A practice in the Hinckley and Bosworth area

4. Mrs E complains about the following aspects of care and treatment she received from the Practice in February 2025. Specifically, Mrs E says the Practice:

• Failed to prescribe Hormone Replacement Therapy (HRT) • The GP was unprofessional during a consultation in February 2025 and • The Practice took nine weeks to respond to her letter of complaint.

5. Mrs E says her health and wellbeing have been negatively impacted as a result of the Practice’s decision. This in turn has impacted her mental health and ability to interact as she typically would in both work and social situations.

6. Mrs E says she went without the new dosage of HRT for five weeks while waiting for her consultant’s response.

7. Mrs E says she must now drive 30 minutes on a regular basis to collect this medication from the hospital’s pharmacy.

8. Mrs E found the comments made by the GP during a consultation to be dismissive and disrespectful. This was particularly upsetting for Mrs E given her medical history.

9. Mrs E would like the Practice to reconsider its decision and provide evidence of service improvements.

10. Mrs E complains about the Practice’s refusal to prescribe her the recommended dosage of Hormone replacement therapy (HRT) as advised by her specialist gynaecological consultant. HRT is a treatment used to help menopause symptoms. It replaces the hormones oestrogen and progesterone, which fall to low levels as you approach the menopause.

11. Mrs E has been under the care of a specialist gynaecological consultant for several years, receiving treatment throughout her IVF and fertility procedures. Mrs E says her consultant recommended an additional pump of Oestrogel alongside Elleste Solo 2mg tablets to support her as she experienced surgically induced menopause.

12. Oestrogel is a form of (HRT) containing used to treat menopause symptoms like hot flushes and vaginal dryness, and to prevent osteoporosis. Elleste Solo 2mg is a hormone replacement therapy (HRT) tablet used to treat postmenopausal symptoms like hot flushes, night sweats, and vaginal dryness.

Failure to Prescribe

16. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

17. Mrs E complains the Practice refused to prescribe an additional pump of Oestrogel alongside Elleste Solo 2mg tablets as recommended by her specialist gynaecological consultant.

18. In its response, the Practice explained the dosage recommended is an off-licence dose. This dose exceeds the recommended dosage to be prescribed. The Practice expressed concern regarding the safety for doses that are higher than the licenced dose.

19. The Practice recommended Mrs E’s gynaecological consultant, who has specialist expertise, was best placed to prescribe this medication. Consequently, it referred the prescription back to her consultant.

20. Under these circumstances, the Practice’s decision to refuse to prescribe the medication is in line with NHS England Guidelines on Responsibility for Prescribing between Primary & Secondary/Tertiary Care (Published: January 2018). These guidelines set out the responsibility of care and treatment of patients between the primary and secondary care settings. Section 4.1.2 states;

‘It is of the utmost importance that the GP feels clinically competent to prescribe the necessary medicines’

‘If the GP considers him- or herself unable to take on this responsibility, then this should be discussed between the relevant parties so that additional information or support can be made available, or alternative arrangements made’.

21. Further, the General Medical Council Guidelines on Good practice in proposing, prescribing, providing and managing medicines and devices, Shared care states in section 81,

‘If you are uncertain about your competence to take responsibility for the patient’s continuing care, you should ask for further information or advice from the clinician who is sharing care responsibilities or from another experienced colleague. If you are still not satisfied, you should explain this to the other clinician, and to the patient, and make appropriate arrangements for their continuing care’.

22. According to these guidelines, if the Practice lacks confidence in prescribing the recommended dosage, they are advised to communicate this concern to both the specialist consultant and the patient. Furthermore, the Practice should ensure that the patient receives continuous care and obtains the necessary medication from an alternative appropriate provider.

23. The Practice acted in accordance with the appropriate guidelines as it clearly communicated with both Mrs E and her specialist gynaecological consultant, setting out its concerns and reasons for not prescribing the dosage as recommended. It communicated the reasons for its decision and went on to identify the risks with prescribing this specific medication. Owing to the Practice's lack of specialisation and concerns regarding the safety risks of off-licence dosing, the clinicians did not feel confident prescribing the medication. According to established guidelines, Practices are advised not to prescribe medication if they lack sufficient confidence to do so. Therefore, we find that the Practice has acted appropriately and in accordance with relevant guidelines.

24. The Practice provided continuity of care by having Mrs E’s specialist gynaecological consultant prescribe her medication directly.

25. For reasons set out above, we do not consider there are any indications of a service failure in relation to this aspect of Mrs E’s complaint.

Unprofessional Behaviour

26. Mrs E complains the GP made disrespectful and dismissive comments during a consultation in February 2025. Mrs E states the GP said, ‘I know I am a woman too’ in relation to Mrs E’s feelings regarding her treatment. Mrs E found this comment to be insulting and disrespectful given the years of IVF and fertility treatment she had undergone.

27. In its response, the Practice acknowledged the comment made to Mrs E regarding being ‘a woman too’ and can appreciate the distress this may have caused. The Practice explained it was attempting to convey sympathy for Mrs E’s situation through this comment and apologised for the distress this has caused. The GP has considered Mrs E’s feedback and endeavours to improve on this moving forwards.

28. We consider the approach taken by the Practice is in line with the Ombudsman’s Principles of Good Complaint Handling and the Ombudsman’s Principles for Remedy. These Principles explain that providing fair and proportionate remedies is an integral part of good complaint handling, and a public body has failed to get things right and this has led to an injustice, it should take steps to put things right.

29. Appropriate remedies can include apologies, remedial action, and financial remedies, and in addition to this, public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement.

30. The Practice has acknowledged that the comments will have caused distress and has explained what actions it has taken to address this so that service will be improved in the future. We consider this is a fair and proportionate remedy in line with the Ombudsman’s Principles of Good Complaint Handling and for Remedy.

Complaint Response Delay

31. Mrs E complains the Practice took nine weeks to respond to her complaint. Mrs E submitted her complaint to the Practice on 6 February 2025. The Practice sent its first response to the complaint on 10 March 2025. The Practice sent the final response on 10 April 2025.

32. In its response, the Practice acknowledged delays with the complaint response. The Practice’s complaints policy aims for complaints to be responded to within 28 working days. However, the complaints policy also states that where clinical input is required to fulfil a response, the timeframe may be extended.

33. The Practices first response on 10 March 2025 was 32 days after Mrs E’s initial complaint.

34. To address Mrs E’s complaint, the Practice sought clinical input. Between the complaint and the response on 10 March 2025, the Practice communicated with Mrs E’s specialist consultant, confirming the need for clinical guidance. This response period aligns with the Practice’s complaints procedure.

35. Mrs E’s complaint was reviewed during a clinical governance meeting at the Practice on 13 March 2025. At this session, her concerns were addressed, and the Practice evaluated their care and treatment approach. This discussion, together with insights from a clinical meeting held on 12 March 2025, contributed to the final written response to Mrs E’s complaint.

36. We do not consider there are any indications of a service failure in relation to this aspect of Mrs E’s complaint.

37. We acknowledge there was a delay in providing the final response, and we recognise how frustrating that must have been. For reasons set out above we consider the Practice followed its relevant policies to deliver a comprehensive response to Mrs E’s concerns, including seeking appropriate clinical input.

1. We have carefully considered Mrs E’s complaint about the Practice. We were sorry to hear how she has been affected. It is clear she had a difficult and upsetting experience, and understandably, she would like to ensure this does not happen again.

2. There are elements of her complaint where we have not seen any indications that things went wrong. This means that from the evidence we have considered, it appears that the Practice provided appropriate care and treatment to Mrs E.

3. Where we have identified indications of service failure in relation to some aspects of Mrs E’s complaint, we have carefully considered the impact this had, and we have considered whether there is more we would expect the Practice to do to put things right. Our view is the Practice has taken proportionate action to remedy the concerns Mrs E has raised, and that this had no notable impact on her care and treatment.