陆船。

This reminds me of the Call of Duty Black Ops edition Jeep on the road the other day. Felt completely surreal.

Or would that seem too complaining/combative/passive aggressive?

I would leave that out and not because of the tone of the additional information. The letter and its concerns are medical. I would keep it that way for now. You can bring other factors and circumstances in as appropriate if a back-and-forth correspondence develops. As written, your first letter is really concise and a strong plea. Don’t attach awkward bits and bobs to your aerodynamic masterpiece, they’ll just introduce drag. Less is more sometimes.

Looks great! Small copy paste correction before you send it off.

I also previously wrote to the surgery about my topiramate prescription but have not received they have not responded.

I also previously wrote to the surgery about my topiramate prescription but they have not responded.

Don’t overcomplicate it. You’ve already stated you don’t expect to become pregnant in the preceding sentences. The bone you’re throwing them in their twisted bureaucrat minds is that you understand the risks of not taking contraceptives while on this medication. Something simple like, “I acknowledge and accept the increased risk of autism and ADHD of children who might be conceived while taking this medication.”

Really good overall. A few nits.

I am unsure whether this is an oversight or intentional.

I would cut this. It doesn’t add much value to speculate the cause of the cut and disrupts the flow of the strong argument you follow it up with.

I have also previously written to the surgery about my rimegapant prescription, but have received no response.

I would switch to active voice here. Try “I have also previously written to the surgery about my rimegapant prescription, but they have not responded to me.”

However as the GP surgery won’t prescribe more than 8 tablets a month, I am unable to take it daily as a preventative, and so still suffer migraines.

You can use fewer words for the same effect here and I think make this train of thought a bit smoother. “The GP won’t prescribe more than 8 tablets per month, which is insufficient for use as a daily preventative.” I think you also remove the following clause of that sentence regarding how you still suffer migraines

and so still suffer migraines.

since the next sentence, (I’ve quoted w/ some suggested changes)

I suffer from migraine with aura which doubles the risk of stroke,

beautifully connects the consequences of lacking an effective daily preventative to take and states the risk to you.

They do usually work for me by ending a migraine

I would cut usually, it’s a “weasel word”.

topiramate prescription but have not received any response.

Another chance to flip passive to active voice. “… but they have not responded to me.”

Maybe as the penultimate sentence in your final paragraph acknowledge the risks to whatever unborn child the NHS is prioritizing above you, the patient. I hate it but it’ll hopefully push the patient has given informed consent button in the recipient’s mind.

What the lack of the soap substitute does, is mean that I have to use normal soap, which flares the eczema up badly again and then it gets infected again.

You’ve nailed the cause-effect-outcome writing style, nice!

I was going to use the cost of this as a reason why they should keep prescribing me the cream - it must be expensive for the NHS to keep admitting someone to hospital - what do you think?

You’re probably right, it is cheaper to give you 2x the $20 cream than $20 cream + a hospital visit and associated follow-up but imo that detracts from the focus of your healthcare outcomes. If you elect to follow my advice to ignore costs in your appeal, then noting the comparative cost to the NHS doesn’t align with that line of reasoning.

I don’t have any real proof that this is why they’re doing it though.

I misunderstood, I thought thought the GP and pharmacist were aligned on the cost being problematic. But I would probably still avoid discussion costs. The comparative cost of giving you adequate supplies vs the cost of a potential hospital stay multiplied odds that, for example, the eczema flares up and becomes infected gives you an expected value to compare costs. And you might have noticed these are hard to quantify even if you had pricing info and it takes the argument to a weird what-if place where you probably won’t win against a doctor.

Your metaphorical high ground is the higher allocation of pills and supplies has better outcomes for you and mitigates specific health risks of yours. You want to stay within that as much as possible.

In any kind of persuasive writing like this I would focus on facts and outcomes. The formula is generally linking cause and effect back to the previous prescriptions you had. You don’t want to use “weasel words” or suggest that you feel the previous prescribed amount was more effective. You want to assert that it was and this downgrade has risks to your health, pointing out the causal relationships between what the medicine does for you and its absence aggravating another condition.

So for example,

My previous rx was 1/day of $medication for migraine prevention. This regimen worked to prevent migraines which cause me $xyz and aggravate my $abc.

Same goes for the soap. You link to your surgical wounds and the risk of infection if you can’t adequately bathe as a factual cause-effect chain and need.

I would leave the emotive parts out. If you have a back-and-forth correspondence with the GP and have exhausted the evidence-based reason these cuts are detrimental to your health then you can use an emotional appeal. I would also leave out the pharmacist and avoid acknowledging the cost. The cost is the argumentative lever they are using to degrade your supplies and you don’t want to give it any merit in your appeal.

Feel free to post a draft here or dm, and I can offer more concrete feedback.