Vitamin D, a Public Health Issue: listen again with the BBCiPlayer to learn more

I’ve got a confession: I, and indeed a significant number of my fellow GPs, have got an unhealthy obsession with vitamin D. Or, to be more precise, vitamin D deficiency and the apparent inability of the NHS to make available to me, as a prescriber, the means to treat it in my patients. You see we can’t, quite literally, get the fix they need, at least not using our tried and trusted prescribing pad. In case this issue is new to you, let me very clear: vitamin D deficiency is common, and the evidence that this deficiency is complicit in a number of serious health problems, including diabetes and heart disease, is growing by the day. Many of our patients, it turns out, know all about this research. they also know, because word spreads fast amongst patients, that  there is currently a ‘supply problem’ that means that GPs are unable to prescribe useful doses of vitamin D without either overdosing the patient on calcium or breaking the  prescribing piggybank.

Supply and demand being what it is, chemists and health shops around the country have taken up the slack and, for anyone who pays prescription charges, buying your own vitamin D over the counter is a reasonable option. So, to summarise, cheap(ish) vitamin D available over the counter but only ‘you must be joking, how many hundreds of pounds did you say’ vitamin D available to prescribing doctors like me.  In my practice, naively suspecting there must be a way round this problem, we’ve invited visiting experts to talk to us and begged the PCT pharmacist to help us sort this out. They in turn have shown us the proverbial scars on their backs from trying to get the Department of Health to wake up to this important public health issue and finally do something.

Now I’m not an expert in this field but I have spent a disproportionate amount of my time trying to get my head, and my prescribing pen, around this one. When I try to explain this to patients they often laugh: they see the vitamin D fiasco as emblematic of what David Cameron would call top down bureaucracy in the NHS. Of course, their nodding and smiling heads imply, you can’t prescribe cheap vitamin D on the NHS but I can walk into the chemist and buy it over the counter. And not, they happily acknowledge, because anyone is actively trying to stop you prescribing it but because it takes someone, someone high up and by definition inaccessible, to active do something to make sure you can.  And they’re not and there’s nothing you can do about it. Smiles all round.

For some of my patients this is all a rather bittersweet reminder of everything that’s both good and bad about the current way the NHS is organised. I and my colleagues care enough to get agitated, to invite in experts, and even to write blogs about it. That, I arrogantly like to think, reminds them of everything that’s good about the NHS. That we’re unable to provide – and for no good reason-what should be a cheap and effective treatment to those who can’t afford to go over the counter is, on the other hand, a prime example of why I, for one, would like a bit more freedom when it comes to sensible local policies.

As so often, the BBC’s radio 4 have summed it up far better than me.

http://www.bbc.co.uk/iplayer/episode/b00t66nr/Food_Programme_01_08_2010/