If I make a complaint about my GP refusing to prescribe medication

[Sconesandgravy]

My neurologist asked the GP to prescribe a medication to help with a medical condition. The medication is one can cause birth defects. I spoke to the pharmacist this morning who called to say she was putting the request through to the GP. The pharmacist messaged that afternoon to say the GP has refused to prescribe unless I go on hormonal contraception or the copper coil. He has claimed that guidelines say he can't prescribe if I refuse the above types of contraception.

I want to complain about this for several reasons:

• My husband is completely infertile. He had multiple samples of testicular tissue biopsied and it was confirmed he has a condition that means his sperm count will always be 0. The only way I'm getting pregnant is with a sperm donor. I obviously can't do this by accident. The pharmacist made the GP aware of this because she called me this morning and said contraception is recommended, so I said I'm not on contraception and disclosed about my husband.

• I checked the guidelines myself. NICE guidelines state the need for effective contraception must be expressed. The BNF says effective contraception must be advised. On gov.uk there is a 2022 safety review of the medication that states health care practitioners "should fully inform the patients of the risks and advise them of the need to use highly effective contraception". Nowhere specifies what contraception should be used, and none of the above bodies specify that medication should not be prescribed if long term contraception is refused. The only thing I can find is that alternative medications can be offered if the medication is long term and the patient doesn't want to use any form of contraception.

• Condoms and abstinence are also effective forms of contraception. If I were a man these would be recommended as they're the only available form of effective male contraception. It seems discriminatory to suddenly decide they're not considered effective contraception just because I have a vagina.

• I'm an adult with full capacity. I have the right to make an informed decision about what I put into my body.

In all honesty it just feels a bit like the GP has refused my prescription and intentionally given me misinformation about the guidelines to try and coerce me into going onto a contraceptive that he deems the most effective, rather than allowing me to make an informed decision based on my own personal circumstances. I know this is dramatic and I won't put that in my complaint but I just needed to get that thought out of my system

AIBU if I complain?

just enter into a dialog with the gp, without the pharmacist in the middle. Appointment? email exchange?

Sure complain but this 'I demand so if I don't get it I will complain' is one of then many things wrong in society, they are not doing it because they are bored or for a bet but sure go for it

Rather than immediately getting in a fizz and complaining, why don't you communicate with your GP to explain that you are happily married, and that your husband has been shown to be clinically infertile? That you are not and do not intend to have extra marital sex.

Discuss the issues calmly, as grown ups. Find out what his concern is, and address it.

Did you read OP post?

the mind boggles.

yes, OP, complain. It's ridiculous.

I would speak to the gp directly first .

Your GP has a personal liability for prescribing so they are allowed to decline if they want to. Yours obviously isn't comfortable with the risk based on the information they have at present.

Speak to them before you make a complaint and have a conversation about it, you're more likely to get the outcome you want. Complaining won't get you a different outcome.

GP isn’t correctly acting to the NICE guidelines. It’s not ok to insist you have to either be on hormonal contraception or have an invasive procedure with a risk of infection. For many women, neither of these are acceptable. And it is for you to choose, not him. He is not respecting your autonomy.

However, I would look to have a conversation before going to complaint. You can assure him you won’t be able to conceive. And mention your right to autonomy and his lack of adherence to the NICE guidelines if he digs his heels in. That should hopefully do it. If not? Yes, complain.

Speak to the GP first. He isn't some thicko he's fully trained and qualified and may and likely will know more, maybe some finer details about the NICE guidelines you have researched. No need whatsoever to complain he was looking out for you.

Make an appointment with the GP and have an adult conversation about it rather than flying straight in with a complaint. Most things can be resolved with a discussion.

It might affect sperm in a different way to eggs, as your eggs are the same eggs in your body since before you were born. Therefore the eggs could be exposed to the drugs for years and years, as opposed to the few days that sperm live for. So the male/female contraceptives argument might not be valid, no matter how unfair or "discriminatory" it feels. Was the neurologist aware that you're not on contraception?

Can the neurologist prescribe it?

Or.....controversially you could say yes ill take the pill, and just dont take them!

If the medicine is sodium valproate then read the mhra guidance. Despite the nice guidelines and information advice babies are still being born who are affected by this drug so the requirements for prescribing are becoming increasingly stringent. No gp will want to take the risk of prescribing valproate to someone who could become pregnant and they are within their rights not to prescribe. Your neurologist can still prescribe for you though.

This.

Surely your Consultant has written to your GP. Go and see your GP and discuss. This is not a conversation I would be having with a Pharmacist. They don't write your script.

I cared for a lady who became pregnant while taking drugs with a very high risk of birth defects, sadly her pregnancy was terminated. The doctor who had prescribed them was beside himself over it. From then on he was incredibly strict about all his patients being on contraception before he would prescribe, no exceptions, ever.

I think its absolutely correct that a GP shouldn't prescribe a medication with potentially very profound side effects without so much as even having a conversation with the patient.

Surely just make an appointment with the GP.

I'm also on a neurological med which causes birth defects and there was no pressure to take birth control, risks were explained to me and I'll taper off them before any future pregnancy. Not sure it's ethical to refuse a medication unless you agree to pump synthetic hormones into your body...

Speak to the GP and point it out. Or see a different GP

posterior protecting 😀

I'd ask for a convo with the GP to clarify the situation before going all guns blazing with a complaint.

It may be that the pharmacist hasn't relayed the full message from the GP.

A short conversation to give your viewpoint and clarify your understanding of the GP's stance is surely preferable to a complaint at this stage.

But I agree that on the face of it your GP is being unnecessarily obstructive in not prescribing a medication that has been recommended by a specialist and presumably will enhance your wellbeing.

Make an appointment and have a direct conversation with the GP about it. The responsibility for prescribing lies with the prescriber, so they can choose to prescribe, or not, as they see fit. Especially where it’s a shared care arrangement or the guidance has come from elsewhere eg a third party.

And NICE guidelines are just that - guidelines. GPs aren’t legally or clinically bound by them. Of course they will influence clinical decision making but they’re not a diktat.

Y

Is this valproate? If so your neurologist needed to fill in a form and fine another specialist to agree. It's the law.

OP if its sodium valproate the guidelines have recently been hugely tightened and any Doctor prescribing has to personally be as sure as its possible to be that pregnancy will not occur whilst the Woman is on the medication. They are personally accountable for their own prescribing decisions and leave themselves liable to being sued if a child with a birth defect is born- it’s taken as seriously as thalidomide which is still prescribed for certain conditions. They cannot take your Husband’s infertility as reassurance unfortunately as of course theoretically you can still get pregnant with someone else. The issue of you capacity is largely irrelevant in this situation as its the potential unborn child who is being protected and not you.

This !

This seems extremely unfair, and putting the rights of a potential foetus and/or the rights of the doctor not to feel guilty, above the rights of the woman to choose what medicines she takes and what risks she is prepared to accept (and what pregnancy options she is willing to consider if necessary). There are some women who can't or don't want to use hormonal or implanted contraception, and that shouldn't prevent them from getting appropriate care for their conditions.