A practice in the Dorset area

3. Miss K complains the Practice:

• are no longer willing to prescribe her HRT prescription, • and did not properly communicate their decision to end her HRT prescription.

4. Miss K says she is left without her NHS prescription which has been essential to her physical and psychological wellbeing for the past 6 years. Miss K said she is upset and angry about there being no explanation about why her prescription ended. Miss K said she was shocked by how she was treated and had to leave the Practice and join a new practice.

5. As an outcome, Miss K would like an apology, service improvements, a review of the Practice’s policies and procedures, and for the Practice to look again at their decision to end her prescription.

6. Miss K was on an HRT regime for 6 years overseen in a Joint Care Agreement by the Practice and a private clinic (the Clinic) specialising in women’s hormone health.

7. Miss K says on 19 February 2025 a clinician at the Practice said her prescription would or wouldn't be continuing depending on the results of her upcoming endometrial scan on 11 April 2025.

8. On 10 March 2025, Miss K received an email from her specialist at the Clinic explaining her NHS prescription was going to be withdrawn. The specialist said her GP surgery had emailed the Clinic asking it to take over her prescription.

9. On 28 March 2025, Miss K’s GP surgery telephoned her to inform her it would no longer issue her NHS prescription. It explained the prescription would be withdrawn at the end of April.

Ending of HRT prescription

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. We have done this and have not found any indications something went wrong.

14. Miss K specifically complains the Practice are no longer willing to prescribe her HRT prescription.

15. The Practice prescribed Miss K with an unlicensed HRT regime of 250 estradot, 150mg desogestrel, and 25mg testosterone.

16. On 19 February 2025, the Practice told Miss K her prescription would or wouldn't be continuing depending on the results of her upcoming endometrial scan on 11 April 2025.

17. On 10 March 2025, Miss K received an email from the Clinic informing her that her NHS prescription was going to be withdrawn. The Clinic said the Practice had emailed it, asking it to take over her prescription.

18. Miss K said the endometrial scan showed her endometrial lining was healthy measuring at 1.6mm.

19. Miss K considers the Practice should have continued to prescribe her HRT prescription.

20. The Practice’s complaint response dated 25 March 2025, stated it was concerned Miss K’s oestrogen supplements were above the normal levels it would ever prescribe and were concerned about evidence of endometrial hyperplasia. This is when the lining of the uterus/womb becomes excessively thick. This is not cancer but can lead to cancer of the lining of uterus (endometrial cancer) in some women.

21. BMA guidance states the GP signing the prescription is legally liable for the prescribing and the consequent effects of the drug. Where a GP considers it is inappropriate for them to issue a prescription on the advice of a third party they may refuse.

22. Our adviser confirmed the doses being prescribed where higher than those described in the BNF and would not be prescribed by a GP.

23. We can see the Practice were no longer willing to prescribe HRT to Miss K as it was concerned about the high doses. We can see the Practice acted in line with BMA guidance when the Practice stopped prescribing as it was not prepared to take the risk that comes with prescribing.

24. Our adviser said the GP’s rationale to end Miss K’s HRT regime was reasonable. According to NICE clinical guidance on HRT, there are many risks associated with HRT, including the risk of developing cancer, which the Practice referred to in their concerns for prescribing the HRT regime in this case.

25. We understand Miss K’s concerns about the Practice ending her HRT prescription. We have carefully considered the Practice’s account, the medical records, and clinical advice. We have not seen any indications of failings and will therefore not take any further action on this part of the complaint.

Communication

26. Miss K complains about how the Practice communicated its decision to end her HRT prescription. Specifically, Miss K complains she is unhappy with how she was treated. Miss K tells us that the decision to end her prescription was an abrupt and a sudden change with no explanation, making her feel that she was disregarded.

27. In its complaint response dated 25 March 2025, the Practice said it was sorry Miss K felt they acted unprofessionally and did not give a proper explanation of their actions. The Practice stated it was acting in Miss K’s best interests and must ensure it is prescribing responsibly and safely within NHS constraints. The Practice said it must be cautious on prescribing on a Shared Care basis for conditions that fall outside of GP expertise, namely prescribing above recommended limits of HRT.

28. GMC guidance states the exchange of information between medical professionals and patients is central to good decision making and that doctors must give patients the information they want or need in a way they can understand. This includes information about:

• their condition(s), likely progression, and any uncertainties about diagnosis and prognosis • the options for treating or managing the condition(s), including the option to take no action • the potential benefits, risks of harm, uncertainties about, and likelihood of success for each option.

Miss K’s medical records show she was contacted by the Practice on 28 March 2025 about the ending of her prescription. The medical records detail Miss K was told the Practice was concerned about the risks of uterine and breast cancer, and the risk of blood clots.

29. Miss K’s medical records also show there were consultations with Miss K and the Practice on 19 February 2025 and 25 March 2025 where the Practice raised their concerns about the high dosage of Miss K’s HRT regime.

30. This evidence shows the Practice followed GMC guidance as they discussed information such as Miss K’s condition, her HRT regime, and the risks of harm and uncertainties about her prescription. We have not seen any indication of a failing in how the Practice communicated to Miss K it was ending her HRT prescription.

31. We are very sorry to hear how distressing this time was for Miss K. We hope our decision provides Miss K with assurance about her care.

1. We have carefully considered Miss K’s complaint about the Practice. We are sorry to hear about the very difficult time Miss K has clearly experienced as a result of the Practice stopping her Hormone Replacement Therapy (HRT) medication. We would like to thank Miss K for sharing the details of her concerns. We know this has been distressing for her.

2. We have carefully considered Miss K’s complaint about the Practice. Having done so, we cannot investigate this complaint further. This is because based on the evidence available to us, we have not found any indications of failings in the Practice’s decision to end Miss K’s HRT prescription. We have also found no failings in how the Practice communicated their decision to end Miss K’s HRT prescription.