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Reality Check's Founder, Kate Gilbert spent almost two years living and working in London in 2004-06, part of it working for London’s largest public hospitals. She shares what she learnt about how to negotiate the health system and getting onto the stuff you need when Type 1 diabetes has to come along on your travels. In this article:
• Everything’s free: insulin (inc. Lantus and Levemir), blood test strips, doctors’ appointments, everything. • The GP is the most important person in the UK health system. Everything starts with him or her (and the costs of everything you need are charged back to them as well!). • Take several months' supply of everything (insulin, strips, etc.) over with you. It might take a while to get set up on the system and you’ll have better things to do with your first exciting months overseas than sit in GP waiting rooms! You also need to have at least a semi-permanent address before you can get in on the UK system. How to get into and use the system 1. Find somewhere to live. 2.
Register with a GP.
Ring around the GPs and make an “appointment to register”. They may tell you they are all full up. This doesn’t just means they have a lot of appointments full, it means they are not taking on any new patients at the moment. Just keep phoning down the list.
At this registration appointment you will probably see the ‘practice nurse’, not a doctor at all. The nurse will take all your details and plug in everything to a computer. You are now registered on the system. A few months later you will get an NHS card in the mail (but this is not needed for anything except taking up space in your wallet!) If you actually need to see a doctor or get some prescriptions for supplies, make this very clear to the nurse when you go in for your registration appointment. I managed to convince the nurse that I was desperate for insulin, so she printed out a script and reluctantly ducked in to get the GP to get it sign it for me. More likely, you’ll need to make another appointment at a later date to come back and see the GP for supplies or whatever you need. 3.
Get prescriptions from your GP for ALL your supplies To get hold of blood test strips, ketone/urine strips and needles as well as insulin and everything, you need to get a prescription from your GP and take it to your local chemist. 4.
Getting supplies from your chemist It’s actually not a rort at all: as people with a chronic illness we have what is called a “medical exemption” from paying anything. In theory .... A) You have to fill in a special form to say you have diabetes, and your GP signs it too. A few weeks later you receive a card that proves you are entitled to free NHS prescriptions. It is not the usual NHS registration card but one specific to the medical exemption, abd you can (in theory) be asked to pay an NHS charge if you cannot show the card. B) If the chemist is particularly thorough, they may ask you to tick the medical exemption box on the green form/prescription and/or present your card. Note that this exemption from paying any fee will apply to any and all medications you are prescribed, diabetes-related or not. So, just keep saying no and ticking that medical exemption box! 5.
Getting repeat prescriptions
6.
Seeing an endo/diabetes specialist There are a few websites that list specialists and specialist clinics and give an interestign range of details about their expertise, training and waiting lists. Try Dr Foster's Find a Consultant or Specialist Info. 7.
Complications screening
Common problems & a little hard-won wisdom Can’t find a GP who’s not full? Phone your local Primary Care Trust – Use this website: www.nhs.uk/England/AuthoritiesTrusts/Pct/ and ask them to tell you which GPs in the area are not full. They have to find you a space somewhere (even if you’re Australian). Some have a specific service to help with this (e.g. Tower Hamlets PCT's Find-A-Doc service) but all will be able to help you in some way. Can’t get enough strips? If your GP refuses to prescribe more than 50 strips at a time and this is causing you problems (eg you’re going travelling and need more to keep you going), the best bet might be stockpiling – just getting your script filled using the Boots Prescription Collection Service described above a few times a week before you go! Another option is to contact your local PCT and get them on the case – ask to speak to the diabetes nurse or the diabetes team. Or as suggested at the beginning, bring heaps over with you from home. Ended up with a useless GP? You have three options:
Emergencies. Break a leg? Run out of insulin? Head to your nearest big public hospital with an Accident & Emergency (A&E) department. In emergencies, you can go to any A&E – you do NOT have to be in the same area as your home. The emergency phone number in the UK is 999. There are several different "no appointment necessary" services to deal with a range of minor emergencies. The services include walk-in clinics and phone support and are detailed on the NHS website at this link: www.nhs.uk/England/NoAppointmentNeeded/Default.cmsx Family planning and Contraception. The Family Planning Association auspice walk-in clinics, mainly in community health centres, around London and the rest of the UK. This is an excellent service, completely separate from the NHS and your GP. That means you can go to any service, any time, anywhere, unlike NHS/GP where you must be in the area where you live and registered/referred. You can get help with ordinary contraception (including free condoms and the Pill), emergency contraception, sexual health treatment and advice, and all that sort of stuff. The clinics are free. Visit www.fpa.org.uk or call 020 7608 5240 to find your nearest clinic and times. Insulin Pumps. Pumps aren’t as common in the UK as they are in Australia. You have Buckley’s chance of actually getting a pump (though being pregnant, or telling your doctor that you are about to get pregnant has been known to expedite the process – sorry, guys).
Lantus and Levemir are both covered by the NHS just like any other insulin. Children. Sorry, not my bag but if you have a child with diabetes or are under 18, I hope this sheet has been helpful as an overview of how the system works – and to the best of my knowledge, and a tiny bit of working with the paediatric diabetes specialist at our hospital it is all very similar but please do some further investigation. Places to start: www.diabetes.org.uk, www.jdrf.org.uk, www.nhs.uk. • NHS – National Health Service is the enormous government-funded organisation which runs healthcare throughout the UK. Private care and private health insurance are growing in popularity but are still a VERY small part of the system. The Brits are very proud of, and committed to, having a health system based on need not the ability to pay. • Consultants – the term they use for all specialist doctors including endocrinologists. So when they offer to refer you to a consultant, you’re not getting some fancy business management advice, just an endo! • ‘Trust’ is a word you’ll hear a lot - they are organisations created by the NHS. ‘Primary Care Trusts’ cover a suburb or two and manage all the GP surgeries, and things like maternal and child health centres, community centres, quit smoking programs; ‘Hospital Trusts’ might just be one hospital, but are often one organisation that manages a couple of hospitals in a local area. • Primary Care Trust (PCT) – Organisations within each local government area that manage local health services – they oversee all the local GPs and are a good port of call if you have any number of difficulties. Some even have diabetes nurses on staff who do things like work to train up the practice nurses in all things diabetes, make sure the GPs have recall systems for complications screening etc. •
NHS Direct. A web and 24-hour phone service staffed
by nurses to provide basic health advice. Visit www.nhsdirect.nhs.uk
or phone
Published November 7, 2006
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At
any one time, the United Kingdom has half a million Aussies calling
it home, and a half of those are in the fine old town of London.
