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?

I don't think anyone is wanting to force a woman to have hormonal contraceptives that she doesn't want but the government has recently issued new and very strict National guidance for valproate and this issue is in sharp focus right now.

Many women were prescribed medications that caused birth defects without adequate explanation of the risks or any offer of mitigation eg birth control. Just a vague mention of that being a side effect has not been shown to be enough. People don't always recall that conversation or their circumstances change. There needs to be a proper serious documented conversation/ a disclaimer signed and annual reviews.

The GP is just trying to abide by guidelines and prescribe safely and I really don't think they should be pilloried for that given the adverse effects that the guidelines were brought in to deal with.

Thankfully they are taken into account in very specific circumstances like this- for equally obvious reasons- precedent set By the thalidomide scandal. This is about not recklessly endangering babies in utero- yes women do this themselves every day by virtue of lifestyle but expecting Medical professionals to be reckless is entirely another matter.

Your gp 100% retains the right not to prescribe - their signature their choice.

if your neurologist wishes you to have the drug then they are welcome to prescribe it for you. That means physically sign the script and not try to instruct someone else.

You wouldn’t be the first ‘happily married’ woman to become pregnant elsewhere.
Given the judgement against the folic acid Dr - I can see why the gp is reluctant.

www.pharmacyregulation.org/standards/guidance/sodium-valproate-resources-and-information#:~:text=From%2031%20January%202024%3A,reproductive%20risks%20do%20not%20apply.

The medication might not be valproate but here is an example of how strict the guidelines are for that medication as an example

But if the medication is going to effect her eggs, surely it will effect them even if she's on contraception. How is the pill going to protect her eggs?

Honestly OP, I'd just agree to the contraception in order to get your meds. Let him prescribe it, you don't need to actually take it.

So the OP can't have her medication because she might have an affair ? Fucking hell.

The GP doesn't have a right to insist on the OP taking any contraception. He can set out the risks and ask her to sign to confirm that she has been told. That is the extent of his professional obligation to her.

If he wishes to not prescribe because it would conflict with his beliefs, he has a duty to refer her to another doctor - he can't just say no.

Sadly society has created this though with its blame culture. Frequently people try to blame others when they have been told or it is common sense, i.e warning on a cup of tea that the contents are hot.
You may be sensible and understanding of the potential consequences but many wouldn’t be - would be told and then if something went wrong, blame the Dr.
We have a very strong jump to blame/complaint rather than discuss. I appreciate that you are saying this is challenging but not impossible - you need to wait for an appointment.
I hope it all works out but don’t blame a Dr who I bet is frequently lied to - I have cut down my alcohol intake, I don’t… etc.

I am a GP.
You need to go in and talk to GP.
There are some medicines that I absolutely cannot prescribe to a woman who may become pregnant without signing a declaration that they have adequate contraception.
GP’s are not supermarkets.
It really gets my goat when specialists do this - ask for GP to prescribe without any discussion.
I have been told by specialists to prescribe things that are wildly inappropriate for a particular patient given their history , my knowledge of their circumstances and other medication.
GPs are often more aware of drug side effects and contraindications than a particular specialist.
Please see your GP and have a conversation— and I really hope it helps. 😁

The pill won't protect her eggs, it will prevent her potentially defective teratogenic eggs being available for her to become pregnant

oh yes - and why aren't you angry with your neurologist? Because of course it is a contractual obligation that they give you enough medication until your GP has agreed to take over. Which s/he didn't do.

oh and BTW, blood group studies show that at least 10% of the population aren't fathered by the person that they think is their dad. so your husband's fertility is irrelevant......

But she's already stated she can't get pregnant because her husband is infertile! So she doesn't need the pill.

I think you're unreasonable to complain without first having spoken to the GP, which I do appreciate is difficult given your update. At the moment the GP is getting second hand information coming at him from both the neurologist and the pharmacist. He's not heard anything from his actual patient. The system is not patient friendly at all at times but I think the GP is actually acting quite responsibly in the circumstances.

Jesus! This is like saying I should be taking the pill even though my husband had a vasectomy, you know just in case I happen to land on some random's erect penis! Fucking hell!

If you are wanting a doctor to put their registration at risk by prescribing you a teratogenic drug which has strict legal conditions, then yes, you need to be on a contraceptive. That's the law.

Firstly my husband's infertility is actually caused by the fact he has spina bifida. He's one of the 75% of men with the condition that are infertile. I didn't mention it in the original post because only the infertility is relevent. But I am well aware of how awful neural tube defects are.

My daughter (not his obviously) has a congenital heart defect. I live with and deal with the consequences of birth defects every day.

Also as an aside. I'm a competent adult. If I were to get divorced and be in a position where I could get pregnant accidentally, I would obviously be happy to go on the relevent contraception. But I'm not divorced, and I can't fall pregnant without fertility treatment.

um, there are other men in the world.

@prescribingmum 👏🏻👏🏻👏🏻

they’d soon complain about the GP if a pregnancy was to happen which had to be terminated or baby born with severe disabilities.

this ‘stamp my feet and complain’ culture is one of the things I find most difficult in our jobs and it’s so draining!

Medicine is notoriously patriarchal in so many ways. This is one of them. If I were the OP I would ask GP again in writing citing NICE guidelines- if he still refuses take it further.

The law says women need to be forced to take a hormonal contraceptive in order to access the medication they need, really? Can you link to the wording of this law? Because I find it hard to believe that in the UK in the 21st century the law requires a woman to be forced to medicate herself against her will in order to access the treatment she needs!

Oh, right ok. So what you're saying is all women are slags and can't be trusted to not shag any man out there.

Agree to a prescription for a contraceptive and then just don't take it ? It's the easiest thing to do all around really. The gp will never know and you'll get the other medication

I would certainly ask to see another GP or the practice manager to discuss it with them. I wouldn't frame it as a complaint unless I was unable to speak to anyone at the surgery.

So you wait three weeks and get the appointment or else you go back to your neurologist’s PA and ask for a prescription that way.

Regardless, complaining is something you should be doing once you’ve properly attempted to speak with the two doctors concerned and even then, you GP is well within their rights to refuse.