Pharmacy Prescribers mixed responses to requests for UTI treatment prior to chemotherapy

  1. A couple of afternoons ago, before I was due to start my 1st chemo cycle (at 10am the following morning), I developed symptoms suggestive of a UTI. Chemo had already been postponed twice & I was desperate to start, as my cancer has shown signs of active spread in the 4 months since I first found a lump. Recent negative experiences (x2 in the previous week when trying to seek pre-chemo immunisations) of not being able to get past my GP Practices’s “gate-keeping” RECEPTIONISTS had me phoning my local Boots Pharmacy Prescriber as a first port of call instead.

  2. Pharmacist went through their protocol, asking a series of Q’s before telling me “I’m sooo sorry I’m gonna have to refer u back to ur GP regardless, because this one’s outwith my (?)competence … (?) prescribing remit…”
    I can’t remember the exact word now.

  3. Mindful of the difficulties I was having with gatekeeping & the urgency due to impending chemo she said she’d send an email through to the GP Practice in hopes of easing my access to clinicians. Advised I give it 5 mins for it to get through, before phoning them myself.

  4. I waited the 5mins and called my GP Practice at 4.44pm (it was due to close at 5pm). Same Receptionist as before responded with “there’s no urgent slots left for the day, and I can’t see an email from Boots in any case”. For some reason she said “I’m going to hand you over to the Practice Manager” (had I been flagged up as a difficult patient, since failing to secure pre-chemo immunisations with a clinician the previous week? The only date they were offering was for AFTER my chemo was due to start … really just not grasping the limited time left to build up that immune response in the remaining days before chemo could impact it). The benevolent side of me also held space for the fact that she could be a new-ish Receptionist, and still being supervised (hence the handover to a more senior member of staff)?

(Anyway, that’s the background story to me resorting to other sources of help where possible now, like the Boots Pharmacy Prescribers as a first port of call).

  1. The Practice Manager wasn’t budging either; saying, “I can’t see any email from a Boots pharmacist in any of our systems; and so we have no urgent slots to offer you. If she wants to CALL instead, she’ll have the number, and can she can TELL me what was going to be in her email instead” (or something to that effect) basically making me believe that I could still potentially be given a chance to be put through to a GP, before closing time). However looking at my watch, 4.50pm, I knew in my heart it was probably a well-rehearsed delaying tactic to her/them off the hook, as at 5pm their phones would be switched off and an automated message would direct callers to the 111 helpline.

Still, I played ball and tried to get through to Boots again; the minutes were passing without being answered, and with rising panic I re-dialled the GP Practice in hopes of pleading & re-explaining things again…in a different way that may help them grasp the gravity of me potentially missing yet another deadline for starting chemotherapy for my highly proliferative tumour that has remained untreated for 4 months.

No such luck.
Phone now switched off. They’d won…finished their job on time, able to go home and switch off whilst leaving me with the weight of the world on my shoulders.

  1. Through sobs at their heartless behaviour, I was still managed to phone 111; waiting 1/2 hour to be answered; spending a further 1/2 hr answering their questions (waaaay longer than the Boots protocol)….only to be told “as long as you see someone in the next 24 hours it should ok”.
    Like the GP Receptionist & Practice Manager, the call handler either couldn’t grasp the gravity of the bigger picture or didn’t care enough about the potential for another delay to chemotherapy starting. What’s the point of a healthcare system that doesn’t work at the most vulnerable time in your remaining life?

  2. Now panicking, I put the phone down rather than waste precious time trying to convince her I needed a more urgent attention. I spent the remainder of the night traipsing through my city to find a Prescribing Pharmacist at ANY chemist that could still possibly help me before everything closed down (either in issuing medication, or in helping me to understand why it might not be suitable, or in offering alternative recommendations for easing symptoms). I walked-in to a Boots chemist a couple of miles away; explained the same story and this time was issued with antibiotics. Had it made a difference going in, in-person; whereas hours earlier my contact with my more local Boots pharmacist had been by PHONE? Initial relief, was soon followed by wariness.
    I sat on a bench and started googling (something I’ve been trying to avoid in this journey, for fear of stumbling across Prognosis statistics about my rapidly spreading cancer). I found some vague blurb about avoiding Nitrofurantoin in certain cancer treatments - sarcomas were mentioned, but couldn’t see references about breast cancers.

  3. I saw a there was an Asda pharmacy still open, til 11pm, so went there in a last bid to be able to discuss my concerns. Landed on a really understanding pharmacist, who showed me his printed crib sheet of the protocol their chain uses, and explained that (? ALL) Pharmacy Prescribers are limited to dispensing only Nitrofurantoin for UTIs (not trimethoprim, which is an antibiotic I’d successfully used for a past UTI; pre-cancer diagnosis). He pointed to a sentence on the sheet that indicated that he wouldn’t have been allowed to prescribe the same drug for me in the context of my impending cancer treatment (I specifically saw the word “breast” amongst a list of other cancer treatments). I thanked him for sharing, whilst I hastily purchased back-up supplies of ‘cystitis relief’ sachets I saw on the counter - keeping my options open whilst I took the time to mull over what to do on the train back home.

  4. Decided to go with the sachets of ‘cystitis relief’ - I had time to squeeze in 3 doses before leaving for the hospital at 9am (it was now approaching midnight). I stayed up all night, and managed to drink 3L of water too. The pain on peeing disappeared, but I still collected a urine sample to hand in on arrival at the hospital. Dipstick showed it was ‘clear’ & I was able to start chemo, with the caveat should symptoms return, especially in the coming days where nausea & vomiting could leave me more dehydrated, I’d have to seek urgent medical care again. They cautioned that I may have only temporarily diluted/ washed out the offending bugs and that they may return.

I’m dreading having to contact my GP Practice again, if this returns (I did have minor pain on peeing an hour ago; but took another ‘cystitis relief’ sachet and my last pee was completely painless).

As soon as I’m recovered from the exhaustion of an all-nighter followed by chemo, I’ll start the process of switching GP Practice. The Drs & nurses themselves are all LOVELY, but non-clinical staff are taking it upon themselves to decide who deserves access to them. It’s not safe. It’s not caring. It’s been an obstacle to getting the urgent help I’ve needed to get my ducks lined up to prepare for chemo starting (I‘ve had very unexpected findings during my cancer investigations which has seen my planned treatment change 4 times. I’ve acted as swiftly as possible whenever Oncologists have made/ changed recommendations - they play their part under their remit in the hospital setting; and there was a list of things to be addressed in Primary Care (up to date smear & immunisations, dental check, eye check etc etc). Cancer really is a ‘shared care’ opportunity, and everyone stepped up to help in a timely manner except for my GP Practice. I understand the pressures, I really do. But I struggle to think of a more pressing scenario that was going to be let over the line to have access to an actual GP (a sick baby, maybe?). I can recover from the exhaustion, but not the fear of feeling unsafe in their hands. So I’m minded to still change Practices, even though I’ve been with them 15 years. I can’t even get through to raise concerns directly with a Dr about what their front of House staff are doing.

Any suggestions, any magic words you think I should’ve said to get a better outcome for me when phoning my Practice? Any point in giving them another chance before I leave (it’s the most conveniently located for me, as a non-car owner suffering with fatigue as well) but there are other Practices in the vicinity (will I face the same level of front desk gate-keeping? Does mine sound particularly bad, or is this par for the course nowadays at most GP Practices?

Sorry for the essay; chemo-steroids have kicked in and I can tell they’re affecting me now. Thanks!


P.s. Forget to also ask: what’s the score with using Nitrofurantoin fir a UTI when receiving cancer treatment?
Is there a potential issue?

If trimethoprim is the more appropriate antibiotic to have in that scenario, am I correct in thinking Pharmacy Prescribers can’t issue it (their scope of prescribing power is limited to Nitrofurantoin)?

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This is appalling, your GP should have your records marked as .“active cancer patient” and you should be given priority.
If you’re having no joy at Practice manager level I would take it to your local ICB, you can Google which one it is for your area. They’ve taken the commissioning from the old PCT’s in most areas.
Good luck and take the time to sort it now, as you will probably need their services in the future.

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Thanks. What’s ICB stand for?
I didn’t know I could be flagged as ‘active cancer patient’ … maybe I have been flagged already; and they’re just heartless? I do feel really stuck, so I will try my best to keep going with this even though I can sense a change in my mental capabilities now I’m on the 3rd day of steroids (& 1st day of anti-nausea med, Domperidone).

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Integrated Care Board (originally Primary Care Trust’s) they are above the GP’s and purchase their services. When the hospital first sent a letter to the GP saying you had been diagnosed with cancer the coding on your electronic GP record should be changed to flag up a message every time your record is accessed by anyone in the surgery. That way you should get quicker, better care not bloody awful :face_with_symbols_over_mouth:


Oh thank you; that’s so helpful to know. I just fear a backlash when they suss it’s ‘me’ that’s contacted ICB… It was the same receptionist who denied me access to prompter immunisations last week … and at that time I DID ask to speak to her manager. A long-standing Receptionist came on the phone and said she was supervising her that day, and had heard all the exchange already and could confirm I can’t be fitted in sooner with the nurse to administer immunisations. I said what about an urgent slot with one of the GPs instead? Nope!

That’s why I didn’t go to them when I got the UTI symptoms….Having to face such disbelief and indifference has me wondering why they bother to answer the phone towards the end of the day … Because the same parting statement was made last week, on a Friday as it happened, “we’re all about to leave & lock up now.”

2 days off for their ‘weekend’, knocked off 2 days of the remaining 6 precious days left to mount a decent response to immunisations.
[As it was, I ended up securing an immunisation 2 days before chemo by using Boots Pharmacist; and another one just a day before before chemo started. I’ve given up on trying to get the 3rd one, for Covid, but I’m still hoping/ waiting to hear about a 4th one, for Hep B. I’d asked if a GP could at least WRITE a prescription for it, so I could take it to Boots to fulfil & to administer as they have more slots than my GP Practice. Still waiting for prescription…

But chemo nurse says it could still be timed carefully to have it ‘between’ cycles … making it coincide with good blood counts. But yeah, much more hassle than if I’d been given it before starting treatment! One quip the Practice came up with (I can’t recall ‘who’ now) was “if your hospital team want you to have it then they should give it”. I didn’t know how to respond to that….hence the ongoing limbo about getting it. But I can’t deal with that just now].

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The receptionist should be aware you are cancer patient and have understanding of urgency of meds for you do you not have a rapid response card from your team? You need one of these and you ring it any problems during chemo or any suspected infections during chemo. You ring your practice back and ask to speak to the practice manager and you explain everything and that they ensure all office staff are made aware that if you ring it needs help immediately not fobbed off as you have been. Also do let your team know what’s happened and the difficulties you’ve had when you’ve been directed back to your gp for meds. You can be firm and polite when speaking to your gp!s practice manager but it will be negligent if they fail with assistance if you are in a position again when you’ve been referred back to them to prescribe meds and you can kindly explain this when you speak to the practice manager. :two_hearts::two_hearts::sparkles::sparkles:Shi xx

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This Is appalling care. I work in a GP’s and vaccinated regularly.
I was able to access pneumonia and shingles vaccine earlier than my age qualifies me because I was going to start chemo.
As you say your vaccines must be timed around the chemo cycles. This is why your notes should be coded accordingly.
COVID vaccine isn’t available anywhere at the moment until the spring booster program starts, the start date hasn’t been announced yet.
If you’re records are coded correctly this will generate an invitation for COVID vaccine as an immunosuppressed patient. The correct code on your GP record is key.

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Tell your doctor’s you want to raise a formal complaint and how do you do that. It might help


I didn’t get issued with the oncology Rapid Response cards until the day after, when I’d actually started chemo. This all unfolded the day before. I’ve never had cause to rely so heavily on my GP in my entire life. It’s taken 53 years to realise you can’t bank on it (or 15 years if you isolate it to this GP Practice. But in reality I can’t ‘compare’ them to any previous Practices, as I literally never had cause to consult with them).

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Oh that’s the other one I wanted!
But Boots pharmacist was most focussed on me getting the pneumococcal and flu jags on board. They didn’t have shingles in on the day, but could order it. I was under the impression I’d have to pay for that one though.

And if I recall, it wasn’t one specifically mentioned by breast care team. But then I’ve had little time to indulge in those convos compared to the bigger picture ones about the changing treatment plans for the actual tumour & mets.

I had chickenpox as an infant & shingles as young child. But I didn’t think to tell anyone about my elderly dad who I try to travel to regularly to help give respite care to on behalf of my exhausted mum (his main carer). He gets occasional bouts of shingles on his forehead (once a year maybe?) that me & mum will tend to with Zovirax cream at the earliest sign (in hopes of him not having to resort to oral acyclovir) …

Obviously I’ll be trying to avoid him during his next bout, if it coincides with my chemo. Thing is, with my rapidly changing picture, I hadn’t got round to telling my parents about my diagnosis yet. My dads so fragile and our focus as a family has rightly been on him.

I don’t want to add another level of stress just yet, when I’ve barely got my own head around it. I know there’ll be lots of Q’s from mum (& therefore then my siblings, who’ll be trying to support her). It’s just not the right time …

But hey, you promoted me to re-think that immunisation you. So thanks for the reminder. My head is too full to have a decent memory these days (at least I’m hoping it’s that rather than early, as yet undetected, brain mets!)

I’m currently waiting to start radiotherapy and was diaognosed with shingles on Wednesday, it didn’t even cross my mind I might get it. My dr thinks it maybe due to the stress of my diaognosis last September and what I’ve been going through which may have sparked this off. I had chickenpox as a child but nothing else and I’m 58 now.

My surgery now has an online system where you send your issue and a gp will respond within an hour or two, so you can bypass the receptionist, does yours have anything like that you could use.

Hope you get sorted

Take care

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I did look up how to make a formal complaint on their website, and it goes via the Practice Manager … the very person who last turned me away. I have no hope she would deal with it fairly (and yet I can’t access a GP to be be able to talk about it to one if them either). So I’m pleased to hear about the ICB suggestion … I wasn’t aware.

No. I’ve been searching their website and the ‘Patient Access’ platform for ways to bypass staff and make direct contact with a GP.
The ‘messaging service’ available on Patient Access is turned OFF for my Practice.
I’d like to join a Practice that has it turned ON - but don’t know how to find that out BEFORE changing Practices …. and then logging back in to ‘Patient Access’ to check whether the Messaging Service toggle is switched to ON or OFF … if that makes sense?


Yes my surgery has the direct messaging switched off, but you can request an online consultation which gets looked at by the drs and they get back to you with what needs to happen. This is what I did on Wednesday morning and I got a response and a phone call from the surgery within 10mins with an appointment later that day, I know there is no way I would have got that through a receptionist.

I do hope you get sorted, you do not need all this extra stress and anxiety at this time.

Sending hugs

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If you go on the NHS app it gives you an option to contact your GP about a health problem. Hope that helps

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I’m going to try and send an email tonight to my ICB so that it’s there for them to read 1st thing. I’m a bit brain fogged from the steroids though, and I really don’t know if I’m looking in the right place for the Contact details of my ICB.

Would u mind if I told u the name of (what I used to call) my “PCT”, so that u could maybe tell me it’s equivalent ICB today?
(Not sure if this forum allows private messaging…but I’ll try to work that out too, if u don’t mind me sending u that info…As I’m assuming it’s best not to share publicly here…)

What an awful time you have had. I also tend to use the online service more times than not if I want to get help from my surgery. My friend who is on immunosuppressive meds permanently for an autoimmune joint condition ran into similar problems that you did when trying to get the shingles jab . She did get it eventually but only because she managed to ask her GP directly if she was eligible - he knew she was eligible but up until he confirmed it it was a case of "computer says no " . It was a similar thing getting the booster jab though again she did get it eventually. Unfortunately clinicians are constrained by systems - your example with the Pharmacist ( and incidentally yes you are likely to be listened to more if you turn up in person) . Trying to get a Ventolin inhaler for my Dad at Easter Bank Holiday I experienced a similar problem - NHS 111 made an appointment for me with a local Pharmacist to collect one only to discover that his surgery had not put it on repeat and although it is life saving medicine that he had had before they were not allowed to dispense it . So it was back to NHS 111 and speaking to 2 people who weren’t allowed to prescribe before speaking to a Dr. who did prescribe it. By that time there was only 1 pharmacy open and they had run out .

I’m really surprised at the lack of understanding about the needs of someone undergoing chemo at your surgery though - sadly it’s something that’s relatively common . If it is possible for you to move to a different one it might be worthwhile .

If I get a UTI or to prevent one coming back I use D Mannose - another forum user asked if it has any interactions so I asked the company I order it from which is SC Nutra and they said it does not. Holland and Barratt , Boots and Amazon also sell it.

Wishing you all the best for your treatment and better luck in future .

Joanne x

Hello Ross24,

Thanks for posting. No need to apologise.

This sounds a difficult and worrying time as you say, and you felt very vulnerable. It’s understandable you wanted to get a treatment for your UTI symptoms as soon as possible. It’s good to read you were able to start your chemo as planned this time.

Hopefully the responses you have had here have been helpful. To connect with other women, you may want to post in this section of the forum and the chemotherapy monthly threads may be of interest.

It may have helped to have attended the pharmacy in person as they could have offered a face-to-face consultation, but it’s difficult to know for sure. To find out more about pharmacists prescribing you can contact the General Pharmaceutical Council. They can hopefully explain what the procedure is and what can be prescribed in these circumstances. They also have a link for reporting a concern.

The Electronic Medicines Compendium is a helpful place to look for drug information rather than Googling. They have a health care professional version and patient version of licensed drugs in the uk. You’ll see from the previous links about nitrofurantoin, it does not say it needs to be avoided in people with breast cancer. It does mention peripheral neuropathy as a side effect which is also a side effect of some chemotherapy drugs.

It’s understandable that you’re concerned about contacting your GP practice in the future. It looks as if you have now been issued with an oncology rapid response card and information about accessing help with symptoms or side effects at any time including out of usual hours. You explain you are going to contact your Integrated Care Board which are operates in England. This information about raising a complaint with your GP might be helpful as well as this link about changing GP practices when you feel up to doing so. Its good to read the doctors and nurses have all been lovely.

With regards to shingles, this isn’t something you can catch or pass on to someone else. The virus lies dormant in anyone who has had chickenpox. This can then get reactivated later as shingles in someone whose immune system is compromised such as during chemotherapy or at times of stress. As you are over 50 and on chemotherapy it sounds as if you would be eligible for the shingles vaccine so do ask your treatment team about his. As your chemo nurse says the vaccine can be administered at a point in your chemotherapy cycle when you blood counts have recovered. As you explain having any necessary vaccines before starting treatment is the more ideal situation, but you will still get protection.

It’s understandable your brain feels ‘full’ with everything you are going through. Do speak to your treatment team about any ongoing concerns you have. Some people find counselling can really help at times like this. There may be a service at the hospital and our information about stress and anxiety might also help.

As well as the forums you may be interested in the range of other free services we offer. It also might help to call our helpline if you would like to talk this through or have any further questions. The helpline team have time to listen, talk things through and signpost you to more support and information if necessary. Your call will be confidential, and the number is free from UK landlines and all mobile networks. The number is 0808 800 6000, (Relay UK -prefix 18001).

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Best wishes


Breast Care Nurse

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