GP problems - advice (UK)

[Mattfromengland]

Cross post - not sure this is the right section, so please move if needed. I feel it falls under the banner of political and legal. (??)

After months of fighting my GP all the way on various things and finally getting shared care etc set up I thought I was getting there, but after my set back yesterday (which to be honest I thought she was going to be like that) of her point blank refusing to do any of the pre-requisits I need for surgery, I have decided I need to face facts and that it looks like everything trans related that comes up will make her go "Woah, I'm not touching that". I feel this means it's time to change GP's and I should have done this a while ago. If I get any little after problem with my surgery, or anything else trans related she will just refuse to help!!!!!!

Having managed to get shared care, I don't want to change surgeries and end up losing that, so my first choice would be to switch to a different Dr at the same surgery. Any suggestions on the best way to try and find one that will be better? I don't want to end up with exactly the same or potentially even worse.

My thoughts are to see if I can talk to the practice manager face to face, and explain how unhappy I am with how I've been treated so far. Hopefully she will be sympathetic and try and help (not holding my breath of course, but it's worth a try).

Anyone know:
1. Would it be the practice manager that I need to see for this?
2. Whether you can make appointments to see the practice manager in person?
3. Assuming they are sympathetic would they be the right person and can they actually help with this?
4. I know our surgery has other trans patients, but I don't know which Dr's treat them (mine said she's never dealt with this before!). Would it be unethical for me to ask which Dr'/s they are?

My other concerns are that my GP came up with excuse after excuse to not do things, all of which were not viable excuses (hence why they kept changing and morphing each time she was proven her excuse wasn't valid!), BUT she appeared to be supported by the practice partners, as they backed her up......or so she said. So this potentially doesn't bode well!!!!! Not that I trust what she's said, so who knows!

Next set of questions:
5. If I do need to change surgeries anyone know how likely it could be that I'll lose my shared care? I'm hoping as it's in place, and was agreed by the Local Mental Health Team in writing in their assessment report and given they are not related to my surgery itself, that this would stand at any NHS surgery.
6. Anyone have any experiences that they don't mind sharing about changing surgeries with shared care in place from a private GIC? Whether they be good or bad....it will help me to make decisions.
7. Anyone got any advice in general?

To wind this up, I will explain my course of action on all this. My aim is to fight my GP and show her she's in the wrong, before changing GP's (both for the principal of it and to help pathe the way for any other trans men or women who end up under her care in the future). Then I will be doing all I can to, albeit small, to help change these attitudes.

First off, I have NHS England on the case. They deal with complaints (I was passed on and on until I ended up there), but I don't want to make a complaint as such and they have made a note of that, and say they will look into what the score is and if it's needed will liase with me and my GP and advise her.

Second I will be going back to the psych I saw at my LMHT as she was consultant level, had dealt with trans patients before and was amazingly helpful and on my side. It was her that just said re shared care "Well of course she can do it! Don't worry, leave it with me, I'll tell her". Which she did and it still took my GP months of various excuses before agreeing to it. She also said if I still needed a referral (I only wanted a referral if I couldn't get shared care due to the costs) or she could help in other ways that I could go back to her. Technically I've been discharged, but she told me I could phone up if need be. I called yesterday but she's away until Tues and the reception just told me I was discharged so she couldn't help, but did say to try calling Tues. I'm confident the psych will help me if I can get through to her.

Third I will speak to someone at my practice (as above, probably the practice manager) and see if the problem can be sorted that way.

Forth, once I've won this battle (and I'm 99.9% sure I will because she is in the wrong and I will prove that to her), I will be changing GP's for an easier life.

Fifth, I will do all I can to help campaign and educate so as to alleviate some of this suffering us trans folk are subjected to.

IT"S ALL SO WRONG!!!!!!!!!!!!!

Sorry for the long post, hope it's not too, too boring, and thanks for any replies/advice.

[jebee]

just complain.. this is the nhs, i got free laser hair removal from mine, maybe just get a new doctor, you can do it in a few minuets.

[Beverly]

By all means speak to the Practice Manager, but take a couple of big sticks with you.

First, ask if they have spoken to their Medical Defence Union about refusing treatment to Transsexuals. The MDU takes a dim view of anything that looks like it will lose in court and will tell the Practice to get its act together and stop messing about or else. No Practice can operate without indemnity insurance.

On the MDU website, it has a section for this. Print the whole page and take it with you. Hand it to the Practice manage and tell him/her that you have read it. The fact that you even know it exists will probably put the wind up the Practice Manager.

http://www.themdu.com/guidance-and-advice/latest-updates-and-advice/mangement-of-transgender-patients-in-general-practice

Which says (in part)

"Management of transgender patients requires great care and sensitivity. Here we review some of the reasons for members to seek our advice.

Some transgender people report that they feel discriminated against when receiving medical treatment ranging from delays for gender reassignment surgery to lack of knowledge by the medical profession about the issues they face."



Next go here

http://www.gmc-uk.org/guidance/good_medical_practice/respond_to_risks.asp

and here

http://www.gmc-uk.org/guidance/good_medical_practice/treat_fairly.asp

and print those and wave them around so that they can be seen. There is nothing they hate more than a patient who looks like they are on the verge of making complaints or lodging action against the practice.

If you have written guidance from the surgeon or GIC advising of a certain type of treatment, then ask for the clinical ground for refusing that treatment IN WRITING. I would also consider sitting down before you go and writing a single A4 page putting out your position - that you have been advised that treatment xxxx is required, that you have asked for this, that is not forthcoming and the reasons have not been adequately explained. Finally say, in writing, that you feel, in your opinion that you are being discriminated against because it seems to you that your doctor does not like transgender patients and make sure you write the subclauses with "feel" and "seems" because that makes it an opinion rather than an accusation and that is very, very important. You cannot make unfounded accusations, but you are allowed to state your feelings.

Hand your one page letter and all the other stuff you have printed to the practice manager and ask him/her to read it and reply in writing.

[Mattfromengland]

Thanks for the replies and advice.

The problem I have is my GIC is private, so my GP doesn't HAVE to help me at all, she's well within her rights to just say no.

I tried calling various places as overall I just feel she's not supporting me and it's more her whole attitude towards the trans thing, but no joy due to the fact of mixing private and NHS.

The worry with changing GP's is that after a massive fight of around 4 months she has been persuaded to prescribe and do bloods for me (not my pre-op bloods though), so if I change I could go backwards and lose that as they don't have to.

I've also taken various printouts with me and they haven't really helped. I've proved to them time and time again that their excuses are not valid, but they just move on to make up another excuse instead. Until eventually they ran out of excuses.


I have managed to get hold of the consultant that tactfully told my GP to prescribe, but even she at first just said I will probably just end up paying privately for my pre-op clearance as she didn't really know that my GP could do it for me. After further chat though she has agreed to call my GP and have a chat with her. The main worry of the consultant was regarding post-op care if I get complications and that I won't be left out in the cold having been refused treatment.

Just need to wait and see what happens now.  Fingers crossed.

Thing is I don't have time on my side. It still took months of excuse after excuse to get the yes to prescribing even after the consultant put it in writing that this was what was going to happen.

[jebee]

Its not about your gender stuff its because of you doing it private, they don't like that, why not get it all for free from the NHS any way?

[Mattfromengland]

The reason I can't get any joy with help from the system in general on his is to do with mixing the two, but the reason my GP is being difficult is because she has doesn't want to touch the trans stuff.

I am 100% happy with my private GIC so would like to stay under their care if possible. Also by the time I swapped to NHS I will have done everything I want to do as my surgery is in May. So switching would just mean I end up going down a care path I don't want to and would also cost me money getting to appointments just to get to the stage where they will take over.

My next GIC app. is 6 months after my last, then all being well should go to yearly, where as I'd need to go through several assessment appointments again.

I am considering doing that but only as a last resort, I don't want to.

[Mattfromengland]

I have good news.

I have changed GP's within the surgery and have just seen my new one this morning and she was great. Really understanding, supportive and apologetic for my bad experience so far. She kept saying that she understands I know more than she does on the subject, and told me if there's anything at any point that she says that I'm uncomfortable with to speak to her about it as it will be due to her lack of knowledge rather than anything else.

My old GP refused to help at all with any of my pre-op clearance and wouldn't even give a recommendation of where I could get the stuff done privately when asked to by an NHS consultant (this is the psych I saw after she refused to refer me direct to the Laurels) but said 'The NHS can't be seen to condone going abroad for surgery'!

Anyway, new GP is happy to do my blood test and my fit for surgery letter (letter will cost £15 - standard charge for things like that) but she's unsure about the mamo and said if I'd asked her first she would have just done it without any problems but of course there's been an issue with it now so it's been flagged up already.  She's going to check with the practice partners and let me know before 3pm this afternoon but did say don't get your hopes up. Bearing in mind my old GP is actually one of the practice partners and the others were all supporting her in her decisions not to support me and so are aware of the refusal to help and seem supportive of that decision rather than supportive towards me!

Either way, that's saved quite a bit of money, but overall the biggest thing is I'm just so much happier to have support, understanding and finally some empathy!

So that's my biggest stress with all this sorted out

Now I can fully concentrate on getting through surgery!

ONE HAPPY BUNNY HERE!!!!

(I have had to put a referral in to switch to an NHS clinic to make things clearer, which I didn't want to have to do as I'm really happy where I am (under Dr Curtis), but I guess needs must!)

[NIP]

I have good news.

I have changed GP's within the surgery and have just seen my new one this morning and she was great. Really understanding, supportive and apologetic for my bad experience so far. She kept saying that she understands I know more than she does on the subject, and told me if there's anything at any point that she says that I'm uncomfortable with to speak to her about it as it will be due to her lack of knowledge rather than anything else.

My old GP refused to help at all with any of my pre-op clearance and wouldn't even give a recommendation of where I could get the stuff done privately when asked to by an NHS consultant (this is the psych I saw after she refused to refer me direct to the Laurels) but said 'The NHS can't be seen to condone going abroad for surgery'!

Anyway, new GP is happy to do my blood test and my fit for surgery letter (letter will cost £15 - standard charge for things like that) but she's unsure about the mamo and said if I'd asked her first she would have just done it without any problems but of course there's been an issue with it now so it's been flagged up already.  She's going to check with the practice partners and let me know before 3pm this afternoon but did say don't get your hopes up. Bearing in mind my old GP is actually one of the practice partners and the others were all supporting her in her decisions not to support me and so are aware of the refusal to help and seem supportive of that decision rather than supportive towards me!

Either way, that's saved quite a bit of money, but overall the biggest thing is I'm just so much happier to have support, understanding and finally some empathy!

So that's my biggest stress with all this sorted out

Now I can fully concentrate on getting through surgery!

ONE HAPPY BUNNY HERE!!!!

(I have had to put a referral in to switch to an NHS clinic to make things clearer, which I didn't want to have to do as I'm really happy where I am (under Dr Curtis), but I guess needs must!)

This all sounds startlingly similar to the experience I had with a GP surgery in Cambridge. They were in the wrong, they knew it, but the GP partners all got together and refused to budge. I could have taken legal action and won, but by that point I was just so exhausted after months of fighting to get them to cooperate in the slightest with my private GP. So I moved, and used an entirely different GP in a different county. Suddenly, there was absolutely no problem. My new GP had no problem cooperating fully.  I now get blood tests and hormones on the NHS via my new GP, and I expect they'll have no problem carrying out pre-ops. There are good GPs out there. Maybe we should make a database from our collective experiences.

[Mattfromengland]

This all sounds startlingly similar to the experience I had with a GP surgery in Cambridge. They were in the wrong, they knew it, but the GP partners all got together and refused to budge. I could have taken legal action and won, but by that point I was just so exhausted after months of fighting to get them to cooperate in the slightest with my private GP. So I moved, and used an entirely different GP in a different county. Suddenly, there was absolutely no problem. My new GP had no problem cooperating fully.  I now get blood tests and hormones on the NHS via my new GP, and I expect they'll have no problem carrying out pre-ops. There are good GPs out there. Maybe we should make a database from our collective experiences.

Yes it is exhausting. I have been very lucky as compared to many I have had very few problems, but just this one has been huge for me and really effected me emotionally. I got to the stage where I wanted to keep fighting and prove to the GP that she was wrong, and also to educate her for the sake of anyone else coming into her care in the future, but in the end decided I'd had enough and needed to just get rid of that stress from my life. Looking for another GP was a scary thought though in case I ended up in a worse position or lost my prescribing etc.

All turned out well in the end and I feel great relief!