Ask the Surgery - Your Medical Questions Answered

Access to Healthcare questions

Why can't I order a repeat prescription over the phone and why does it take 48 hours to prepare a repeat script?[Click to show/hide answer]

Your surgery will not accept a repeat prescription request over the phone because this helps to minimises any potential errors that could occur through any miscommunication that a telephone conversation can create.   Prescribing of medication is a serious issue and goes to the fundamentals of providing quality healthcare to patients as such any request should be done in written form via your practice website or email if they provide these facilities, in person, by fax or post.  

Your doctor will need 48 hours to process your request for a repeat prescription because this timeframe allows them to thoroughly assess your medication and the many other patient requests that are made of them on a daily basis.

Prescriptions are important medical documents and the doctors need to make a number of checks before signing them in order to ensure the best possible care to the patient. These checks vary and may include blood tests or blood pressure checks

Answered by: Telisha Milton, Assitant Practice Manager - Melbourne Grove Medical Practice

I missed three consecutive appointments at my surgery because my situation changed at the last minute.  I was told that if I missed the next appointment steps would be taken to remove me from the patient list because I was a “constant DNA.”  Is the practice allowed to do that?[Click to show/hide answer]

Whilst a patient may have a genuine reason for missing an appointment, the cumulative effect of patients not attending their appointments is substantial for  practices.  Patients who fail to attend appointments (known as ‘DNAs’; short for Did Not Attend) cost the NHS about £700m a year, with up to six million appointment slots wasted annually. In addition to being a significant cost to practices, DNAs lead to longer waiting times for patients wishing to book an appointment and to an increase in unnecessary visits to A&E.

For these reasons most GP practices will operate a policy to educate patients who miss appointments. Although the policy may vary slightly from practice to practice, a general guide is that practices will issue three warnings which explain the impact of DNAs and the importance of cancelling unwanted appointments. Practices are indeed entitled to then remove a patient from their list if the patient persists in missing appointments despite warnings. However, GP practices do need to think carefully before removing any patient from their list and this should only be a last resort. There may be health or social problems that are impacting on the patient’s ability to attend or the patient may not understand the appointment system or be able to reach the receptionists to cancel an appointment they no longer need. This should be considered before any patient is removed from the practice list.

As a patient it is your responsibility to cancel any appointment you have made in reasonable time so that another patient can benefit from the appointment slot. Even if you are unable to avoid cancelling at short notice, often the receptionists will know of another patient who can use the appointment. You may wish to discuss your particular circumstances with the Practice Manager to see if you can reach an agreement with your practice.

Answered by: Sandra Connolly, Practice Manager - Melbourne Grove Medical Practice

I have a condition that I believe should be assessed by a specialist and I want to be referred to a hospital consultant but my GP doesn't think a referral is clinically indicated. Can I demand a referral from my GP?

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Most GPs are generalists; some have specialist knowledge in certain fields of medicine, for example in Sports & Exercise medicine, Ear Nose & Throat or Maxilofascial surgery. As a doctor and on occasions a patient, I can understand the frustration of the situation where you firmly believe that your condition needs a specialist to assess. The GP's main role is to diagnose, investigate, treat and if necessary refer. A referral is indicated when the collection of signs and symptoms and maybe investigative results or lack of response to treatment suggest that there is a problem that requires the input of a hospital doctor who specialises in the area; or the further investigation requires the hospital doctor to initiate.
Your question highlights ethical dilemmas faced by many GPs:

1. Do we give in to what the patient demands and refer? Some would argue that this drains vital NHS resources that others need; this of course assumes the patient doesn't have anything to refer for.

2. Do we act as a clinician and resist referrals if we feel it is not necessary? Some would argue this creates barriers to maintaining doctor patient relationship and distresses both sides

Ultimately, if a patient feels so strongly about being seen by a specialist, they do have options. I have listed three; each one has its possible outcomes:

1. Argue and demand the GP to refer. The GP may cave in and refer but the doctor patient relationship will crumble. Do you really want your GP to be just a referring vassal or a clinician who listens to you and thinks logically and uses his experience?

2. Ask for a second opinion. This avoids a direct confrontation but be prepared that the second GP opinion may be the same as the first

3. Involve a third party like PALS (Patient Advice and Liaison Services). They act as your voice and may speak to the GP.  Be mindful that they are not clinicians though so they cannot give any clinical input on the matter.

Answered by: Dr. Jun Ming Zhang, General Practitioner - Melbourne Grove Medical Practice

What are urine water samples checking for?

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Urine tests are very useful for providing information to assist in the diagnosis, monitoring and treatment of a wide range of diseases .In addition, a urine test can determine whether or not a woman is ovulating or pregnant.

Urine can also be tested for a variety of substances relating to drug abuse, both as part of rehabilitation programmes and in the world of professional sport.
The urine can be tested very quickly using a strip of special paper, which is dipped in the urine just after urination. This will show if there are any abnormal products in the urine such as sugar, protein, or blood. This is done routinely at some outpatient appointment and medicals.

If more tests are needed to get more details, the urine will be analysed at a laboratory

Answered by: Sonia Hall, Clinical Manager and Nurse Practitioner - Melbourne Grove Medical Practice

My urine has started to smell very strong and seems to have become worse since a recent hernia operation. Is there a particular reason for this and is it something I can resolve with diet etc.? Many thanks

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Normal urine is clear and has a straw colour. Urine’s odour can vary but it shouldn’t be a noticeable strong smell. The most common course for the smell to intensify is when it is more concentrated and this is easily resolved by increasing your fluid intake .Consumption of some foods, such as Asparagus and taking some medicines may alter the odour of urine.

In the presence of an infection in the urinary tract, urine may take on a foul smelling odour as well as appearing cloudy or bloody, but you would expect other symptoms such as passing urine more frequently or some pain or fever.
The urine may also have an abnormally sweet odour in uncontrolled or undiagnosed diabetes, and some rare genetic conditions can also cause the urine to have an abnormal odour.

If the smell doesn’t seem to improve with increasing your clear fluid intake , a recommended intake of 2-3 litres of water per day is the norm then please consult your GP or Nurse Practitioner who can investigate further.

Answered by: Sonia Hall, Clinical Manager and Nurse Practitioner - Melbourne Grove Medical Practice

I think the terminology used by the NHS can be really confusing. If I need to see a doctor outside of my surgery opening hours I’m not sure if I should go to a walk-in centre or clinic, call an out of hours telephone line, phone NHS Direct, use the online symptom checker, or simply pop into the A&E department at King’s College Hospital – or do something else. Could you please clarify this for me?[Click to show/hide answer]

If you are unwell and your GP Practice is closed you do have a number of options. Although it may seem confusing, the aim is to provide good access to healthcare for everyone at any time of the day or night. Which service you use will depend on the medical problem troubling you, but there is a goldmine of information about the types of NHS Services available on the NHS Choices website at www.nhs.uk

I would like to stress that major A&E departments, such as the one at Kings, are for treating patients with serious illnesses or injuries. Examples would be severe chest pain, breathing difficulties, loss of consciousness or bleeding that cannot be stopped. You should only go to A&E in a genuine emergency or if advised to by a healthcare professional.
If you are unsure which services to use, a good place to start is by phoning NHS Direct on 0845 4647 (24 hours a day, seven days a week). They will assess your medical problem and can provide you with some medical advice or direct you to the most appropriate service in your area. Tools such as the symptom checker at www.nhsdirect.nhs.uk can also help you work out which is the best service for you.

All GP practices provide an out-of-hours GP service; in Southwark this is SELDOC on 020 8693 9066. You can also find their phone number on your GP Practice's answerphone message. This service is for problems you would usually see your GP about, which cannot wait until your practice reopens. Alternatively NHS walk-in centres can help if you have a minor illness such as a rashes, sprains, cuts and bruises or burns. A well stocked medicine cabinet can help with many common illnesses and your pharmacist will be able to advise you.

Answered by: Sandra Connolly, Practice Manager - Melbourne Grove Medical Practice