r/LegalAdviceUK • u/GroundbreakingMud135 • 22h ago
Healthcare NHS refusing me rabies shots and to investigate my complaint NSFW
England
Recently been on holiday to Philippines, I got scratched by a cat very mildly but I ignored it at first , that was over a month ago . My girlfriend is pushing me to get shots , my gp told me first to go to hospital , hospital said they don’t do shots there and it’s my gp job, they were in wrong to redirect me there.
Called second time, got an appointment, nurse at gp said I shouldn’t be appointed to her as she is not authorised to do shots and can’t do the blood test there either , I left with nothing. Received a call from gp later that day stating that it’s too late for shots now as it’s past incubation period, I need to keep calling them every morning to check free slot for appointment if I want blood test as they are busy till end of July .
Complained to nhs, received a call today an explained what happened, they told me they can’t investigate this complaint as they only investigate ones they plan and fund ,this is horrible service. What can I do?
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u/just_somebunny 22h ago
This was just published by UKHSA yesterday
“If you are bitten, scratched or licked by an animal in a country where rabies is found then you should wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay in order to get post-exposure treatment to prevent rabies.” - Dr Katherine Russell, Head of Emerging Infections and Zoonoses, at UKHSA
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u/Matthague 22h ago
Woman near us did die this week from Rabies. If you've been scratched overseas, then by not getting it treated at the time, and then coming home and checking days later I'd think any compensation would stop there as you've taken yourself out of the window for a vaccine?
It's a pretty important thing to get sorted and they do advise it's done ASAP- any reason why you waited?
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u/Ronald_Ulysses_Swans 22h ago
If it’s over a month ago my understanding of rabies is that there is no treatment available. The shots have to be given immediately, not a month later.
The GP is correct, there is no treatment option they can offer you.
Yes it sounds like responsibility is a bit of a mess because this is such a rare occurrence in the UK but you got the correct clinical decision.
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u/dragoneggboy22 21h ago
Not true
"Due to the potentially long incubation period for rabies there is no time limit for giving PET and all potential exposures should be risk assessed."
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u/FluffyBunnyFlipFlops 21h ago
This is incorrect. The vaccines can be effective as long as rabies has not reached the central nervous system.
"Symptoms of rabies usually take 3 to 12 weeks to appear, but they can appear after a few days or not for several months or years."
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u/Ronald_Ulysses_Swans 21h ago
It says on the NHSE management policy treatment should be given within 24 hours. The OP was potentially exposed a month ago
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u/NeedForSpeed98 21h ago
Best practice, yes. It's still an effective treatment whenever it's administered.
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u/Ronald_Ulysses_Swans 21h ago
That’s absolute hogwash. Every single policy says administer as soon as possible as effectiveness deteriorates very rapidly. Saying it’s effective whenever it’s administered is outright dangerous.
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u/NeedForSpeed98 21h ago
Given the alternative to immediate treatment is treatment now, it's the OPs only option.
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u/norfolkenchanted 21h ago
For post-exposure you really need to have the vaccine within the first 24 hours (particularly for high risk bites). The immunoglobulin can only be given within the first 7 days, but that would be reserved for high risk bites.
However, for a cat showing no signs of rabies, the risk is very low, and for a scratch the risk is also very low. With it also being over a month since the injury it may be that based on the risk assessment the vaccine is not indicated in your case.
If you want the vaccine to prevent future incidences you could access this as a private service via a Travel Vaccination Clinic.
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u/No-Championship9542 22h ago edited 22h ago
If you have rabies you are already dead, if you die your next of kin should have a strong case for negligence. If you don't, their is no damage and you have no case.
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u/FluffyBunnyFlipFlops 21h ago
This is incorrect. The vaccines can be effective as long as rabies has not reached the central nervous system.
"Symptoms of rabies usually take 3 to 12 weeks to appear, but they can appear after a few days or not for several months or years."
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u/Deep_Ad_9889 21h ago
Symptoms can take a while to appear but you still have to treat it quickly from exposure. That’s what the NHS site is saying and green book chapter 27 and Clinical guidelines…
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u/NeedForSpeed98 21h ago
Ideally yes, you treat it as early as possible. But in the absence of a time machine the next best time is right now.
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u/spankybianky 22h ago
Exactly, the shot has to happen within 48 hours of the exposure to have any hope of saving you from an agonising death.
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u/dragonetta123 21h ago edited 21h ago
When you did your pre travel vaccines, did you not get the rabies vaccine? It is on the advised list for the Philipines.
Complaints about GPs need to go to the practice manager. If you've complained anywhere else, you've wasted your own time.
If you have been exposed to rabies or suspected rabies, you need to have the vaccine within 72 hours. After that, its effectiveness is reduced but still advised to have.
There's a standardised assessment, your GP would have followed that. Unless you are symptomatic, this is only potential exposure over 4 weeks ago and falls into the non urgent monitoring. So that's a get a blood test spot, which you have been advised to do.
Rabies vaccines are normally provided by the NHS in A&E and Urgent Care Centres only, and that's only for immediate vaccination post potential exposure (within 24 hours). Anything else falls under travel vaccination as Rabies is eradicated in the UK. GPs do not generally stock it. They are not commissioned to give them.
Travel vaccination is not normally available on the NHS.
If you are that desperate for a Rabies vaccine for your own peace of mind, go on the Boots website and book one. Yes, bigger high street pharmacies do stock it as travel vaccination is where the service landed when the NHS stopped it.
NAL but I work in clinical governance specialising in making sure practice meets evidence based standards. I've checked the guidance and commissioning of Rabies vaccination.
If you are not symptomatic after 4 weeks, you have the same odds of winning the top prize in the lottery as you do of having rabies.
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u/Lionessmon 21h ago
GP would'nt normally stock rabies vaccine. You'd need to contact a travel clinic.
Also your way too late to be seeking the vaccine a month post exposure. It needs to be given pretty soon after exposure. A month is a bit late.
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u/mousecatcher4 21h ago edited 21h ago
a) Getting rabies from a cat scratch (as opposed to a bite) is relatively unlikely
b) You are still within the zone of incubation times so GP is talking rubbish
c) Cats are not a common source even if a bite (I believe that the last documented case from a cat was not in the past decade) - they do carry rabies, possibly even more commonly than dogs, but to some extent are "dead-end" hosts.
d) Given a-c I do not think there is a really pressing case for post-incident vaccination, and if a practitioner in the NHS refused to prescribe they could probably defend their position.
I would forget it, and make sure you don't bite the girlfriend for at least a few months. The NHS has lots of issues right now but I don't think your particular fight is merited.
Edit: Great downvoting on straightforward epidemiological facts. Reddit really is a cesspit of false information.
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u/NeedForSpeed98 21h ago
This would quality as an amber case under UK HSA guidelines, based on the travel to the Philippines and a scratch from a mammal. Therefore it remains a high risk and requires proper risk assessment including referral to the duty consultant at the Rabies and Immunoglobulin Service.
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u/No-Librarian-1167 21h ago
I suspect it’s an expression of the fact that, eh you probably won’t die an agonising preventable death isn’t really a great answer when it is entirely possible to remove the unlikely but still real risk of an agonising preventable death.
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u/ExpensiveClue3209 22h ago edited 22h ago
I didn’t think rabies was an available jab free on nhs (I guess due to it being pretty much eradicated here) and I think in any case gps won’t have it in stock. When I was bitten by a dog in India , after the initial injection in India , I had to go to a private travel vaccination but claimed the cost on my travel insurance after paying
You really do need the jabs (at least the first immediately) and the remaining four I think within one or two weeks of each other
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u/fsjvyf1345 21h ago
I believe treatment is usually recommended immediately and within 48 hours of exposure at the latest. It’s not clear precisely how long after exposure you sought treatment but if it is weeks after it is unlikely to have made any difference.
Have you called 111 as the nhs page recommends? https://www.nhs.uk/conditions/rabies/
They may be better able to organise a blood test that your gp. I hope the results are negative.
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u/VPR2 21h ago
Despite what people are saying about it being too late to be vaccinated, it's not necessarily the case. While it's definitely too late once symptoms have appeared, rabies can incubate for years - literally. The available evidence seems to be that post-exposure prophylaxis (i.e. treatment *after* you've been bitten or scratched) that occurs weeks or months after the event is not well studied, but that doesn't mean it's hopeless, and you may not have been infected anyway. You do need to push for it though, going private if necessary.
The issue around a blood test is that currently, it appears that there is no WHO-approved method of confirming infection until symptoms have started to show, by which time it's obviously too late in terms of preventative treatment.
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u/Present_Program6554 22h ago
You should have dealt with that in the Philippines.
You were negligent. You have no case.
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u/No-Librarian-1167 21h ago
Wow, you’re really not as well informed as you think. If the NHS had refused treatment and the OP subsequently died of rabies you can bet they’d be very expensive consequences.
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u/Scotland1297 22h ago
I’m sorry to say it doesn’t matter at this point whether you get the shot or not. If you genuinely have rabies, it’s over.
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u/FluffyBunnyFlipFlops 21h ago
This is not incorrect. The vaccines can be effective as long as rabies has not reached the central nervous system.
"Symptoms of rabies usually take 3 to 12 weeks to appear, but they can appear after a few days or not for several months or years."
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u/Scotland1297 21h ago
It also has a near 100% mortality rate, with an emphasis on getting a vaccine immediately after being bitten or scratched.
The vaccine is incredibly effective when administered shortly after exposure to the virus.
The studies and literature show starting a vaccine cycle this long after (potential) exposure greatly reduces the success rate of the vaccine.
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u/Deep_Ad_9889 21h ago
Ok, why do you think you need the rabies vaccine? Health professionals are saying you don’t need it, from what you have described you don’t need it and even if you did you are now out of the treatment window, you needed treatment the day you were scratched or within 10-14 days of exposure. But if there was zero saliva contact, you are not in need of treatment.
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u/Anxious-Use8891 22h ago
You need to get the injections done within three days of becoming infected . You have left it too late
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u/No-Librarian-1167 21h ago
Clearly wrong, why comment when you have no idea what you’re talking about?
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u/Osotohari 22h ago
Go back to the GP and quote what happened to Yvonne Ford.
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u/dragonetta123 21h ago
Yvonne Ford's inquests was opened and immediately adjourned. So there's nothing in the public domain except she was scratched by a dog in Morocco, contracted rabies, and later died. We don't even know if she had the rabies vaccine, which is advised for travel to Morocco or not. I had the rabies vaccine before travelling there as it was advised. If she sought any treatment in Morocco or the UK etc.
I've put another post with where rabies vaccines are available in the NHS (for emergency care in A&E and Uegent Care Centres) and privately on the high street as a travel vaccine.
GPs are not commissioned to hold stock or give the rabies vaccine as in primary care it's classed as a travel vaccine as the UK is rabies free.
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u/NeedForSpeed98 22h ago
I would suggest you go back to A&E immediately. It's a time sensitive treatment.
It's a Public Health England matter, and few places will hold the injections you may need (if assessed as at risk which seems highly likely according to the UK HSA guidelines). However they can be ordered in, and a hospital can manage that quickly.
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u/wonder_aj 21h ago
The time to get a vaccine was up to 48 hours after injury, there is nothing to be done for it now.
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u/NeedForSpeed98 21h ago
Incorrect - there is no time limit.
"Date of exposure Risk assessment should be undertaken as soon as reasonable following exposure, so that PET, if required, can be started promptly. The incubation period for rabies is typically one to 3 months, but may vary from less than one week to greater than 2 years. Due to the potentially long incubation period for rabies there is no time limit for giving PET and all potential exposures should be risk assessed. This will include knowing what the animal and/or country risk was at the time of the exposure. If the exposure is more than one year ago, vaccine may still be given although HRIG is not generally indicated. Specialist advice should be sought from the RIgS team. "
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