"Palliative care prescribing"

I am receiving outpatient care, which I thought would have been obvious from my story.

Both my GP and oncologist are very angry about what this policy puts many of their cancer patients through.

The shared care excuse is a nonsense as I've described above. The only reason I can think of that a dedicated palliative care service won't prescribe pain medication to terminally ill people is to increase productivity for Hammond and shift the work to the GP, who often doesn't even know yet what the patient is on or even know the patient, or to another specialist who is often in the same situation, plus is already managing lots of other aspects of patient care.

Either way, a sick and often weak patient spends another few hours to get a script, not to mention pharmacy wrangling for S8 scripts.

Could you please explain this policy and the reason behind it clearly? It should be transparent to all. And please don't hide behind shared care. You don't need to prescribe the painkillers as a GP to be involved in shared care. Further, as previously mentioned, it is not uncommon for GPs to be called about patients they've never seen. I've heard from my GP this has occurred to them even if the palliative care doctor is actually at the patient's house at the time.

The distress you are putting patients through is unconscionable.

I'd rather you respond publicly than to me on the phone.

Looking forward to your response.

Dear Mr James

Thank you for your response, part of which isn't clear to me, and much of which sounds like a proforma reply.

It sounds as if you have never been responsible for an individual patient in a clinical sense, and are coming from a primarily PR/commercial perspective. Tell me if I'm wrong and you're a practicing clinician.

You repeatedly fall back on and hide behind the excuse that your service doesn't prescribe pain medications for palliative care patients (in pain) because you are encouraging coordinated or shared care with GPs.

However, there are several factual problems with your argument.

For instance, please tell me why GPs and oncologists are being phoned by your service to write scripts for patients they've never even seen? Even when your staff member is in the patient's home with a script pad in their hand? This obviously isn't shared care, and in itself reveals your excuse to be a furphy. I can confidentially provide names of doctors willing to testify to this if you'd like.

You could easily fulfill this purpose of clear practitioner communication by sending a letter or email to the GP keeping them in the loop, as the vast majority of specialists do. Why make it hard for patients and non-Hammond doctors?

And as you know, prescribing S8 drugs is much much more time-consuming and difficult for practitioners who don't know the patient, have no evidence of their condition and are in the midst of a fully-booked day seeing their own patients? GPs are already stretched. Why do you force patients to ask them to do that work for nothing when your doctors have the patient and computer in front of them?

I'm also sure you're well aware that community practitioners such as GPs and oncologists do not get paid for this work where they do not see the patient face to face, but includes learning all about a complicated patient's medical history from scratch, or writing scripts requested by phone. This is what you're often telling patients to request - sounds like asking other doctors to do Hammond work for free.

So you can see why your policy sounds like simple cost-shifting and buck-passing.

Several of your doctors have told me or implied that the non-prescribing policy is imposed by your institution, and is not supported by them. Some if not all of their computers and software by the way are pre-historic and connected to no-one. It's a joke. They don't even seem to be supplied with computer compatible authority script forms, which most palliative care patients require. Funny that.

In summary, you are going directly against your charter by adversely affecting the quality of life of terminally ill patients, who often have to see many practitioners and often. Shouldn't your service make it easier for these patients, when possible, to not have their precious remaining time and energy monopolised by spending it in doctors' waiting rooms and appointments just to get a script?

In my case, I have three medical specialists, a GP, and three allied health practitioners. Plus I'm struggling to keep working to pay the bills. And I'd like to see my kids.

Couldn't you help out?

This is not to mention that many people these days don't have a regular GP for various reasons, and that is their choice, whether for financial, time, geographic or other reasons.

For these people, they can be treated as drug seekers and denied pain relief when seeing a new GP.

I look forward to a meaningful reply without the spin.

Kind regards

PK