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Crohn's Disease Forum » General IBD Discussion » Medical Care in the UK/London


12-16-2014, 10:26 PM   #1
Catherine
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Medical Care in the UK/London

My daughter who is 19 is planning a 6 months working/holiday to the UK.

Due to the length of the stay will need to obtain medications in the UK.

My understanding is you need to register with a medical practice? Will a GP be able to issue scripts for Imuran? And arrange the necessary blood tests? What costs would be involved? She should be covered under the NHS.

She will have travel insurance but this doesn't cover regular medications.

Many thanks for your assistance.
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Catherine
Mother of Sarah dx aged 16, Jan 2012
DX - CD 1/12, asthma
Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

Prednisolone (from 30 mg 01/02/2012 to 17/06/2012, 30mg 24/10/12-28/12/12, 50mg 24/1/13-27/4/13)

Last edited by Catherine; 12-17-2014 at 03:10 AM.
12-17-2014, 03:04 AM   #2
J_Matrix
 
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Hi,

I hope this http://www.tripadvisor.co.uk/Travel-...stralians.html may help
12-18-2014, 08:25 AM   #3
MissCadenza
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It might be worth seeing if you can get all the medications she will need for her trip from your doctor before she leaves, just because it's easier. And quite frankly she'd be better off doing that because the health system here can be unreliable and if something goes wrong and she can't get her meds it's best to have what she already needs to hand.

I did a working holiday for six months to Canada (many many years ago) and I was advised by the lady I was working for to get all the meds I needed before I came out there. She said it was easier than trying to register for a doctor etc as I was going to be in the country for a short time. I only suffered from asthma at the time but I got six months supply of all my inhalers and a note from my doctor explaining why I was carrying so much medication.

Having the security of knowing that you've already got what you need plus the letter to keep customs officials happy is probably much easier in the long run. Having your luggage gone through at customs is a pain though, haha, although they do help you pack again afterwards. At least Canadian customs did!
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12-19-2014, 08:30 PM   #4
Carrie
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I was an American expat in the UK from 2009 to 2013. Getting an appointment with a GP, and getting them to give a prescription for Imuran shouldn't be difficult (I essentially did the same thing when I moved, but was taking 6MP instead). It's only really complicated if biologics are involved.

It wouldn't hurt to see if she could get a 90-day supply of meds before moving, though. I don't think getting registered for the GP took that long, but with moving and working, it can be difficult to fit it in!

Blood tests should be easily arranged as well. The GPs generally know they need to check blood levels for that, but if not, she can mention it, too. If she's completely covered under the NHS, her only cost will be for the prescription which was 7.40 when I left, but probably closer to 8 these days.

Another thing to note is that the NHS has some silly rules about not letting expats see specialists until they have lived in the UK for a year, or if they end up in A&E. This might be different for Australian expats because I know there are some reciprocity agreements between the countries, but worth noting. If she's fit to travel abroad for six months, I'm hoping this isn't an issue, but good to know if moving in the middle of a flare like I did.

I hope this helps a bit! If you have any other questions, let me know!

My daughter who is 19 is planning a 6 months working/holiday to the UK.

Due to the length of the stay will need to obtain medications in the UK.

My understanding is you need to register with a medical practice? Will a GP be able to issue scripts for Imuran? And arrange the necessary blood tests? What costs would be involved? She should be covered under the NHS.

She will have travel insurance but this doesn't cover regular medications.

Many thanks for your assistance.
12-19-2014, 08:33 PM   #5
Carrie
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Also, when she does go to the GP, have her take her medicine bottle/blister pack with the label affixed to the doc. It helps them know that you're not asking for random medicine!
12-21-2014, 11:33 AM   #6
wellen1981
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Also I am sorry that I do not have any specific references or links to this but do some research into how customs handle medication (especially the requirements/restrictions in place for UK customs) when your daughter gets off the plane in the UK as our customs may do things differently and if you do get her to stockpile meds in OZ then plan to bring them over on the flights it may well be ok leaving OZ but at customs in the UK it may be a problem.

Like i say i dont have anything for sure to offer you linkwise but the terrorism regs are always changing and liquids were awkward and now recently if you have a phone that can not be powered on to show airport security eg due to dead battery - then they WILL conviscate the phone due to risk it is a dummy phone and could be a risk. I know in the end here i am talking about phones and not meds but that is just to highlight 1 of the recent changes affecting our UK airport customs rules and regs.

Hope it helps, if only slightly!
12-21-2014, 08:47 PM   #7
Muppetgirl
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I have had to travel and access healthcare abroad. I think the most important thing for both healthcare and customs is carrying documentation with you. If she doesn't have one already, your daughter should ask her main doctor to write a brief (i.e. no more than a page) summary of her medical history and needs, inc current and past medications (if there is any chance it could be needed even if only occasionally it should be on there) and previous surgeries. It should also have clear contact details in the event of any queries (email addresses are most useful).

Any items actually travelling with her should as be in original packaging and labelled as Carrie has suggested. As it's a long haul flight its worth thinking about the temperature her meds should be kept; hand luggage avoids them getting chilly in the hold! I have travelled with meds and liquids for my catheters in hand luggage, and was able to access the healthcare system in this way without encountering problems. I hope the trip goes well for her.
12-22-2014, 07:30 PM   #8
Carrie
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I took a 90-day supply of both Humira (injectables!), 6-MP, and prednisone and a half-full sharps container when I moved to the UK, and no one stopped me at customs. Of the two-dozen or so times I travelled internationally, I only ever got stopped at customs once, and that was when I was traveling back to the US. Having a note from the doctor is probably a good idea, though. It would be useful for potential customs issues, and would be helpful with the GP, too.
12-24-2014, 01:13 PM   #9
littlemissh
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I am a GP in the UK. Most GPs (if not all) only prescribe imuran/azathioprine to patients who have shared care with a specialist who advises what to do in the event of the blood results being abnormal. I doubt a GP would prescribe without- we are not really allowed as is outwith the scope of our practice (though I possibly could as I have intimate knowledge of immunosuppressant meds!).

Referring to an NHS specialist depends on whether she is eligible and will take a long time also. If she has private health cover via her insurance she could be referred to a specialist privately who would likely be happy to share the care with the GP.

You would not get a biologic prescribed by a GP-not allowed, not even allowed for our own patient- has to be secondary care with special funding applied for and agreed.
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Diagnosed Crohns small bowel 2010,Gastroduodenal crohn's Jan 2012. Gastroparesis june 2014.
Duodenal perforation/peritonitis nov 2011. Portacath placed Nov 2013. Gastric pacemaker 2015.
Perforated jejenum/peritonitis oct 2015, PEJ for enteral feeding nov 2015

On Humira every 7 days, intermittent iv iron, regular blood transfusions :faint:
On TPN since March 2016.

Last edited by littlemissh; 12-25-2014 at 06:12 PM.
12-24-2014, 05:17 PM   #10
Catherine
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Any idea what the cost of a private specialist would be? Her insurance will not cover it as Crohn's is a pre-existing condition.
12-24-2014, 07:00 PM   #11
DEmberton
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It often takes three months to see a specialist on the NHS so that isn't really going to work. I understand it's generally around 200 to get a consultation privately but the cost of any tests or treatment could well be significantly more. If I were you I'd try to arrange it beforehand, IE make some phone calls.
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12-25-2014, 03:40 PM   #12
DustyKat
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Any idea what the cost of a private specialist would be? Her insurance will not cover it as Crohn's is a pre-existing condition.
I imagine it would be similar to here pre medicare rebate.

The kids GI bulk bills his IBD patients but sitting in the waiting room a couple of weeks ago the quotes being given out were between $190 and $220 for an initial consult. Mind you the IBD specialist was in Sydney, 4 years ago, was charging $220 so lord knows what he is charging now!

Dusty. xxx
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12-25-2014, 06:11 PM   #13
littlemissh
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Its about 150-200 pounds for the initial consultation. But once they have agreed to shared care the GP can do the blood tests so that should be covered by the NHS as I believe there is a reciprocal agreement with Australia.
12-26-2014, 01:08 AM   #14
Catherine
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Its about 150-200 pounds for the initial consultation. But once they have agreed to shared care the GP can do the blood tests so that should be covered by the NHS as I believe there is a reciprocal agreement with Australia.
So it your believe even if she was to take the necessary medication with her, she would need to see a specialist to get the necessary blood tests.

Thanks for you help.
12-26-2014, 06:59 AM   #15
littlemissh
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I think it will depend on the GP. Basically prescribing azathioprine is for specialists because of the potential toxicity. In some areas GPs don't get involved at all and others GPs 'share' the care with the specialist. There will be a shared care agreement which states when the blood tests should be taken, what to do if there is an abnormality in the blood- in levels of abnormality e.g. if wcc drops below x do a, if wcc drops below x-2 do b, same for liver tests etc. This may be simply stop and ask advice from specialist in next few days or if really bad then seek immediate advice.

I was thinking about this and it may be worth getting such a letter from her current GI and some gp's MAY accept this. Many may not though, it is worth a go.

Can I ask, is she planning on moving around a lot, how long is she planning to stay in one place? There are different registration levels at a GP for a non permanent visitor
a) Immediate and necessary- just visiting for a day or 2.
b)temporary resident (up to 3 months)
c)more permanent resident (more than 3 months) .

Most GPs probably would not prescribe/do bloods for a).

There are ways around it, but knowing how long she plans being in one place would help advise.
12-26-2014, 09:27 PM   #16
Muppetgirl
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Another thing if she knows whereabouts in London she's headed is to work out which specialist she will see and ask her specialist at home to write directly to them. (Or if she doesn't know in advance to arrange this while she is there). It's not a guarentee but it can help if they feel they have a direct relationship. I have done this as well, though I still carried my own documents for wider health needs.
12-27-2014, 08:44 PM   #17
Carrie
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From the receiving side of care, I have to agree with littlemissh--it probably does depend on the surgery she attends, how it's run, and how willing a GP is to consult (i.e. the GP talks to the GI, but the patient doesn't see them at that time).

I got lucky there in this regard. My GP was happy to prescribe the Imuran and consult with a GI to understand the recommended course of treatment (dosage, blood work). But he left the surgery, and I had a much more difficult time with the GPs (mostly locums) and trying to get treatment. I was flaring really badly at the one-year mark, and it took awhile to get the GI consult, and also a prescription for prednisolone.

The NHS certainly has it's benefits, but it's an awfully frustrating system if you're used to care in the States.

I hope your daughter has a fab time abroad!
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