13. 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.
Eye medication prescription requests
14. Mrs N has told us the Practice consistently missed items off her prescription. Mrs N told us this left her without Ikervis over a period in September and made her eye health worse.
15. Mrs N told us every time she made a paper request she would request every medication available on repeat. On Mrs N’s GP record, we can see the requests documented on the system mostly line up with what is prescribed, either the same day or the day after.
16. It is possible if there was a consistent difference between what Mrs N tells us she was requesting and what she was receiving then items may have been missed in translating the paper requests to the online request system.
17. The Practice have told us they only hold the original copies of paper repeat prescription requests for two weeks before shredding them. Mrs N told us she only began taking pictures of her requests once she realised there was a consistent issue, meaning she has not been able to supply us with evidence of what she requested during this complaint period.
18. Without the evidence of what Mrs N says she requested, it is difficult to decide based on the balance of probabilities whether the Practice consistently failed to process and respond to paper prescription requests. This is not to say we disbelieve Mrs N’s account of what happened.
19. There is one instance where a request is documented in early September for Ikervis which does not seem to be actioned until another request for Ikervis is made a week later. Mrs N told us the impact of this missed request meant she was unable to pick up her prescription before she went away on holiday, meaning she went a longer period without the Ikervis.
20. The Practice has agreed there was a period in September where Mrs N was left without Ikervis. The Practice said it was possible the Practice failed to process this request properly. The Practice apologised if this was the case and ensured its admin staff would be further trained in the importance of properly taking down information from paper repeat requests.
21. We do note there is a record from early September where the Emergency Department noted Mrs N had reported she had stopped using Ikervis because her eyes were crusting a lot. The Emergency Department encouraged Mrs N to restart Ikervis.
22. The possible effects from stopping Ikervis include uncontrolled inflammation in the eye which could lead to impaired vision. We have not seen evidence to suggest Mrs N’s eye health significantly worsened because of this short period without Ikervis. Mrs N had eye surgery scheduled for late September and there is no information to suggest her eye health was any worse, or to suggest she required any further medical intervention as a result of this period without Ikervis.
23. As we cannot see a clear clinical impact from the one documented missed request, it is not proportionate for us to investigate this issue further when the Practice has already apologised and proposed actions to improve the process.
24. We appreciate Mrs N is certain the prescription issues extended beyond this one event. We are unable to make a judgement based on the lack of information about what Mrs N requested compared to what was provided. We will therefore be taking no further action on this part of the complaint.
Hylo-Forte changed to Eyeaze
25. A letter from the Opthamologist prescribed Hylo-Forte 0.2% from late April 2024. Hylo-Forte’s main ingredient to treat dry eyes is sodium hyaluronate (a naturally occurring chemical in the body found in connective tissues), and 0.2 means 1ml of Hylo-Forte contains 2mg on sodium hyaluronate.
26. Eyeaze also contains 0.2% sodium hyaluronate as the main active ingredient.
27. Although the additional ingredients differ slightly, both prescriptions contain sodium hyaluronate in the same levels. These are essentially the same medication.
28. The BNF guidance for sodium hyaluronate shows Hylo-Forte 0.2% costs the NHS £9.50 and Eyeaze 0.2% costs the NHS £4.15.
29. The BMA guidance on prescribing in general practice explains if medications are changed to a less expensive medication, the change must be done in the patient’s best interests and this change must be fully explained to the patient.
30. We cannot see any documented conversations with Mrs N about changing the prescription to a cheaper alternative until Mrs N raised her concerns.
31. The Practice did explain in its complaint response Eyeaze is an accepted alternative for Hylo-Forte. It is possible discussing this with Mrs N when the decision to change medication was made may have provided Mrs N with more clarity.
32. We do note the Practice did change the prescription back to Hylo-Forte when Mrs N requested and also refunded her £20 for the previous Eyeaze prescriptions. We consider this put right the impact on any lack of discussion and communication with Mrs N about the prescription change.
33. We will therefore be taking no further action.
Dermatology creams
34. We can see Mrs N had an appointment with a hospital dermatology department in mid-November 2024. The outcome of this appointment was a diagnosis of psoriasis and a request to the GP to place Doublebase gel and Enstilar foam on repeat prescription.
35. This letter is dated late December 2024, suggesting it was not sent to the Practice immediately. This is supported by the Practice’s response apologising for the delay in the Practice receiving the dermatology letter.
36. In mid-January Mrs N told us she requested Betnovate, Doublebase and Enstilar foam. We can see a message was sent from the Practice mid-January asking Mrs N to contact the surgery to gain a prescription for the topical treatments (creams) she had requested.
37. A week later the Practice made two call attempts to Mrs N and sent a message asking her to contact the surgery. The next day Mrs N had an appointment where a GP placed the Zerobase (a similar cream) and Enstilar foam on repeat prescription as per the dermatology letter. It appears before this appointment the Practice had not seen or considered the dermatology letter which had been sent to it.
38. The dermatology letter did not ask the Practice to prescribe Betnovate. The GMC good practice in prescribing guidelines state if you prescribe based on the recommendation of another healthcare professional you must be satisfied the prescription is needed, appropriate, within the limits of professional competence, and that there is enough information to safely prescribe. Based on this, we would not expect the Practice to prescribe Betnovate on request when the dermatology letter did not ask the GP to prescribe it.
39. It is also noted Mrs N had tried Betnovate previously after a prescription from the Practice in May 2024 but had found no benefit so it was stopped. This would be evidence to suggest to the Practice prescribing Betnovate when requested in January may not be appropriate for Mrs N.
40. From the records available, the delay between Mrs N requesting the creams and being given the prescription is around one week. We cannot see any evidence Mrs N requested these creams any earlier.
41. We appreciate this delay will have been frustrating, especially in the context of the other issues Mrs N was raising with the Practice at the time.
42. We do note the Practice apologised for the delay in receiving the hospital letter with the prescription details. The skin condition did not appear to be severe and it is unlikely Mrs N will have experienced any clinical harm from this week delay. Based on our principles of remedy, we would consider an apology alone as sufficient for a minor delay.
43. We therefore consider the Practice has already appropriately remedied any injustice resulting from the short delay with the dermatology creams.
44. We thank Mrs N for brining this complaint to us.