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?

Oh believe me I am angry with the neurologist. For many many reasons.

I did ask him to prescribe the first month of medication. He refused and said it's the GPs responsibility.

In fact, the neurologist has been an absolute nightmare from day one. Last year he didn't tell me about an abnormal brain MRI nor that I needed an urgent lumbar puncture within 4-6 weeks. I found out about both four months after my MRI when my husband told me there's a new app where you can access hospital records. There was a half written report stating all of this. When the lumbar puncture came back clear, he refused all requests from the GP to expedite my next follow up claiming it was trapped nerves and that lots of women get them. It took me emailing videos and threatening PALs to get him to see me.

He saw the videos I sent and said I needed to be seen the next day because he was concerned. I had other episodes and the GP requested he do a spine MRI. Neuro rejected it. I was rushed to hospital last week due to a medical episode and a registrar contacted him to request a spine and neck MRI as he's in charge of those and she figured he'd accept from her. He's also refused those because he disagrees with both the registrar and the GP about the cause of the issues, even though they both agree it's the same thing despite not having communicated with each other and having seen me weeks apart.

I will be requesting a referral elsewhere once I can actually speak to a GP, but that will still potentially leave me without meds because the waiting list is over a year where I am (which is why I didn't ask sooner).

Though, yes, you could accept an accompanying prescription for the pill and then just not take it. However, that's only worthwhile if the GP is willing to prescribe both together without seeing you for an appointment.

I really do not think your GP wants to force you to take contraception and obviously they cannot but they are required (legally in the case of valproate and tretinion) to get a signed disclaimer to say that you understand the risks, were offered contraception and declined and you accept any consequences. It really isn't too much to ask. The new MHRA valproate guidance came into force on 1st Jan this year only so possibly whatever NICE guidance you read could be out of date.

How do you know so much about what someone else's doctor prescribed and who to?

I didn't say she needed the pill! The OP said

"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".

My point was that if a woman is taking a particular drug for let's say 10 years, that's 10 years in which her eggs are being exposed to the drug. Sperm only lives for a few days. If a man is taking the same drug for 10 years, his sperm will only have a few days exposure to the drug. So sometimes things just aren't the same for men and women!

This. Women really are still seen as mere baby carriers at times.

Shall we imagine for a moment a scenario where a man cannot be prescribed a medication for his health because it might cause defects in a child he were to impregnate a baby carrier?

Just get prescribed the pill and don't take it

It's not sodium valporate, it's topiramate.

I don't know if you've seen but I've explained further down that my husband has spina bifida and my daughter has a congenital heart defect, so I'm well aware of the impact of birth defects, and really wouldn't do anything to risk it.
I know the GP isn't obligated to believe me, but please know I happily be abstinent for the rest of my life if it meant preventing another child going through the things my daughter and husband have been through.

FWIW my daughters heart defect wasn't caused by medication. It was bad luck.

If the neurologist is that bad then no wonder the GP doesn't want to prescribe on his say so. He probably knows what he's like and that he will not have fulfilled the requirements.

Can You agree to go on the pill and then just not take it? Presumably they don’t actually test to make sure you’re taking it so long as you pick up the prescription? Obviously a complete waste of nhs resources and you shouldn’t have to do it but that’s on the GP not on you.

So let them prescribe the pill and don't take it?

Definitely complain.

This is crazy. No prescriber is obliged to prescribe anything. Ever. You cannot demand a prescription and complain if you don't get it. Well I suppose you could try but you'll not get very far. A neurologist cannot tell another presciber what to prescribe. The only thing the GP is obliged to do, is act in your best interests. The only valid thing you can do op is request a meeting and explain why you believe prescribing is in your best interests, or change GP.

www.ema.europa.eu/en/news/prac-recommends-new-measures-avoid-topiramate-exposure-pregnancy

www.gov.uk/drug-safety-update/topiramate-topamax-start-of-safety-review-triggered-by-a-study-reporting-an-increased-risk-of-neurodevelopmental-disabilities-in-children-with-prenatal-exposure

Topiramate is about to be the new valproate
The GP is wise to require a disclaimer

I'm considering this if it means getting the medication that will stop hemiplegic migraines giving my horrific symptoms.
I don't want to waste NHS resources but I also don't want to live with debilitating migraines.

PS for those thinking this is a feminist issue valproate has just been restricted from prescription for men as well as women because of its teratogenic potential

Many women whose babies were harmed actually campaigned for more restrictions on valproate and saw it as a feminist issue that the differential impact on them was not acknowledged by male prescribers.

Damned if you do
Etc etc

He's willing to prescribe both at the same time without seeing me. The message I received said if I want the pill then contact the clinical pharmacist who will put through both prescriptions, or make an appointment to see the nurse and once the coil is in place my script will be issued. I just don't want to waste resources if I'm honest.

He's doing the right thing in not prescribing because her hasn't personally had the contraception and risk conversation with you

He has a duty to prescribe responsibly and that's what he's trying to do

He's said no to the pharmacy request - he hasn't said no never

You don't need to lie
You shouldn't lie
Just ask to sign a disclaimer

This is all well and good but as stated I'm not prescribed sodium valporate

And as I also showed you the links for very soon topiramate will have similar restrictions because the issues now being uncovered in studies are much the same

I mean I'm booked in, but I'd rather not live with debilitating Hemiplegic migraines for another 3 weeks.

Can't you just ask for an emergency appointment then? It doesn't have to be with your own GP. Any GP could authorise it and they probably would if there was a documented conversation about the risks

Nonsense. We don’t just get to demand what drugs we want to take.

it's a really difficult topic.

the issue is the continuity of care. nhs protocol for consultanscto hand over care back to gp without giving enough detail. or prescribing medicines that a gp can't prescribe.