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Pharmacy white paper - Fight for dispensing GPs' survival

Dispensing practices are at risk from DoH plans for pharmacies, says the DDA's Dr David Baker.

Dr David Baker
Dr David Baker

In her introduction to the White Paper 'Pharmacy in England, Building on strengths - delivering the future', health minister Dawn Primarolo gives no hint of the turmoil it will cause for those who deliver medical services in rural areas of England.

The White Paper will, if it were to be implemented unchanged, spell the end of dispensing practice in England in all but the most rural and isolated areas.

It could have been written by a pharmacy chain's PR company, so glowing are the tributes and hype surrounding all that pharmacists can and will do in the future.

Clinical aspects
Pharmacists are urged to rely less on dispensing and more on clinical aspects of their work.

Under the plan they will offer minor ailment schemes, management of long-term conditions, vascular screening, blood testing, vaccinations, and even Choose and Book in addition to their current main task of advising on the use, and dispensing of, medicines.

But it will be a long time before the infrastructure in terms of buildings and training is in place to support the proposed changes and the paper is more than a little vague on where the financial resources for implementation are to come from.

PCTs will be directed to commission these additional services along the lines of the GMS enhanced services but the paper does not say where they will find the money.

Control of entry
The concern to dispensing doctors is the proposal to change the 'control of entry' regulations from the current criteria of rurality and distance of patients' home to nearest pharmacy, to a single criterion of distance between surgery and pharmacy.

This potentially devastating proposal is in a part of the paper which is more 'green' than 'white', so further consultation will happen.

But the intention is distressingly clear; dispensing by doctors will cease except in the most isolated areas.

If the policies were to be implemented unchanged, more than 3.5 million dispensing patients would lose their right to choose to have their medicines dispensed directly by their doctor; rural practice would be destabilised and thousands of dispensers would lose their jobs.

The vast majority of dispensing practices, who already run a mixed economy of prescribing and dispensing patients, will at a stroke find themselves forbidden to offer this service to their more rural patients.

The more rural practices are not really protected either. If a practice has a list size of more than 2,500-3,000 patients in total and no pharmacy within 1.6km of their premises they will now be vulnerable to pharmacy applications.

Pharmacy threats
Indeed, well before the publication of the White Paper, one pharmacy chain had already put in apparently unviable applications in scores of locations across the country; nearly all of these would become viable if the changes happen.

It is therefore tempting to think they had some prior knowledge of the proposals.

There is only one crumb of comfort in the paper. Those very few practices that meet the new criterion and continue to dispense will be permitted to dispense for their entire list and will be able to sell OTC drugs to their patients.

The DDA has in recent years tried to foster joint working with pharmacy and to bring stability to the delivery of rural practice. We have no problem working in partnership with pharmacists to deliver the best possible dispensing service to our patients but this must not be at the expense of a reduction in medical services.

Integrated service
Most practices that could viably provide an integrated, under-one-roof service with pharmacy have already done so; those that have not, but could, would be well advised to explore the possibility now.

We should like to develop more innovative ways of joint working rather than the blanket all or nothing approach suggested in the paper; current regulations governing pharmacists such as those on delegation and the physical presence of the pharmacist at all times, tend to make it difficult to continue to give the same level of timely service to our patients when a dispensing practice is led by a pharmacist rather than a doctor.

The one-stop service we currently provide for our patients is safe, efficient, cost-effective and hugely appreciated. To replace it with a two-stop, less integrated service is not in our minds either necessary or sensible and will certainly alienate the majority of the 3.5 million rural voters who will lose their right to choose.

It is also vital that politicians are aware of the effect these changes could have and we urge all dispensing doctors to let their MP know how their practice would be affected should the proposals be implemented unchanged.

Dr Baker is the chief executive officer of the DDA and a GP in Lincolnshire.

What the White Paper Proposes

Pharmacy providers will, in time:

  • Become 'healthy living' centres - promoting health and helping more people to take care of themselves.
  • Offer NHS treatment for many minor ailments (for example, coughs, colds, stomach problems) for people who do not need to go to their GP.
  • Provide specific support for people who are starting out on a new course of treatment for long-term conditions such as high BP or high cholesterol.
  • Offer screening for those at risk of vascular disease - an area where there are significant variations in access to services and life expectancy around the country.
  • Use new technologies to expand choice and improve care in hospitals and the community, with a greater focus on research.
  • Be commissioned according to the range and quality of services they deliver.

The DDA is the only organisation that ensures the views of dispensing practices are heard by the government and key negotiating bodies. We also provide telephone advice to members and essential updated information via our website, and email alerts. To find out more call Jeff Lee on (01751) 430835 or visit www.dispensingdoctor.org

The DDA does not necessarily support or endorse the opinions or information contained on this page.

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