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?

Yeah. GPs love patients who just think they are being bloody minded when they actually have genuine safety concerns. Makes us much more likely to go above and beyond for that patient next time......

Thank you all for your advice and different views. Especially those about the safety aspect. Now I'm less annoyed I do see where you're coming from.

I've been made aware a lot of this situation has been created by the neurologist as he should have done the paperwork, prescribed and stabilised etc. I wasn't aware of this prior to making this post. I've mentioned further up thread some of the previous issues I've had with this neurologist. I'm going to seek advice from PALs because the prescription issue isn't the first issue I've had. After thinking through all the issues I've had, I'm reconsidering whether I trust the prescription he's recommended. I'm actually moving to a different part of the country in a few weeks, so I'm considering asking to be referred up to what will be my new local hospital, and asking for a second opinion.

I've decided that I'm not going to write a complaint about the GP. However I am going to email the practice manager with some feedback about the approach of the GP and the one sided communication. I understand it's an approach that works for notifying patients prescriptions have been accepted, but I don't think it was a good approach for this specific situation or rejecting prescriptions in general. In my specific situation I do feel the refusal to prescribe should have been part of a wider conversation with me. Why don't I want those types of contraception, what other alternatives to this medication are there, Am I willing to sign a disclaimer expressing I understand etc.

I don't think it was fair to effectively send a text saying no contraception, no medication and then put me in a position where I have to wait weeks to follow this up with a GP. I do feel that it would be good for the GP surgery to know my feelings about what happened today, and be given the chance to change their approach. I will make it clear it is feedback and not a complaint.

Thank you again for sharing your views and letting me see different perspectives.

Great response OP, but this is mumsnet, you're not allowed to read the replies, digest them, and then use them to be completely reasonable and realise where the fault lies. that's not how this works!! ;-)

and I do agree the communication could have been better. I tend to just pick up the phone to the patient in situations like this.

I would just caution you that you're likely to wait a year for another opinion on the NHS......topiramate perfectly reasonable option for migraine

Yes it is, I tried the lower dosage and it didn't help at all. My symptoms are so bad I end up on the prescription dose of fexofenadine, prescription creams, inhalers, montelukast tablets and at least one course of steroids to control the symptoms. I do buy the other stuff like sprays and eye drops otc. It's purely the fexofenadine that was put on my records

I’m on Topiramate @Sconesandgravy. I couldn’t cope without it tbh. My migraines were absolutely horrendous and I had them almost everyday. I’ve been on it for around 10yrs or more, I’d say.

At no point have I been told never to get pregnant. I’m not planning to because my pelvis was severely damaged when I was pregnant with DS2, which had resulted in 8 major surgeries. My husband has had a vasectomy, too. I’m post menopause now, so that ship has sailed, but it’s strange how absolutely no one warned me.

On the subject of GPs being asked to prescribe medication by consultants - hospital specialists know a huge amount about a small range of conditions and drugs. GPs know a smaller amount about a huge range of conditions and drugs.

Many drugs have been around for ever, and all GPs will have experience of the risks, benefits, side effects etc. Newer drugs won’t be as well known. Or they might have been around a while, but only very recently been licensed for certain conditions.

GPs need to be confident that they can manage any problems that may arise after they prescribe a drug, and also that they have the expertise to defend themselves in court and justify their actions, if things go wrong.

If a GP refuses to prescribe a drug after a request from a consultant, it’ll be because their guidelines prohibit them doing it. Or because they don’t have the confidence or expertise.

You wouldn’t want the pilot of your Boeing 747 to be someone who’d only ever flown Cessna light aircraft would you!

I had a similar issue with meds prescribed by neurologist & gp.
Do any off tour apps let's have your neurologist direct / secretary's direct number or email? I called and she invited ne back in to squeeze me in between apps asked me exactly what had happened then spoke into something (don't know what they're called I'm tired) for her secretary to type up and send priority to my gp, she wiped the floor with them & told ne to complain to qcc. Never had a problem since, gp was so apologetic I almost felt guilty.
Definitely complain. Good luck x

sorryI'm half asleep

*do any of your appointment letters

I ideally need to transfer my care anyway as I'm moving 180 miles and the neurologist still has me on his books for follow ups (although he hasn't clarified how often). Part of my reluctance to take the medication is because of the issues I've had with the neurologist.

The other part is because I've had a lot of medical issues over the past year. When I was admitted to hospital after becoming unwell last week, the registrar who examined me said she thinks all my issues including the migraines are linked and referred me for a variety of tests.

I don't know whether it's worth delaying medication until all these tests are done or not, but I can't get advice from neurology as they take weeks to respond, and the GPs is so full I can't get an appointment until a week after the first lot of tests. When I asked the department that does the tests they said ask my GP so I'm none the wiser in that sense. I won't lie I do feel a tad frustrated 😔

They do, but the neurologists secretary isn't particularly helpful either. I have to email or call multiple times to get the bare minimum. When my symptoms worsened I had to threaten PALS after sending multiple videos of the issue before anyone responded to me. She wouldn't help with a prescription issue as she's very "what he says goes" x

Even for lesbians?!

Red herring my arse. It's her current situation. She can manage her own fertility whether her marriage ends or not. But for now, contraception isn't an issue because the man she sleeps with is incontrovertibly infertile. Which is enough reason not to make contraception a condition of prescribing the neuro medication she needs.

Why are some women happy to be patronised because they own a womb?

How much does the surgery make from patients who have the copper coil fitted by them?

They receive no money or government funding from abstinence or condoms.

Follow the money on this dictatorship of contraception.

You don't want to waste resources by taking the obvious go-around, but you do want to waste resources by making a complaint about the GP who is trying to follow guidelines?

Trust me no one has the time to do extra procedures that are not needed

half the time GPs struggle to get the essential things done

there is no conspiracy.

Hey OP - firstly, my sympathies. Hemiplegic migraines are fucking vile. The weird hemi paralysis that goes along with the migraine is horrible.

I was diagnosed about 15 years ago following neurological investigations including an MRI.

I’m asthmatic so my neuro didn’t want to try beta blockers. Have they tried those with you? I was actually prescribed a glaucoma drug that’s used off label for hemiplegic migraine. I took that for years and it really helped.

I’m now 48 and for the last 10 years or so my hemiplegic attacks have calmed down hugely. I don’t take any meds now - just pain relief when an attack strikes.

The attacks were horrific in my late 20s and through to my late 30s. They're incredibly disabling so I really feel for you.

I’ve had a complete brain blank and can’t remember the medication I used to take! 🤦🏻‍♀️ I was just thinking you could ask your neurologist about it as an alternative. My neuro was excellent, really on the ball- I don’t think this medication was widely used but it really worked. And quickly.

Secondly, long story but my partner collapsed two years ago with a neuro condition which causes severe migraines and dizziness. His neuro prescribed Topiramate for him about 6 months ago. As per PP, they do make him very zombified so it’s a bit of a balancing act.

Interestingly though, he wasn’t asked about his fertility, nor about contraception. The neuro didn’t know my age so I could easily have still been of childbearing age as DP is only 40.

I appreciate there would have been no way to foist contraception on a bloke, but if the risks are so high surely he should have been warned about getting me pregnant?! Nothing was said. Topiramate prescribed without a murmur.

Personally, I would challenge it via the practice manager. The GP is citing guidelines that don’t exist, leaving you in pain as a result. The neuro’s opinion normally takes precedence in these situations and you shouldn’t have to take hormonal medication - which have their own risks - that you don’t need just because the GP can’t employ some critical thinking.

I feel your frustration OP. I’m on a medication with similar side effects and the amount of grief I got from hospital, consultant, GP & nurses(currently single, for the foreseeable) about contraception. It felt really invasive. I don’t want to take contraception if I don’t need it. Luckily they gave it to me in the end but I almost agreed to take the script and just not take it just to make it stop. Which would be a total waste of funds

A positive story. DD is on topiramate and has definitely assisted migraine aspect considerably and had no side effects apart from some paresthesia which was easily solved by changing timing of taking tablets, so like every medicine, side effects are not universal for everyone.

Actually the funding for coils and implants is so miserly that many surgeries lose money on each fitting. We continue to do it for the benefit of our patients.

Yes but if it doesn't damage sperm then that would have been irrelevant.

Take the appointment in three weeks.

In the meantime write a letter to your GP explaining everything you have said here so there is a paper record.

In the letter say you accept the risk.

Yes this is the same at my surgery - stopped doing them a while ago as couldn’t finaciakly continue to offer the service

How can you lie about your contraceptive plans? If highly effective contraception = coil or implant? Not sure a GP is going to believe that