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Why should I have a chickenpox or shingles vaccination?

Serious illness as a result of chickenpox in childhood is rare. It can be more problematic in adulthood, especially in pregnancy or in the context of other underlying health conditions. Most adults have been exposed to chickenpox and are therefore immune to it. However, the virus which caused chickenpox can be reactivated and cause shingles, usually later in life. Shingles can be unpleasant, and sometimes results in lasting discomfort.

Immunity as a result of chickenpox vaccination might wear off, such that it is better at preventing chickenpox in childhood (usually a relatively mild illness) than in adulthood. There is therefore some concern that having the chickenpox vaccination as a child might increase one’s risk of the more severe chickenpox illness as an adult. This has to be balanced against the benefits of reducing the risk of shingles.

Evidence suggests that 9 out of 10 children vaccinated with a single dose will develop immunity against chickenpox, but there is an even better immune response after two doses of the vaccine, so it is strongly recommended that two doses are given (4-6 weeks apart).

The vaccines

Vaccines to reduce the risk of shingles are available for adults. The NHS offers these to people aged 70 to 79. Zostavax (a “live” vaccine) is given as a single dose, while Shingrix is given as 2 separate doses 2 months apart.

Vaccines to prevent chickenpox are also available for those who have not already had chickenpox (usually, but not always, young children). They are usually given as 2 doses 4-8 weeks apart.

Are they safe for me?

Allergies

If you have ever had a severe allergic reaction to any ingredient of the vaccine, you might not be able to have it, or special precautions might be necessary (such as administering it in hospital). Depending upon the particular vaccine, ingredients might include the antibiotic neomycin, gelatin, and/or polysorbates.

Immune suppression and pregnancy

If your immune system is severely suppressed, or if you might be pregnant, Zostavax or either of the chickenpox vaccines might not be suitable for you. This is because they are ‘live’ vaccines which contain a tiny amount of the virus.

We aim to offer our patients an unhurried, high quality GP service, with continuity of care at its core, and allow them to make the choice about whether to access secondary care on the NHS or privately, and in all things to make meaningful choices about treatment options.

If you think about it, paying a fixed fee for any service for which demand is unpredictable is “betting against the house” – and the house is always going to win (or go out of business).

There are some private practices that offer an all-inclusive package for around £100 per month (over the age of 50). I would hope that a typical 50 year old would need to pay considerably less than £100/month in consultation fees, but we would expect to be there for them when they need us.

Most concierge-style services that we are aware of set a limit on the number of contacts in a year. Furthermore, many seek to attract the healthy and undertake assessments and tests that are not indicated, and therefore have significant potential to cause harm such as anxiety and complications of unnecessary treatment.

Further, such an arrangement necessarily encourages people to consult when they might not necessarily need to.

One of the challenges for NHS General Practice is that it is free at the point of delivery and therefore has had placed on it expectations (in terms of access, helping people who are not ill, etc) that it could never meet.

We want to form long term, adult-adult relationships with our patients, where we are no longer the gate-keepers, but can help to guide them through their options when they are ill.

Additionally, our practice has a strong emphasis on not recommending unnecessary investigations or treatments, for fear of doing harm. In private medicine, where one is paid for activity, we believe it is important to resist the temptation to encourage unnecessary consultations.

Finally, consider how eager we will be to book each appointment if that is the only way we get paid! We certainly do not want to become embroiled in contractual disagreements about whether we are failing to offer appointments of sufficient length or readily enough, or whether our patients use of our service is “fair” – hardly a respectful interaction!

Our approach might not be for everyone. We consider it to be ethical where others might not always be. Our price list is at www.FormbyGP.com/pricing.

We do, however, offer Priority Club membership, benefits of each include a guarantee of access, waiving of our prescription fees, half price text consultations and access to our community forum. If this appeals, why not ask at your next appointment whether it could be right for you!

We are of course happy to prescribe most medication that you might need. In practice, we have a little more prescribing freedom than an NHS GP might.

We can prescribe controlled drugs if you are happy for us to share this information with other prescribers involved in your care, including your NHS GP.

Our prescriptions should be accepted by any pharmacy in the United Kingdom. Whenever possible, we will give you a paper prescription which you can take to the pharmacy of your choice. If that is not possible, we can send the prescription to you by email, which you can then show to the majority of pharmacies in the UK.

We make a charge for each item that we prescribe. We waive that charge for our Priority Club members. Our current prices can be reviewed at www.FormbyGP.com/pricing.

Regrettably, we are unable to issue NHS prescriptions.

Your pharmacy will charge you for dispensing your medication, even if you do not pay NHS prescription charges. They will usually not have to charge VAT. It is likely that prices will vary, so you might like to shop around before choosing a pharmacy.

We are often asked if we are able to access your NHS GP record. Because we are outside the NHS, we don’t automatically have access to it. However, this isn’t normally a problem: in many cases, we are happy to rely on information you provide us regarding your health conditions, medication, and allergies, and we will ask you about these before your appointment by means of our registration form.

You have the right to receive your record in electronic format from your NHS GP if you ask for it electronically (a “Subject Access Request“). If you would like, you may then share it with us, either by emailing it to Clinical@FormbyGP.net, or uploading it from our registration form. Often, a summary of your record will suffice. Sometimes, however, we will need your full record, such as if you ask ask us to write certain reports. It can sometimes be helpful to know recent blood test results, to save us duplicating work privately; if you have online access, you will often be able to view your results there.

With your consent, we will usually keep your NHS GP and any other relevant professionals updated. If you would prefer us not to, that’s generally fine too, so long as you are happy for us not to prescribe any controlled drugs. If we feel that information-sharing is particularly important, such as in particularly complex cases, we may broach the subject with you again and explain why we would recommend information-sharing.

If you have been asked for a medical report or examination, we can help! Simply email Clinical@FormbyGP.net the request or form that you have received and let us give you a quote.

Many such reports – such as an HGV medical “D4” – we will be happy to complete during your consultation for no extra charge. On the other hand, some might simply require us to review your GP record, and we might not even need to see you.

Please email us a copy of your NHS GP record before your consultation. For some reports (including HGV medicals), a summary of your GP record will suffice.

Some reports, however, expect the examining doctor to have access to your full GP record. For these, please download from your NHS GP your full record and then email or upload it to us.

If in doubt, just email us the blank report or form and we can advise you what we would need.

There are a small number of organisations that ask a doctor to certify that you are fit for a particular activity that they organise. At the time of writing, the Paris marathon is an example. It is very difficult for any doctor to say this, as there is no way for them to be certain that the organisers will have in place proper safeguards, not is it possible to predict that your health will not change before or during the event. We would be happy, however, to provide a summary of your medical history and an opinion as to whether that is likely to be problematic.

We can organise many tests directly, and as GPs we can diagnose and manage a great many conditions ourselves.

Sometimes, we will offer to make a referral asking another professional or organisation whom we trust for their opinion using the specialised resources and expertise at their disposal.

If you have any concerns about your health, do book an appointment with one of our expert GPs. We will undertake our own assessement, collect any information and tests necessary to support any referral, and advise whether a referral would be appropriate.

We will advise you which specialty, organisation or individual we believe is most likely to accept the referral and to give the most helpful opinion. This is the reason why patients, specialists and insurers value the input of GPs in the referral process.

We will of course facilitate your preferences as best we can, mindful that this might sometimes result in “going round in circles” if the preferred specialist is either not available, too busy, or feels they cannot help.

If you have a fixed view about the need for a particular referral, we may be able to add less value to the process. You might like to contact the specialist directly, as some do accept self-referrals.

In any case, when we make a referral, we will usually let you have a copy of the referral letter. This will put you in control, so that you can produce it in case of communication difficulties, and so that you can take it to a different, similarly qualified, individual or organisation, should you subsequently discover that they are more convenient. Feel free to search for other providers yourself. If you happen to know of any specialists who live nearby, you might like to suggest they consider using our premises!

If we make an NHS referral, you will very often be able to take that referral letter to a private provider. Please be mindful that it does not always work the other way around, as it can sometimes be more difficult to refer to NHS providers: they are often not even allowed to accept referrals which some might consider less appropriate; they also often expect the GP to undertake more preliminary assessment, the expense of which we would otherwise seek to save you.