Don’t like to bother you GP? Feel they must have better things to do? Such stoicism is common but, unfortunately, it is not good for your health.
Britain has one of the worst cancer survival rates in Europe due, at least in part, to the fact that people delay going to their GP about their symptoms, according to recent research from the University of Cambridge and University College, London.
Even when we do go and see them, we are just too timid with our doctors, says Professor David Haslam, head of the National Institute for Health and Care Excellence (NICE) – the organisation that approves treatments for use in the NHS.
A recent government report revealed a third of kidney cancer patients and one in three patients with motor neurone disease are not getting the drugs they need.
Professor Haslam believes patients are missing out partly because they are not pushy enough with their GPs. He suggests we should be more like Americans, who are less deferential when they see a doctor and go in armed with research about their conditions and its treatment.
‘As long as they’re clinically appropriate for them, patients have a legal right to the drugs we’ve approved,’ said Professor Haslam. Indeed, the right to have NICE-approved drugs is enshrined in the NHS Constitution.
The problem is that nearly 80 per cent of Britons have never heard of the NHS Constitution, says Katherine Murphy, chief executive of the Patients’ Association. ‘How can you challenge the system unless you know what you’re legally entitled to?’ she asks.
So how far can you push, and for what? We asked experts to explain.
Getting the latest drug treatment
Legally you can ask for any drug once it has been approved by NICE to treat your condition. If your GP or specialist thinks it is appropriate to prescribe it, your local clinical commissioning groups must fund it.
However, if there are cheaper drugs doing the same job you may have a fight on your hands. For example, if you are one of the 1.2 million Britons with a faulty heart rhythm, known as atrial fibrillation.
Because of the raised risk of stroke, many patients are on warfarin to thin their blood. This treatment requires blood tests every few weeks to check they’re on the right dose.It also interacts with certain foods.
A new NICE-approved drug, Pradaxa, is more effective but more expensive. But a recent survey found only one in 20 atrial fibrillation patients is prescribed Pradaxa or one of its sister drugs, Xarelto or Eliquis.
Legally you can ask for any drug once it has been approved by NICE to treat your condition
Dr Michael Dixon, president of the NHS Clinical Commissioners and a Devon-based GP, explains: ‘Doctors have to be convinced Pradaxa is worth the extra money because prescribing it means you’ll be taking money away from another patient.
‘No doctor will withhold something that will make a real difference, but if the difference is marginal it is a subject for discussion between patients and doctors.’
If your request is rejected, you can complain to your CCG, the new GP-led health authority that makes funding decisions. To find your CCG, go to the NHS Choices website.
If you are not satisfied with the outcome you can take your complaint to the parliamentary health service ombudsman (0345 015 4033, email@example.com).
If you ask them to, your GP might appeal on your behalf to get a treatment or procedure being rationed in your area.
In the Leeds area, restrictions have been imposed on the number of IVF cycles patients can have and the number of gastric band procedures carried out.
‘I recently appealed to our CCG for a patient with several medical problems who needed a gastric band. I was successful and he has benefited greatly from it,’ says Dr Richard Vautrey, a GP in Leeds who is deputy chair of the British Medical Association’s GP committee.
You can ask to have your treatment in any hospital in the country if it has the necessary expertise
Choosing a specialist or where to have an op
We all want the best treatment for our condition, but what if you’ve heard favourable reports about an expert who works in a hospital 300 miles away?
The good news is that you can ask to have your treatment in any hospital or clinic anywhere in the country if it has the necessary expertise. Your GP can help arrange a referral to the specialist you would like to see.
You (and your doctor) can access the electronic national referral service called Choose and Book at chooseandbook.nhs.uk – this allows you to select your hospital or clinic as well as the date and time of your first appointment. (A new NHS e-Referral Service will supersede Choose and Book later this year.) Of course, there may be other practical reasons for not travelling too far; if you need hospital treatment, you might not want to be 300 miles from family and friends.
Seeking a second opinion
While you can ask for a second opinion from another GP, you actually have no right to one.
The alternatives are paying to see a specialist privately or getting advice from a nurse at a walk-in centre – these are open 365 days a year.
However, if you are unhappy with an NHS specialist you’ve been referred to, under the NHS Constitution you are entitled to ask your GP to refer you to another.
Seeing your medical records
You have the right to see any medical report written about you by your GP or specialist for a new employer, say, or for insurers if you had to cancel your holiday because you were ill.
You also have the right to see your health record, which contains all your medical history.
To do this, put in a request to the GP who holds it. It should be available within 40 days, but you may be charged a small fee.
Unhappy with your GP’s care?
If you think you’re receiving poor care from your GP, first speak to your doctor or practice manager, as every surgery has its own complaints procedure.
If you prefer, you can complain in writing or via email to your local NHS England team. These are listed on the NHS England website.
Alternatively you can complain to your CCG.
You must notify your doctor’s surgery in writing that you have done this so they know the complaint has been lodged and have the chance to resolve it.
If you think you’re receiving poor care from your GP, first speak to your doctor or practice manager
According to the NHS Constitution, any complaint you have about NHS services should be acknowledged within three days.
If you’re unhappy with the response, you can refer the complaint directly to the Parliamentary Health Service Ombudsman who will conduct an investigation.
NHS bodies, such as the Patient and Advisory Liaison Service and the NHS Complaints Independent Advocacy Service, will provide advice, as will patient advocate groups the Patients’ Association and Patient Concern.
‘In our view the complaints procedure does not work well,’ says Joyce Robins, co-director of Patient Concern.
‘While some people can write a good letter, others can’t. I don’t think the Department of Health has come up with anything that works.’
Taking part in a clinical trial
When you have tried all the available treatments, going on a clinical trial investigating the effectiveness of a new drug can offer the hope of finding something that works.
You can look up clinical trials on the World Health Organisation (WHO) International Clinical Trials Registry Platform which acts as a central database.
Talk to your GP and specialist to see whether you are suitable and might benefit, but remember that you may be in the part of the trial getting the placebo rather than the new drug itself.