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?

There is a lot of national scrutiny surrounding this drug and the importance of not getting pregnant on it right now and the GP is doing their job and trying to ensure the measures are in place. Instead of using a pharmacist as a communication medium, make an appointment and see your GP. Explain the situation in person, sign the paperwork - they need you to sign and say you know the risks, have acknowledged them and do not want contraception. They will then prescribe for you.

Sometimes a little communication is all that is needed

I am a HPC, and I’ve had many patients tell me there’s no chance they could be pregnant because their partner has had a vasectomy/is infertile/in prison/they don’t have a partner. It’s all very well to take it at face value, but when you have one of these patients come back and announce they are in fact pregnant, despite assurances there was no way they could possibly be, and even having a negative pregnancy test, then I cannot blame your gp for being extremely cautious.

She absolutely should stand against this crap. I'm sick to death of these people having so much power. It's probably to do with costs.

I would email the surgery, ask for the email to go straight to the doctor and ask for it to be prescribed again based on all the information you have provided. I've challenged directly in writing before with reasons and have had the original request prescribed.

I'd tailor it nicely as a request rather than complaint at this stage OP

In response to everyone saying enter into dialogue with the GP - I would if I could but I have no way to.
The practice only sends one way messages via text with no way to reply, I asked the receptionist if I could book an appointment or get a message to him, he isn't available for 3 weeks.

GP also stated on my records that I've had a conversation with the pharmacist about my reasons to decline contraception and he's decided it's inappropriate to prescribe until I agree to a contraceptive. So I'm really not sure what else I can do other than complain.

As health professionals, we are sick to death of patients like you who jump the gun and assume everything is to do with us being difficult or costs.

It is nothing to do with costs and everything to do with safety. There are far too many women still getting pregnant whilst on this drug despite being told the extremely high risk of birth defects. As a result, more stringent criteria have been enforced on a national level. The GP is personally responsible if she were to get pregnant whilst on it and they are rightly not taking the risk based on communication via a middleman.

You can book the appointment in 3 weeks and ask your neurologist for a prescription

Horrible post. Health care professionals are damned if they do damned if they dont. Honestly people like you are the first in the Q for compensation when something goes wrong!
no Doctor’has’ to prescribe anything in actual fact, its always their right and indeed responsibility to make the best decision possible and sometimes that means NOT prescribing.

The neurologist asked the GP to prescribe it. That does not mandate that the GP must do so. Every Dr is responsible for the safety of their own prescribing and this GP did not feel assured that it was safe. It will not be about cost certainly not for valproate which is cheap as chips. If you did go on to have a baby with birth defects the GP would be held responsible.
I'm afraid people are unfaithful to their husbands and babies are conceived to men other than the patients spouse not uncommonly so your husbands infertility is not a complete reassurance to the GP.
As has previously been suggested a simple direct conversation with the GP to explain that you fully understand the issues and you still wish to be prescribed the medication and will accept all the attendant risks will likely suffice to resolve the matter rather than a complaint. They just need to be able to document that you made an informed decision so it doesn't come back on them.

This is what I would do

@Sconesandgravy your neurologist is at fault for not doing the necessary paperwork regarding pregnancy prevention, issuing the first prescription then handing over the the GP to continue.

That is just appalling beyond words. It's like you're mentally defective and can't be trusted without taking forced contraception.

In light of all the above, I understand complaining. I think I would in this situation now you have highlighted all the above. I'm sorry if you said but I have had to go direct to consultants for prescribing with some similar issues.

Ask the neurologist to prescribe it
They are recommending it so presumably they are happy to accept responsibility for prescribing and they can write to the GP again saying why they feel it is safe to depart from the guidance.

So take the appointment in 3 weeks then?

I think it should be the neurologist's responsibility to prescribe this as the specialist recommending the treatment.

I take medication that causes birth defects, I also can't take hormonal birth control and I'm unwilling to have a copper coil.

I had a bit of a job initially but I was very firm that I am an adult, can advocate for myself, and if I was to get pregnant I wouldn't keep the baby.

The medication is bad enough as it is, I'm not being forced into BC methods I don't want as well.

Potential unborn children do not have a right to be protected. This is not the Republic of Gilead.

Make an appointment and speak to the GP. The neurologist put me on something that does the same. My GP spoke to me, I am assuming they noted on my files we had to consult and I have the medication. Each year the surgery send me a letter reminding me not to get pregnant and if I am thinking about it to book an appointment to discuss this. I am not sure how they think they can help with my dating life, but hey ho.

You are entitled to request a change of GP or an 2nd opinion from a colleague. There is no rule that says you just have to accept whichever GP you happen to be allocated.

I spend a lot of my time attending GP appointments with service users. It's astonishingly common how many people feel they don't have any sort of understanding with, or feeling of trust in their GP. Requesting a change is usually accepted without any fuss, and I've had plenty of GP's themselves say to the patient that they agreed a change was probably in the best interest of everyone.

I can see why you would feel the GP's response here is a bit patronising or condescending, but personally I don't really think it's a "complaint" level issue quite yet.

Christ almighty. Do you honestly think you and the Op know better than then making this decision with all of his training and the fact that you know his entire life, livelihood and financial security of his family can depend on a decision being made like this if he was to make the wrong one?

So they are refusing you because you currently have a functioning reproductive system?!
That does sound bang out of order. I guess they can say it's bad in pregnancy, but it makes it seem like every woman of child bearing age would be denied it? They can't force coils and stuff into people surely?
You shouldn't have to, but I'd just say 'well I don't have penetrative sex with men' I've had to say that when they demanded to know why I knew I wasn't pregnant. It's not their business.
I'd definitely complain.

This was my first thought too tbh!

No GP is personally responsible for a patients pregnancy unless he inseminated her himself.

It's the GP's role to outline the risks and to obtain a disclaimer if they wish. It's is barbaric to refuse a female patient medication for her current health on the basis that it's risky to an as yet, non existent and may never be conceived, foetus.

Women should not be treated as 'pre-pregnant' or as if their capacity for pregnancy outweighs their health needs. Her interests always come first and as long as she is fully informed, she has the right to make her own decision on the risks she is prepared to take and whether she wishes to use contraception.

Surely a conversation with the GP is the way forward?

Does he know your husband is infertile - if not - surely he's doing the right thing to not prescribe this drug if there is a risk of you becoming pregnant ?

the logical thing is a conversation with the GP and they would actually listen. Not sure why they are being difficult. I’m on two meds that aren’t compatible with pregnancy. I also have serious risk factors for both hormonal birth control and the coil. My husband had a vasectomy. GP wrote that in my file and prescribed my meds. I think I also volunteered that I recognize in the extremely unlikely event I found myself pregnant, I would have to terminate.

maybe it would help if you had your husband’s actual medical records showing he is infertile. Might be worth asking the GP if that would be sufficient.

I did a quick Google and what immediately came up was high risk of neural tube defects. I can see why he doesn't want to risk prescribing it without you being on contraception and he is within his rights to do so.

The husband infertility thing is a red herring, marriages do end, people do have affairs, he can't take chances and make a judgement call on the likelihood of this happening, he doesn't know you.

Neural tube defects can be horrific. Anything from a cleft lip to spina bifida or even holoprosencephaly. Google an image of a child with Cyclopia and I think you'll understand. If you are currently pregnant or don't have a strong constitution I suggest you do NOT Google cyclopia. Its not a sight you'll forget in a hurry.