Case-based learning: menopause and HRT consultations — transcription (audio clip four)

Nuttan Tanna: The one that I always struggle with, [chuckles] and I’m going to share this with you, is where they want six-monthly blood tests because in private practice, they get that, whereas in the NHS, we know that blood tests are not that much, not that helpful when it comes to actually managing patients. It’s actually their presentation, the symptoms that they’re presenting with. We have a symptom assessment chart that our patients complete at Northwick Park Hospital, and that actually is a better objective assessment rather than actually just doing blood tests. And I explain these to patients, and, generally speaking, on the NHS, many patients, some of them will say, ‘I think, I still think it’s cost’.

I still think it’s because you don’t want to… because it may be expensive for the NHS. And I would say to them, ‘Well, if it helped my management,’ and there are certain scenarios where it does, ‘then I will order a blood test, but I’m not going to do it routinely every six months’. And these are some of the hurdles that we have to go get through. So, it’s non-commissioned therapies working on NHS pathways. What medicines will the ICB pay for? What medicines do we have to be very careful about? What are the high-cost drugs? Now, as a professional, when I talk about high-cost drugs, I’m not saying that I don’t want the patient to have the high-cost drug. I’m actually just saying that I want to make sure that it’s the most cost-effective option.

So, if you’ve got a high-cost medication, but there’s something that’s the similar product but actually costs less, doesn’t it make more sense to use that? And when I explain this to patients, some of them agree, some of them don’t, and I work with each individual. But I do try and make it easy for them to accept that on the NHS, we are going to give them a very high standard of care.