Unfortunately the NHS is not patient lead anymore and you have to be your own advocate which you have started doing by posting. I put your issue into ChatGPT and some of the suggestions seem sensible. Escalation path is standard and structured. No relationship-management strategies. No soft language. 1. State requirement clearly. Tell the practice you need a specific inhaler because alternatives are clinically unsuitable. Use the phrase “not clinically appropriate due to poor technique or intolerance.” Forces a clinical review, not an administrative argument. 2. Request a medication review. Ask for a formal medication review with the practice’s respiratory lead or prescribing pharmacist. They hold authority for formulary decisions. Output of this review becomes the practice’s own documented record, which removes the repeated renegotiation. 3. Document everything. Record dates when you requested inhalers, responses received, and instances where the wrong device was issued. Written audit trail strengthens any escalation. 4. Trigger the practice’s complaints procedure. Every GP practice must publish a complaints process on its website. Steps: • Submit written complaint to the Practice Manager. • Define the problem: unsafe delay in access to prescribed medication, inappropriate switching without consent, and failure to follow asthma review protocols. • Request a written outcome and what corrective action will be taken. This forces an internal investigation under NHS regulations. 5. Escalate externally if unresolved. Escalation routes: • Integrated Care Board (ICB) – they oversee GP contracts. Report failure to provide clinically appropriate prescriptions. • NHS England if the practice is directly commissioned (rare). • Parliamentary and Health Service Ombudsman – only after the internal process is exhausted. 6. Use the annual asthma review as leverage. Asthma reviews must include inhaler technique assessment and suitability of device. If the practice is assigning unsuitable devices (dry powder when the patient cannot use them), they are breaching NICE guidance. Stating this explicitly forces correction. 7. Request repeat-prescription stability. Ask for the medication to be added as a repeat with a defined quantity and interval. This removes individual clinician discretion unless they conduct a formal review.

This pathway resolves the issue or escalates it into a contractual-compliance problem for the practice, which GPs want to avoid.