UKH

Mrs Ridge has been having a number of knee issues (we think meniscal tear), on top of that she's having hip issues when riding and ankle issues when walking.

After a 6 week wait for a GP appointment after having (more) problems walking due to the knee, she's been offered:

1. A list of websites with knee exercises (she's already doing them).

2. Lansoprazole so she can continue with OTC Brufen for the pain.

3. Suggestion that she finds a private physio as theres a 9 month waiting list for NHS Services and the GP won't refer.

4. No chance whatsoever of MRI/X ray unless she goes private.

So, Hive mind, what's the next steps, initially to deal with the knee, and long term to engage with private providers to get a prognosis on the hip and ankle issues? Info relevant to Cumbria very much appreciated.

Thanks in advance.

In reply to Ridge:

Private physio seems like the obvious starting point. They are not very expensive, easy to find and usually pretty easy to get appointments with. I would see what they say and go from there. 

In reply to Ridge:

Next step? Vote labour.

In reply to Ridge:

3) Suggestion that she finds a private physio

Is actually good advice. If they feel the need then they often have a pathway for arranging imaging. GPs usually can't arrange MRI unless private and the wait for someone who can on the NHS is typically measured in months-years,

In reply to Ridge:

Different injury, to my shoulder, but I found a private consultant, paid for the scans he recommended and then paid for a consultation with him.

Ended up paying for the surgery needed as well. Not cheap but in my case well worth it. As much for the time saved if anything, could have waited years for the NHS.

Agree with girlymonkey, private physio would be the best and most cost effective place to start.

It would be great if the NHS could offer quicker access for these kinds of things but I wouldn't want the job of trying to balance their budget and allocate what funds they have.

In reply to Ridge:

I would go with physio as others have mentioned for the knee. I understand the thinking about tears in the knee has changed over the years and that now ops are only generally considered if the knee locks and not as a matter of course. Physio is recommended as the first step as the majority of tears apparently repair themselves with time.

If the physio thinks the knee needs further investigation (or physio treatment just does not help) it should be easier to get a referral from a physio.

In reply to Ridge:

In your position i would be absolutely seething. GP has refused you treatment. Personally i would first get the knee really strong. That is really really strong. That is what a physio is going to tell you. A really good physio is really hard to find. The reason to see a physio is that you can tell the gp you have been to physio. Shauna coxsey's instagram of revovering from knee op is interesting, i think she ended up single leg pressing 100kg before it stopped hurting. If you then want to go further find out which consultant you want to see. Then i would go back to gp, preferably a different one, and ask to be referred direct to that consultants dept. I would argue the case very strongly and not be fobbed off. They can do it. Once on the list i would go and see the consultant privately (find out where they work from and just pick up phone and ask to see them, circa £200) and get scans etc. Then, if menisectomy required, ask to be transferred to his/her nhs waiting list and say you can take a cancellation. You will not jump the queue but get on it maybe a year faster.

Re scans. Find out if consultant needs mri or can they do ultrasound on the spot. Liase with consultants private secretary. Vis mri, shop around. The consultants handy mri machine might set you back a grand but i have found them (nhs hospital) for less than £300, again talk with secretary and hospital to see that they will accept outside scans, that they can read them and what spec they want. Consultants very used to hearing what you can and cannot afford don't be fazed. Re x ray. If consultant wants them, ask how much they will cost before proceeding, they are cheaper that way. Last ones i had were £50 a pop, £100 list. 

You never know. 10 years ago i took my mother to see a private knee guy. She could hardly stand up or sit down. He wacked her with a steroid injection and has never had a problem since. 

In reply to Ridge:

What about pay as you with BUPA or similar: https://www.bupa.co.uk/health/payg

I don't remember the prices but if it's just advice and x-rays etc the price won't be too high. Then if something more expensive is required at least you can then be referred back to the NHS.

In reply to Ridge:

From the list of symptoms you give, an osteopath might be able to help. They deal with the mechanics of how things are connected. A physio deals with tears and strains, but there is some overlap in skills. Perhaps that might be an option for a second opinion?

For a running injury I saw an Osteopath, who was also a tri-athlete in her spare time. She did some poking, and observations of my movements. Said there is too much tension on this side, due to lack of mobility in that area, which is pulling things out of line. She did some manipulations. (I was most impressed when she cracked my hips, like you can crack your knuckles.) She gave me some exercises, that were tailored to my issues. It wasn't an instant cure, but helped me along the way.

In reply to minimike:

Already on the to do list, and has been for quite some time.

In reply to Ridge:

See a private physio. This is beneficial in 2 ways. Firstly the treatment and secondly they will write to your GP recommending further treatment. Your GP will find this specialist advice difficult to ignore.

The physio will also have contacts to provide further private treatment should you choose that route.

You are West Cumbria based? Physio first in Egremont are very good.

In reply to Ridge:

I had almost identical symptoms after a football injury about 6 years ago. Initially that resulted in me  going to A and E in Whitehaven and then referred to NHS physio in Cockermouth. Intially that resulted in  similar exercises to the ones you refer to, that  did make a difference at the time.

This year after a deterioration after one GP appointment (June) it led to an MRI in Carlisle (August) and a follow-up consultation (Sept) but my understanding was this was much quicker because it was made, by the GP, through the NHS physio side of things, due to my previous physio records.

Edit. I'm not sure, but from what other posters have said, I'd be tempted to look into if a private physio. could have the same effect as the NHS one did for me, as a quicker route to an MRI 

In reply to Ridge:

Mant thanks to all who have replied, particularly those with recommendations for physios.

In reply to Ridge: you could also see if your GP practice has a ‘first contact physiotherapist’. Their job is to deal with the musculoskeletal injuries seen by GPs, who are not specialists in this area. They can refer for scans if needed, can also often do injections and prescribe. They normally just see you once as the service is not designed to provide ongoing therapy, but they are very experienced physios. 

In reply to Isabelle Booker:

Thanks. The GP said to keep looking at their website as they 'might' take on a physio later this year.

In reply to minimike:

28-7 

interesting, I guess that’s about what I’d expect on here. Without wishing to hijack the thread I wonder if the 7 are Tory voters who favour private healthcare or people who just don’t think a labour govt will help? 

In reply to minimike:

Or people or think the answer is far too detached from the question to be helpful (not me voting but I got that impression)

In reply to Ridge:

That may not deliver results within 90 days (from now) and so OP may need more immediate stuff like physio etc etc

In reply to minimike:

How will that help?

Labours plan is further privatisation and no new funding for public health provision. It's identical to Tory plans for the NHS.

https://www.independent.co.uk/news/uk/politics/labour-nhs-spending-streetin...

"Labour’s Wes Streeting claims ‘wasteful’ NHS using winter crises as excuse for cash. Mr Streeting insisted that NHS bosses were “going to have to get used to the fact that money is tight” even if Labour wins power next year, and would have to “get used to switching spend, and rethinking where and how care is delivered”."

https://www.thenational.scot/news/23932636.wes-streeting-wants-nhs-wide-ope...

"LABOUR shadow health secretary Wes Streeting has said he would “hold the door wide open” to the NHS for the private sector. He said he hopes to get “quite tough on NHS England” to work with private sector companies".

[Don't want Ridge's request for advice to get derailed so I won't get drawn in to any replies here].

In reply to Ridge:

Just to echo the crowd - find a good private physio.  I can recommend one on the wrong side of the Pennines.  If I wanted to plan next steps on something, my physio would be my go to resource.

In reply to Ridge:

I would suggest a one off consultants visit to see if either a physio or a scan is the right way forward then go from there. You could potentially waste alot of money on a physio. 

Find the local bupa, spire hospital.  Look up the list of knee / hip. consultants registered there and book an appointment with one of them. 
 

In reply to Ridge:

When I injured my knee last year, I was told at the hospital that it was definitely not a complete ACL tear. The NHS physio said the same. 

I wasn't convinced so I paid three hundred and something pounds for a next-day private MRI scan with report to me and my GP, which showed a complete tear of the ACL. This meant I was immediately put on the orthopedic list, assessed quite quickly, and given appropriate advice for pre-op rehab of the injury I have, rather than the injury I might have had.

I'm ideologically opposed to private healthcare, but as a hypocrite I will just get a private MRI scan immediately for any future joint problems. It's not worth risking the potential further damage that could be caused by an incorrect diagnosis for the cost or my principles.

In reply to Ciro:

I don't waste my time with NHS physios. You get 15 minutes with them which isn't enough time to discuss the history, nevermind for them to assess you.

£60 for a private 1 hour physio gives you so much more value.

I assumed an MRI would cost more. Why doesn't the NHS automatically send more people for MRI's. Since they pay private contractors something like £250 for a 10 minute wheelchair push in A&E (so I've heard on the radio) surely £3## MRI is cost effective for them. 

In reply to montyjohn:

I imagine it's down to the physical resource required; you can rattle a lot more patients through an x-ray machine per day than you can an MRI scanner, so if MRIs were routine you'd need a department several times the size of your x-ray department to process people. By reserving MRI for complex cases where initial diagnostics and treatments haven't worked, you can weed out the "wasted" scans and have a smaller department.

Of course, if the MRI scanner in the NHS hospital wasn't available for me to book privately there would be more capacity for NHS scans, but you know, I'm middle class so I'm alright jack.

Perhaps I should buy shares in private healthcare companies so I can profit from the two tier system as well as taking advantage of it.

In reply to Ciro:

I can only comment from a veterinary POV, but MRIs are slower to acquire than x-rays as you say, but also much slower to report for radiologists - need to evaluate 100’s of images rather than just 2-4.

The growth in advanced imaging needs a lot more radiographers than traditional techniques, and numbers have not kept up (again veterinary, but likely translates) AI may have a big influence here. 

In reply to Ciro:

I didn't realise the private healthcare companies used NHS machines. I figured it was their own machine, in which case I would see no problem at all paying for it. Keeps the pressure off the NHS.

I wonder if the NHS rent it out at a loss then.

In reply to montyjohn:

It's in an NHS hospital, but I would imagine it's owned by the private company, who rent it out to the NHS at profit.

It won't keep pressure off the NHS, it'll take trained staff from the NHS, and give profits to shareholders - money that could be kept within the state healthcare system.

In reply to montyjohn:

Depends on the Hospital. The private Hospital I work at has its own MRI, CT and X-ray facilities but refers out to NHS hospitals for DEXA scans etc.

In reply to montyjohn:

A whole year's worth of GP appointments is about £100 and the tariff for a single consultant orthopaedic appointment is about £160 so doing lots of MRIs significantly increases costs.

There is not the capacity in the NHS either.  This applies to the MRI scanners themselves, the radiographers to operate them and the doctors to report the scans. 

There's also the issue of over investigation. Using the example of a meniscal tear in the knee, about 1/4 - 1/3 of all over 50s will have a meniscal tear on MRI scanning, whether or not they actually have any symptoms. If we look at something like low back pain then there's actually evidence scanning worsens outcomes as people see their spine is "degenerating" when this is usually a normal finding. 

In reply to Ennerdaleblonde:

My elderly Dad has been seeing a private physio after a bad fall, so he can get mobile and walk unaided again (eventually). She recommended a 3-wheeled walker, but NHS said they couldn't listen to the advice of a private physio and would need to assess him themselves to see if he was suitable before they could supply one. There was a 9 month waiting list to be assessed! Luckily you can get them fairly easily elsewhere anyway.

In reply to montyjohn:

Uk something like no. 18 in the world for density of mri and ct scanners per head of population and a long way behind number 17.

I have had loads of physio, spent loads on them, my mother was a physio and i can't think of a single thing they fixed. Things they made worse yes but fixed, no.

Incidentally at our gp, physio is a 15 min telephone appointment and immediately signed off. 😂 

In reply to dread-i:

God knows why you got so many dislikes.

I used spend a lot of time working as a drystone waller, both in this country and Eire I sometimes go back/hip problems .    After one injury in Eire I went to a  Chiropractioner .  I'd never used either physios, osteopaths or chiropractioners.  I was a bit cynical, and limped from the car park to his room.  He spent  nearly an hour stretching and manipulating my spine.  I forked out the money and wondered wether I'd wasted my money  as I walked to my car.  Then I noticed my limp had gone.  
I've also had physio in Spain from two very experienced and qualified physios. after straining my hip/psoas muscles to the extent I could not reach my feet, shoes, put on trousers or shorts without pain or lift or bend to any great degree  One of them spent an hour on my hip, also making it crack on one side several times!!  Within a few days I was back running. (and working).   Osteopaths, physios etc all have their place and as you say work on the same issue from slightly different approaches.  

NB I'm not suggesting any of these  can repair detached tendons, cure madness, broken legs or hearts.

Perhaps you got the dislikes for mentioning osteopaths ?

In reply to Billhook:

I was wondering if people confused osteopaths with chiropractors and homeopaths. The latter two are not regulated in the UK, and are related to snakes and oil. However osteopaths are legally regulated in the UK. I suggested it for a second opinion.

For the injury I mentioned above, I went to a physio and received a spots massage and some generic exercises. Which didn't really do much. However, a different physio may have had different results.

https://www.nhs.uk/conditions/osteopathy/

In reply to dread-i:

I guess its like doctors, Dentists - or indeed many other trades or professions.  Some people are simply better (or worse) than others at their jobs.