), so apologies for only turning up when I want something but I'm hoping one of the old timers with god-like status (or anyone else) may be able to advise. Apologies also for the length of the post – I’m afraid it’s the inevitable result of stress + ASD + un-medicated ADD:
HERE GOES:
I have been under a shared care agreement for the last couple of years with my local CMHT overseeing the prescribing of my Equasym which I take most days, and a short-acting Ritalin top-up to take on work days 'as-and-when needed' (which is now every day as I have just gone full-time).
Prior to last week, I had received my last prescription form the GP surgery back in February - there was a gap because I decided to stop taking my meds at the end of March when I was furloughed (it seemed like a good idea at the time to take a med break whilst I wasn't working). Last month, in preparation for returning to work I titrated myself back up to my usual dose of Equasym (by splitting the capsules at first), and ordered both Equasym & Ritalin prescriptions ready to return to work. When I went to collect it last week the Equasym was there but the Ritalin was missing.
After going around the houses a bit, I have just now got off the phone from the GP who told me that they are no longer allowed to prescribe the short-acting Ritalin under their shared care agreements, and that if I want that prescription again I will have to get the specialist overseeing my care to prescribe it to me themselves. She claims the reason for this is “new rules” brought in to protect patients from the risks of certain controlled drugs - such as increased risk of heart problems, high blood pressure etc. – when the surgery does not have clinicians of their own who are expert enough in these areas. I pointed out that Equasym and Ritalin are the same drug – but apparently the level of risk from the Equasym makes it OK for the GP to prescribe, but not the Ritalin – go figure eh!
My particular issue at this point however, is that my CMHT specialist signed me off in March with a letter to my GP surgery stating that a GP would need to refer me to the new adult ADHD service that has recently started-up in my area and that they would need to take me on for my next annual review (due August 2020). It was made clear in the CMHT specialist’s letter (I received a cc.) that I am stabilised on the Equasym with Ritalin to-up & there were no further recommendations.
The GP has said she will contact the ADHD Service and ask someone to give me a call to ‘discuss it’, but this is as far as she will commit. I explained that I cannot afford to be on a waiting list for this as I need the Ritalin SR ASAP due to the impact it will have on my work – I have just started a new full time contract case-working with vulnerable people and need to be on the ball. I told her my option will be to take another dose of Equasym at 3pm each day which will prevent me from sleeping at night and mean I am taking more Methylphenidate in total – at which I believe she audibly shrugged!
I explained to the GP that taking my Ritalin away during my working day is analogous to taking someone’s prosthetic limb part-way through their working day, but no one seems to be able to understand this – least of all GPs it seems.
SO MY QUESTION IS:
Can anyone tell me of - or direct me to - any changes in guidelines hat suggest what the GP told me is in fact the case?? – I can’t find anything by Googling that seems relevant - these changes are supposed to have taken place in February.
I strongly suspect that these “new rules” are the surgery’s own cost-cutting rules, but would like to check my facts before jumping the gun and raising complaints up the wazoo….
So far as I can tell the GMC link below contains the national guidelines that should apply here……which I can see may be open to interpretation by different GP practices:
www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices/shared-care
Looking at these guidelines, even if my GP surgery has decided to ‘reconsider’ their competencies in relation to ADHD medications and their potential side effect, I still would have thought that paragraph 43 would apply, meaning they would be obliged to discuss it with my original CMHT specialist OR “make appropriate arrangements for their [my] continuing care”.
43 If you are uncertain about your competence to take responsibility for the patient’s continuing care, you should seek further information or advice from the clinician with whom the patient’s care is shared or from another experienced colleague. If you are still not satisfied, you should explain this to the other clinician and to the patient, and make appropriate arrangements for their continuing care.
If anyone can guide me on where to look, what to quote and how best to go about getting my Ritalin back I would be hugely grateful. Without this medication I simply will not be able to hold down my job.
It's a long time since I've visited these boards (real life got in the way), so apologies for only turning up when I want something but I'm hoping one of the old timers with god-like status (or anyone else) may be able to advise. Apologies also for the length of the post – I’m afraid it’s the inevitable result of stress + ASD + un-medicated ADD:
HERE GOES:
I have been under a shared care agreement for the last couple of years with my local CMHT overseeing the prescribing of my Equasym which I take most days, and a short-acting Ritalin top-up to take on work days 'as-and-when needed' (which is now every day as I have just gone full-time).
Prior to last week, I had received my last prescription form the GP surgery back in February - there was a gap because I decided to stop taking my meds at the end of March when I was furloughed (it seemed like a good idea at the time to take a med break whilst I wasn't working). Last month, in preparation for returning to work I titrated myself back up to my usual dose of Equasym (by splitting the capsules at first), and ordered both Equasym & Ritalin prescriptions ready to return to work. When I went to collect it last week the Equasym was there but the Ritalin was missing.
After going around the houses a bit, I have just now got off the phone from the GP who told me that they are no longer allowed to prescribe the short-acting Ritalin under their shared care agreements, and that if I want that prescription again I will have to get the specialist overseeing my care to prescribe it to me themselves. She claims the reason for this is “new rules” brought in to protect patients from the risks of certain controlled drugs - such as increased risk of heart problems, high blood pressure etc. – when the surgery does not have clinicians of their own who are expert enough in these areas. I pointed out that Equasym and Ritalin are the same drug – but apparently the level of risk from the Equasym makes it OK for the GP to prescribe, but not the Ritalin – go figure eh!
My particular issue at this point however, is that my CMHT specialist signed me off in March with a letter to my GP surgery stating that a GP would need to refer me to the new adult ADHD service that has recently started-up in my area and that they would need to take me on for my next annual review (due August 2020). It was made clear in the CMHT specialist’s letter (I received a cc.) that I am stabilised on the Equasym with Ritalin to-up & there were no further recommendations.
The GP has said she will contact the ADHD Service and ask someone to give me a call to ‘discuss it’, but this is as far as she will commit. I explained that I cannot afford to be on a waiting list for this as I need the Ritalin SR ASAP due to the impact it will have on my work – I have just started a new full time contract case-working with vulnerable people and need to be on the ball. I told her my option will be to take another dose of Equasym at 3pm each day which will prevent me from sleeping at night and mean I am taking more Methylphenidate in total – at which I believe she audibly shrugged!
I explained to the GP that taking my Ritalin away during my working day is analogous to taking someone’s prosthetic limb part-way through their working day, but no one seems to be able to understand this – least of all GPs it seems.
SO MY QUESTION IS:
Can anyone tell me of - or direct me to - any changes in guidelines hat suggest what the GP told me is in fact the case?? – I can’t find anything by Googling that seems relevant - these changes are supposed to have taken place in February.
I strongly suspect that these “new rules” are the surgery’s own cost-cutting rules, but would like to check my facts before jumping the gun and raising complaints up the wazoo….
So far as I can tell the GMC link below contains the national guidelines that should apply here……which I can see may be open to interpretation by different GP practices:
www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/prescribing-and-managing-medicines-and-devices/shared-care
Looking at these guidelines, even if my GP surgery has decided to ‘reconsider’ their competencies in relation to ADHD medications and their potential side effect, I still would have thought that paragraph 43 would apply, meaning they would be obliged to discuss it with my original CMHT specialist OR “make appropriate arrangements for their [my] continuing care”.
43 If you are uncertain about your competence to take responsibility for the patient’s continuing care, you should seek further information or advice from the clinician with whom the patient’s care is shared or from another experienced colleague. If you are still not satisfied, you should explain this to the other clinician and to the patient, and make appropriate arrangements for their continuing care.
If anyone can guide me on where to look, what to quote and how best to go about getting my Ritalin back I would be hugely grateful. Without this medication I simply will not be able to hold down my job.