Lack of follow-up following prescription of HRT patches
22. 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.
23. Miss R told us the Practice did not offer her any follow up appointments, or review her blood pressure after she was prescribed HRT patches.
24. Our adviser explained that following a new or a changed prescription of HRT, patients should be offered a follow-up appointment at around three months after the prescription.
25. The NICE guidelines explain this by saying that the Practice should “arrange to review the woman after 3 months if HRT has been started or changed.” The NICE guidelines do not mention blood pressure tests specifically. Our adviser explained blood pressure is not checked as part of the standard follow up care after prescription of HRT.
26. Miss R’s medical records show the Practice prescribed the Femseven HRT patches on 15 March 2023. On 16 and 17 May 2023 the Practice called Miss R to say she needed a appointment for review of her HRT patches.
27. In the 17 May 2023 telephone consultation (two months after the initial prescription of HRT) Miss R explained that the Femseven patches seemed to be working well, however she was having a reaction to the patches on her skin. The Practice advised her that she should contact a pharmacy about this.
28. On 2 June 2023 (two and a half months after the initial prescription) Miss R contacted the Practice asking if she could change the brand of HRT patches that she was on. The Practice agreed to this and she changed to Evorel Sequi patches.
29. In summary, we are sorry that Miss R had a difficult time while she was on HRT patches. The Practice acted in line with the relevant NICE guidelines in offering her a review appointment two months after the prescription of the patches. For this reason, we have decided to take no further action regarding this part of the complaint.
The Practice did not offer Miss R a change in medication
30. Miss R explained that she told the Practice of the multiple side effects she was having from Femseven and Evorel Sequi patches and they did not offer her a change in medication.
31. Our adviser explained that the Practice were correct to not automatically offer Miss R a change in medication.
32. We can see from the medical records that Miss R contacted the Practice on 18 August 2023 and discussed the negative side effects that she was having. These included “thinning of hair and nails and alopecia patches on scalp”. Miss R explained that this was making her distressed.
33. At this same consultation Miss R expressed that she would like to be prescribed the contraceptive pill that she was taking previously instead of the HRT patches.
34. The Practice explained that it was not happy to prescribe her the contraceptive pill due to her age and a history of smoking. It explained that they would refer Miss R to gynaecology for a further review.
35. Our adviser referenced the guidance for contraceptive use. It says both smoking, and being aged over 35 are risk factors for complications in patients taking the oral contraceptive pill.
36. The Practice were correct to refer Miss R to gynaecology for further advice before prescribing her the oral contraceptive pill. This is because Miss R was over 35 and had a history of smoking. This meant the risk factor was too high for her to be prescribed the contraceptive pill routinely through her GP.
The Practice were difficult to get hold of via phone, meaning Miss R struggled to get appointments
37. We are sorry that Miss R found it difficult to get an appointment with the Practice.
38. Miss R explained that the Practice were very difficult to get in contact with. She described long hold times on the phone.
39. She explained that because of this, she found it difficult to get in contact with the Practice to discuss her medication issues. She said that this lack of contact contributed to her taking an overdose.
40. When we look into complaint components, we need to consider if they can be linked to the claimed impact.
41. Miss R’s records from 27 August 2023 show she attended A&E after an ‘impulsive and intentional overdose’. These records mention various factors from her past which may have led to the overdose. The records also show the change in hormone from the HRT patches may have been a trigger.
42. Miss R’s records show she had a number of appointments and contacts with the Practice throughout August 2023. The first of those was due to be on 8 August but Miss R did not attend. The records show the Practice sent text reminders on 4 and 7 August.
43. On 18 August, Miss R had a telephone appointment with the Practice and discussed the combined oral contraceptive pill which she expressed her wish to return to. The Practice referred her to gynaecology as the GP was not comfortable to prescribe the pill, given Miss R’s risk factors. We have already established this was the correct course of action.
44. The next contact with the Practice was the information received from A&E following the overdose.
45. We recognise that Miss R wanted to seek help with her mental health issues at the Practice and wished to change her hormone medication from HRT patches to the contraceptive pill. We can see she had an appointment and discussed those issues and the Practice then referred her to a gynaecology specialist clinic.
46. We acknowledge Miss R says there were occasions she was on hold for long periods and unable to get through. We cannot link Miss R’s overdose to failings at the Practice, which meant she could not contact them when she wished.
47. We appreciate the difficult experiences Miss R has had while under the care of the Practice.
48. We have not seen any failings in the care the treatment provided. They acted appropriately in referring Miss R to gynaecology for further review and followed the appropriate NICE guidance in the level of follow-up they gave her after the prescription of HRT patches. For that reason we will not consider this complaint further.