does the NHS dictate policy re prescriptions?

Question

eg. Friend's Granny - nitrazepam stopped. Spent 2 years on anti-hypertensive drugs (4 different) feeling dreadful. Now sleeping badly, but scared to visit GP as not willing to take more BP drugs. Just hopes if she has a heart attack or stroke it's a big one!
eg. Tramadol,given for severe headaches following neurosurgery years ago - quantity now reduced. Also refusing anti-hypertensives. Just had mastectomy. Scared of inadequate pain relief.
Neither is suicidal. Both drugs ? addictive, but for someone over 70 & under medical supervision does it matter?
Neighbour just died - massive stroke. Last few years miserable - anti-hypertensives again. Was it worth it?
It's like medicines by rote. don't these people count as individuals?

Answer 1

not sure what your question is here, being in USA and not in UK, don't know who oversees prescription policies, but it is not uncommon in healthcare today, (anywhere in the world) to feel like nothing more than a number on a roster, and an unimportant one at that.

Answer 2

The NHS has to take its recommendations from NICE, but the GP has a big say in who can take what drugs. Local authorities also play a part. It really depends on any ther types of medication the person is on, their history and a few other things. Doctors have to use their massive knowledge and abilities to make these decisions, they cant just give a tablet to a patient because they want it!

Nitrazepam isnt recommended long term as it can cause dependance, GP's dont tend to prescribe it long term for this reason.

The same with tramadol, yes it works well, but it also has some side effects as do all other drugs, such as causing drowsiness, nausea, vomiting, sweating and seizures etc.

if a doctor has reduced a medicine its usually for a good reason, with a lot of medicines you get a re-bound effect, the more you take the more you become immune and so need higher and higher doses, so doctors try and wean people off higher risk drugs.

Also, its doesnt matter if someone is not suicidal, theyve been taken off the drugs for a reason, unlikely to be cost as tramadol and nitrazepam are fairly common drugs and not that expensive.

As for your friends gran refusing her blood pressure medication, more fool her. Some people try many more than 4 types before they find one they are ok with, she is risking her life by not bothering to try other alternatives. The problem with high blood pressure is that the patient often feels quite well, and doesnt realise they have it. Until its too late. A lot of older people refuse to try different drugs, they are stubborn and cant be bothered to try at their age. Also they do have a habit of forgetting to take them, taking too many, or at the wrong time of day etc. This can cause problems, which they then blame on the drug, when in fact its their fault for not following the prescription instructions.

As for the pain medication, tramadol isnt the only one, there are loads of different ones, some work better than tramadol. if she is feeling a lot of pain from the mastectomy then she needs to go back to her consultant or GP, whoevers care she is under with the mastectomy.

Doctors refuse to give drugs for a reason, maybe with your friends gran, its because she has the high blood pressure -
drugs used to treat high blood pressure, such as moxonidine and doxazosin interact with nitrazepam, and if she has been taking BP tablets in the past, he wouldnt want her on the nitrazepam. Also her age is against her, doctors have to be cautious using nitrazepam with the elderly and its very carefully monitored if its used by an older person.

I could give you loads of reasons why the doctors have reduced or removed drugs, but I just dont have the room on here! Rest assured however, the doctor did it for a good reason. And with both these drugs its not cost.

Answer 3

Although the NHS DOES make the rules about which drugs can or should be used, it is really all down to cost - although some of it IS to do with not prescribing drugs which the doctor considers unnecessary or detrimental. It really is up to the patient to go back & just say what they want!