If your Primary Care Trust (PCT) refuses to fund the medication that your consultant or doctor has prescribed for you, there may be various reasons for this.
One reason could be that the Chief Pharmacist of your local PCT has disallowed the prescription in which case you need to find out their name and challenge them directly about this.
The second could be that PCT is looking to cut corners on health care because they are in the red. Patient Advice Liaison Service should be helpful and refer you to (ICAS) Independent Advisory Complaints Service who will handle the full complaint, from writing the letter to going to meetings with you.
If the complaint isn’t taken care of then it should be referred to the Overview and Scrutiny Committee that should be meeting locally and in public in some instances. You can find out more from the local library or ring directory enquiries. The OSC can overturn a Primary Care Trust’s decision.
You should get in contact with the local Patient and Public Involvement Forums (PPI) —there should be one in your area that meets in public. They are the lay people running investigations into the Health Service and have been appointed by parliament. PPI members can refer problems to the OSC.
Sometimes you have to find out the names of people and get their reasoning behind a decision.
WRITE TO YOUR LOCAL PRIMARY CARE TRUST IF IT REFUSES TO FUND THE MEDICATION YOUR DOCTOR HAS PRESCRIBED.
You should write formally and privately to your local Primary Care trust with full details of other PCT’s and endocrinologists and general practitioners who you know are currently supplying and prescribing Armour with full names of PCT’s and doctors, etc. You could ask questions from other members about their PCT’s and doctors. Your letter could end with something like the following:
" . . . The PCT and the doctors treating me are under a moral and legal obligation to prescribe the treatment that best fits the patient for a resolution of the symptoms. In answer to this moral and legal obligation both my GP and endocrinologist have complied with their hippocratic oath and want to prescribe XXXX, and my continuing health (just like other patients who are benefitting from this approach) depends entirely on access to this medication which gives me a high degree of symptom relief and well being.In the circumstances, if due to your denial of treatment I have to continue taking unsuitable treatment with worsening symptoms attributed entirely to your denial of treatment causing me constructive bodily harm and disability, I will have no option but to seek a legal reversal of your decision plus compensation and costs. There are well-established legal precedents on reversal of denial of treatment decisions. This is something I would like to avoid, and I hope you will seriously reconsider your decision, your continued refusal will leave me no other option to ensure my continuing good health…”
Tell them you would like a reply in writing, (give them a sae for this purpose). Tell them that you wish for a response from them within say, one month.
Good luck.
The following is a letter written by Nick who successfully managed to get his reluctant Primary Care Trust to fund Armour. If your PCT refuses, then perhaps you can follow what Nick did. Again, good luck!
Many of you will be aware of the saga of 'Sheila's friend' who has been
trying to get Armour Thyroid and having a long battle with their local
PCT.
Well, it's time to 'come out' and tell you that friend is me! We dcided not to reveal my identity for several reasons but now I can tell you that I have been successful. So here is some information that I hope will be useful to others in the same position.
If you are refused Armour by your local PCT, write to them straight away and ask for the reason, in writing, within 10 days.
If they don't respond, get onto the PCT complaints department and tell them that you want your answer in 10 days.
If they don't respond, contact your local ICAS branch and ask for help. I believe that it was their offer of taking up my case that finally swung things in my favour (after five months).
I also complained to the Medical Complaints Commission. They have just witten back to me telling me that they can only take up the complaint if I have a written refusal from the PCT (no wonder they were so hesitant to put anything in writing!).
I also tried the council Overview and Scrutiny Committee (OSC) but they told me that they don't handle personal issues of this nature. They did however telephone the Chief Executive of the PCT to ask what was going on.
The OSC guy also referred me to my local councillor. I was a bit skeptical about this but contacted him and let him have copies of the corresponsdence between the PCT and myself. I have to give him credit for telephoning our MP (who had not responded to my plea for help after three weeks). The MP suggested that he start at the grass roots and go and see the doctors at my local medical centre. He did that and then phoned me to say that they were prepared to try and help me.
However, by that time, I was contacted by PALS to say that the PCT had now agreed to fund the Armour Thyroid, if it was prescribed by my specialist and not my GP. They gave the reason for this as being that my GP was unfamiliar with Armour and therefore unhappy to prescribe it.
I suspect the real reason is more to do with politics. Where I live, we are in the vicinity of a nuclear power station. Apart form the (very) high incidence of cancer around here, it seems that everybody and their dog (no kidding) is being treated for thyroid problems. I suspect that the PCT did not want to set a precident of prescribing me Armour but knew that they could not legally refuse. So they have found a workaround by having somebody outside of the PCT area prescribe it for me.
I don't give a fig who pays for it, so long as I get it.
So, to sum up for anybody trying to get Armour. Don't take no for an answer unless it is given in writing with a reason. The fact that Armour is an unlicensed medicine is not grounds for refusing it if you canot get on with the licensed alternatives. (BTW - my specialist was prepared to back me from the start but only because he accepted that after four years on synthetics, I was not making any progress).
ICAS seem to be the ones to get help from as they are independent of the NHS. The rest of the b*st*rds will stick together and send you round in circles (no matter how nice they talk to you on the phone).
Also try your local councillor.
Write letters or emails and keep copies. If you can, tape any telephone conversations as they will say things on the phone that they won't put in writing.
Use the files that Sheila has assembled for just this purpose. Even if they don't 'move' the PCT/doctors, they do impress independent observers like ICAS.
And lastly, keep going. They employ thousands of people in the NHS to stop you getting the treatment that you need/deserve. It would be cheaper to sack these idiots and give you the medication in the first place. But this is Blair's UK and nothing is logical, fair or right. But in the end, if the law (and your doctor/specialist) is on your side, you will win even if at times it doesn't look like you will.
Nick