Appealing against GP refusal of treatment....Any Advice ?

kingrollo

Really hoping there is a GP or healthcare professional who can help me here:-

Since my mid twenties (55 now) I have had episodes of low back pain - despite physio exercises, etc the only thing that worked was a steroid injection into the facet joints. Initially I needed these quite frequently (twice a year) - But since regular stretching, pilates and Yoga I have needed then less - last one was 5 years ago.

These injections have proved 100% successful - I have never had one not work

Now my back has flared up again - and once it gets to this stage it pretty requires an injection - physio, ice packs, hot water bottles, stretching initially provide some relief but the overall trend is downwards until I get a injection.

However this time GP is refusing treatment (more specifically the injection) initially the gave me the "injection carries risk spin" - But now they have at least come clean and said that this falls under there policy:-

"Procedure of limited clinical priority"

Thats not to say the procedure wouldn't work - just that "they aint funding it"

I now have permanent 24/7 pain from this - my cycling is pretty limited

I have thought about appealing to the CCG - or asking my MP to intervene - but I am not hopeful of either - to get an injection done privately would cost around £2500 - which I can not afford.

It would seem that beyond A+E and antibiotics there isn't an NHS any more..

Anyway I always think there is a way around things - knowledge is power etc - any ideas folks ?

imposter2.0

If the injections are no longer on the cards, then presumably your GP is suggesting an alternative treatment plan? To be fair to the surgery, the steroid injections are clearly only treating the symptoms, rather than the cause...

3wheeler

Hopefully you'll find some sort of solution, pain and becoming inactive when there are treatments available is no fun whatsoever.

Unfortunately for you, and many others, sustained under funding of the NHS by the current government means they are struggling. If you talk to a few people who work in the NHS you might be shocked at some of the cuts and how that affects the service they can deliver. This isn't helped by the stealthy privatisation meaning private companies took £3bn for services they provide.

kingrollo

Imposter wrote:

If the injections are no longer on the cards, then presumably your GP is suggesting an alternative treatment plan? To be fair to the surgery, the steroid injections are clearly only treating the symptoms, rather than the cause...

Agree - but without the jab I once went 18 months in daily pain. GP has recommended physio - which in 30 years has never helped - yet the injection which always help me are now non funded.

I thought about appealing to CCG (who make decisions on funding) - But I can't appeal it has to come from the GP anyway I looked into the appeal criteria and was staggered to find the following :-

“The fact that a treatment is likely to be effective for a patient is not, in itself, a sufficient basis for establishing an exception.”

Thank you Dudley CCG !

webboo

I thought there was a maximum number of steroid injections you were allowed. Something like 4, although I have heard it is an arbitrary figure.
What about paying privately to see an Orthopaedic consultant. You get seen fairly quickly but you then dip back in to the NHS for any treatment.

kingrollo

Webboo wrote:

I thought there was a maximum number of steroid injections you were allowed. Something like 4, although I have heard it is an arbitrary figure.
What about paying privately to see an Orthopaedic consultant. You get seen fairly quickly but you then dip back in to the NHS for any treatment.

They will not fund it even then. The treatment is available on the NHS by my clinical commissioning group - will not fund the injections. There is a limit but I asked about this at time of the last jab he said he was only injecting minimal amounts - so if more rounds were needed these could done - but 1 shot has alway been enough.

Last time he offered me a process to deaden the nerve ends which was the next step up - I declined it as the jabs had always worked. Wish I had of taken it now.

Had a quote its almost £2k to get it done privately as it has to be under x-ray or mri conditions. - Really annoying

Killerclown

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

imposter2.0

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

craigus89

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Shame it isn't affordable for everyone isn't it? OP said he can't afford it.

With that being said, if the last one sorted you for 5 years, would it not be worth seeing if you can scrape together to get it done privately? If it's as bad as you say then surely it's worth it?

Killerclown

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

He can’t afford not to.

imposter2.0

Killerclown wrote:

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

He can’t afford not to.

If only you could resist the urge to post bollox on every thread. You've already been banned three times - why not take a break for a while..???

Killerclown

Imposter wrote:

Killerclown wrote:

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

He can’t afford not to.

If only you could resist the urge to post bollox on every thread. You've already been banned three times - why not take a break for a while..???

If you can give an example of anything more worthwhile proritising spending money on first, than your health and well-being, and cutting your cloth accordingly, I’d love to hear it.

imposter2.0

Killerclown wrote:

Imposter wrote:

Killerclown wrote:

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

He can’t afford not to.

If only you could resist the urge to post bollox on every thread. You've already been banned three times - why not take a break for a while..???

If you can give an example of anything more worthwhile proritising spending money on first, than your health and well-being, and cutting your cloth accordingly, I’d love to hear it.

He's already said - he..cant..afford..it. Do us all a favour and go away.

Killerclown

oxoman wrote:

To the OP. Can't help on appeal procedure however the comment about max number of injections made me think. My wife used to have routine steroid injections for respiratory problems and the last one she had caused problems, she now has muscle wastage problems at the point she was injected. It could be that after so many jabs the risk of damage is beyond the risk a doctor will take. I also agree on several comments above re NHS funding. Another option is to possibly find a private practice that will do it.

I’d agree with that.

mouth

Killerclown wrote:

Imposter wrote:

Killerclown wrote:

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

He can’t afford not to.

If only you could resist the urge to post bollox on every thread. You've already been banned three times - why not take a break for a while..???

If you can give an example of anything more worthwhile proritising spending money on first, than your health and well-being, and cutting your cloth accordingly, I’d love to hear it.

At the age of 55, having paid into the system for probably close to 40 years, I'd argue that he's already paid for it. It's not like we get a discount on our 'deductions' section when we go private medical, or send our kids to the fee paying private school and such like.

I take great personal interest in threads of this nature, being 37 and knowing I've got it all to come in the future.

keef66

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

He's repeatedly demonstrated that he doesn't bother reading anything before posting. It's like internet Tourette's.

@ the O.P. have you ever had any detailed imaging done to determine what exactly is going on with your lower back? Is it simply facet joint pain, or are there other things going on such as degeneration of discs / vertebrae, nerve impingement etc?

Rant mode on
It's a sorry state of affairs that the NHS witholds a relatively cheap and simple treatment which could keep somebody pain free, mobile and contributing to society, ignoring the fact that a decline into chronic painkiller use / long term sick leave / disability could cost the individual and the country / society in general a whole lot more.
There's nobody in charge with the balls to look at the bigger picture, a long term strategic vision, or to focus on improved outcomes rather than budgets and bean-counters who see no further than the end of the financial year. Sorry, it's been a long week.
Rant mode off

webboo

kingrollo wrote:

Webboo wrote:

I thought there was a maximum number of steroid injections you were allowed. Something like 4, although I have heard it is an arbitrary figure.
What about paying privately to see an Orthopaedic consultant. You get seen fairly quickly but you then dip back in to the NHS for any treatment.

They will not fund it even then. The treatment is available on the NHS by my clinical commissioning group - will not fund the injections. There is a limit but I asked about this at time of the last jab he said he was only injecting minimal amounts - so if more rounds were needed these could done - but 1 shot has alway been enough.

Last time he offered me a process to deaden the nerve ends which was the next step up - I declined it as the jabs had always worked. Wish I had of taken it now.

Had a quote its almost £2k to get it done privately as it has to be under x-ray or mri conditions. - Really annoying

What about acupuncture
Having just been reading about it on UKBouldering which is the other place I live. It might be an off the wall idea but given you are only being injected with small amounts of steroids, it might be the needle doing something.
Most physics perform it these days.

cycleclinic

The injection is a sticking plaster. The cause of the pain should be addressed. Maybe thats what the doctor is trying to get you to do. Pan killer for the rest of your life are probably not the answer.

orraloon

OP. Have you tried an assessment by a chiropractor? Ok, so is classified as alternative medicine, but perhaps perhaps.

I have an initial assessment session by one tomorrow to take a look at my weird shoulder / collar bone issue, after chatting with a mate who had recurring shoulder pains for several years, chiropractor worked out cause, sorted it out, now painfree, hoping I get such a successful outcome.

Need to pay for it, but normally not that expensive, say £60 per hour, and if it works then big tick.

Meanwhile, back in normal NHS world, first stop x-ray shows nowt, MRI soft tissue scan appt will come along in due course. My GP tacitly agreeing I go down the alt route to see if it works.

kingrollo

O/P here
Thanks all for the suggestions Its heartening that at least some people are trying to helpful - Just clear up a few things

1.Imagining
I have loads of xrays, Mri, MRI with dye. The last x-ray did show very minor wear on one of the discs - overall though my back per the images is normal for someone of my age. BTW Imaging is not not offered in my area for diagnosis of low back pain

2. Steriod injections
I have often been told that this is masking the real problem. I try not to roll my eyes whenever I hear it. Said physio then does a massive investigation - diagnoses a muscle imbalance, a weak lumber spine, occasionally one gets closer (IMO) with stickin facet joints. I am them put on lumbar strengthening programs, given core exercise to do - which I do diligently - occasionally they pull me up on technique - this goes on for a few weeks or months - physio's often get quite arsey when I report no improvement - they often re word the question in different ways - so they can record some improvement and discharge me. This ends with me being discharged back to the GP, who having initially declined the facet injection then refer me for such an injection - problem solved !
The only sure fire way to diagnose a facet joint injury - is to inject it - if it works - you know that was the problem

3. Acupuncture
I haven't tried this to any great extent - but I have a private physio booked for next friday - where I will ask for this. I am not helpful though - as on one of the episodes I was injected with prolotherapy not steroid - which didn't work

Its weird how it happens - when I feel an episode coming on I treat it with ice, ibuprofen, hot water bottle - initially this helps and it appears to get nearly better as the pain sort of moves into my buttocks - and sometimes up my back - however it always returns to the epicentre - then doesn't move - the ice packs etc stop working.
My theory (and I am not claiming to be a doctor) is that the initial injury - is soft tissue and maybe bone - all the ice and meds helps with the soft tissue injury - but the cartilage remains inflamed and nothing can get to it - bar the now forbidden steroid injection. (but wtf do I know)

yellowv2

I'm surprised MRI is not offered in your area for diagnosis, is this with a GP referral ?
As a sufferer of lower back pain myself I would thoroughly recommend visting a Chiropractor as this has helped me tremendously since 2006. I have also used pilates and more recently Yoga (which has been a revelation) to ease the problems, along with core strengthening exercises.
As the Cycle Clinic says steroidal injections are a sticking plaster to mask the problem and are not a long term solution. Rightly or not, unless your condition is disabling to the point of affecting your ability to work or function correctly, the NHS will not treat it as urgent, so self help is the only option. I view it as an expense I cannot do without, rather than one I can't afford.
As far as I am aware Acupunture is used to prevent the muscles spasming and enable further treatment. rather than a cure in itself. I have received it in this way by my Chiropractor when in pain and needing to release muscles to treat me.

cooldad

Acupuncture and chiropractic are snake oil. Acupuncture is, at best, a placebo, and chiropractic can be dangerous.

The correct term for alternative medicine that actually works is medicine.

https://health.spectator.co.uk/the-evid ... than-good/

964cup

Notwithstanding the way your CCG has phrased it, repeat steroid injections is not a good idea, and others who have said that you should be addressing the root cause are right. However, the likely means of resolving the problem will be surgical, which isn't fun. I have private insurance, so funding is not usually an issue, but in both cases where I have had joint issues (lumbar spine and shoulder) they have allowed a maximum of two injections (total, not annually) before moving to a surgical intervention. My back had a much more obvious causal problem than you appear to (two failed discs and a spondylolisthesis) and I had a fusion - you may "just" need decompression. I'm about to have the second (and final) injection in my shoulder before moving to a decompression there.

Of course, the next interesting question will be whether your CCG will fund a decompression...

DeVlaeminck

If the OP has gone 5 years since the last injection and at that time he was told further injections weren't a problem due to the small amounts being injected I would feel similar frustration at this. It's fine saying it's treating the symptoms not the root cause but itbsounds more to me that the injection moves the condition on from an acute phase and then the body - helped by the pilates etc - is able to restore normal function.

I can't help with advice on how to appeal this but I would say if you've gone 5 years without a problem I wouldn't rule out that just because some solutions haven't worked before that they couldn't work now. If it were me I'd go ahead with the physio and maybe go large on some kind of yoga/pilates if your back allows it. If you do appeal the decision find what are valid reasons for success - for example maybe the alternative treatments such as a lifetime of painkillers, maybe physio and surgery - would cost them more? I agreeyou have to look at what they consider relevant according to their criteria not just make a common sense argument or appeal to their better nature.

StillGoing

Imposter wrote:

Killerclown wrote:

Go private. I did 20 years ago, you see the same specialists, but on your terms, in your choice of hospital, when you choose. I’m a huge fan of the NHS system, but it’s very pressurised now. The benefits of private outweigh the costs.

Do you not bother to read posts before replying? He already said he can't afford to do that.

My understanding is also that private health insurance won't fund pre-existing conditions.

orraloon

Snake oil, CD? While I retain a healthy ambivalence to 'alternative' therapies, prepared to give 'em a try, if get benefit then good.

I have had osteopath treat my back must be 20 years ago, symptoms relieved, no recurrence; is that because of the treatment or just sorted itself out, no idea.

The initial assessment I have today with a chiropractor might be a waste of time - depends if I feel confident in her (bells, chakra and humming 'om' will not be good indicators) - then again might lead to a treatment which resolves my issue with collarbone alignment, the one which has my GP going 'hmmm, that's strange'.

amaferanga

yellowv2 wrote:

I'm surprised MRI is not offered in your area for diagnosis, is this with a GP referral ?

Unfortunately MR departments are also struggling with demand so if GPs were allowed to refer any body area scan directly then a huge investment in new scanners would be needed. There'd also be a lot more unnecessary imaging (there's a lot of that already). For some areas MR spine referrals come through physio instead of direct from the GP.

I work in a number of radiology departments and every single one needs additional MR scanners, but there's little funding available so we're in a situation where urgent scans (e.g. 2 week wait scans for cancer) have to take priority and unfortunately for the OP, back pain is one of the least prioritised.

mac9091

Put a business case to the GP, going down the physio line.

I will require 'X' amount of appointments per month at a cost of 'Y'. Over 5 years that will amount to 'Z'. So in total it will cost 'Z' to achieve something that has already been proven not to work in "my" case. Where as in the short term yes it will cost £2.5k but will be saving money overall. Not to mention freeing up said physio for someone else to perhaps benefit from it.

But then again substantial long term gains are normally ignored due to short term savings which will be eaten up in the mid term.

webboo

amaferanga wrote:

yellowv2 wrote:

I'm surprised MRI is not offered in your area for diagnosis, is this with a GP referral ?

Unfortunately MR departments are also struggling with demand so if GPs were allowed to refer any body area scan directly then a huge investment in new scanners would be needed. There'd also be a lot more unnecessary imaging (there's a lot of that already). For some areas MR spine referrals come through physio instead of direct from the GP.

I work in a number of radiology departments and every single one needs additional MR scanners, but there's little funding available so we're in a situation where urgent scans (e.g. 2 week wait scans for cancer) have to take priority and unfortunately for the OP, back pain is one of the least prioritised.

The OP has MRI and MRI with dyes if you read above.

amaferanga

Webboo wrote:

amaferanga wrote:

yellowv2 wrote:

I'm surprised MRI is not offered in your area for diagnosis, is this with a GP referral ?

Unfortunately MR departments are also struggling with demand so if GPs were allowed to refer any body area scan directly then a huge investment in new scanners would be needed. There'd also be a lot more unnecessary imaging (there's a lot of that already). For some areas MR spine referrals come through physio instead of direct from the GP.

I work in a number of radiology departments and every single one needs additional MR scanners, but there's little funding available so we're in a situation where urgent scans (e.g. 2 week wait scans for cancer) have to take priority and unfortunately for the OP, back pain is one of the least prioritised.

The OP has MRI and MRI with dyes if you read above.

I didn't think he'd had anything recently. Scans from 5 years ago won't be used to diagnose his back pain now.

cooldad

orraloon wrote:

Snake oil, CD? While I retain a healthy ambivalence to 'alternative' therapies, prepared to give 'em a try, if get benefit then good.

I have had osteopath treat my back must be 20 years ago, symptoms relieved, no recurrence; is that because of the treatment or just sorted itself out, no idea.

The initial assessment I have today with a chiropractor might be a waste of time - depends if I feel confident in her (bells, chakra and humming 'om' will not be good indicators) - then again might lead to a treatment which resolves my issue with collarbone alignment, the one which has my GP going 'hmmm, that's strange'.

Chiro and osteopathy are not quite the same thing, but similar in that they both commonly suggest that they can treat ailments that have fuck all to do with the treatment. I did go to an osteopath many years ago, who did help me with a slipped, rotated disc as I didn't want surgery (nasty op with good chance that it wouldn't actually work) He helped. And fortunately no humming or chakras, or I would have run (or at that point, hobbled) a mile.

I don't argue that at times, alternative treatments can work, similarly to massage, or 'natural' remedies.

But most are a load of bollocks. There are a lot out there - from homeopathy to faith healing, which don't have a hope in hell of working, except in cloud cuckoo land. But the practitioners do often prey on the desperate and vulnerable. Not to mention the stupid.

That's not a dig at anyone here, just the overall reality of the situation.

It's something I've been interested in for a long time, and more so over the past year. I have terminal stage 4 cancer, so kind of know first hand what it's like to feel a little bit desperate. I know no snake oil will help, but the amount and variety of crazy remedies that friends have suggested is amazing. Basically now I just tell them to fuck off. Nicely.

Good luck anyway.