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Pharmacy White Paper - The future for Scottish dispensers

Scottish practices face erosion but are fighting to protect services, writes Dr Iain McLean.

Dispensing north of the Esk/Tweed line has been undertaken by GPs for generations.

Located in rural areas with few retail businesses, these comprehensive one-stop care centres pre-date the NHS and the authors of its latest reforms.

It is frustrating that such an effective and proven service is under threat of erosion, not due to cost issues (dispensing surgeries are the best value option) but as a result of apparent prejudice, indifference and ignorance on behalf of decision makers

Scotland’s dispensing doctors are developing a co-ordinated view to defend their profession

Dispensing doctors
There are 276 dispensing doctors in Scotland in 130 practices. Most are in the Highlands, northern Isles, Ayrshire and Arran and the southern regions.

Location is determined by distance to other services and not based on controlled areas.

More than 300,000 patients use these practices and 4 per cent of prescription items are dispensed by them.

Traditionally, they cater for older populations and cover large geographical areas with less accessible services and transport.

These practices offer general medical services of high quality plus emergency and out-of-hours services, minor surgery and trauma treatment plus work often associated with secondary care.

A dispensing friend was recently asked by a holidaying physician where he could find the nearest eye trauma centre. The latter was amazed in equal measure by the distance he quoted and by my friend's ability to manage his condition.

Effect of the White Paper
Throughout the UK we are having to fight to keep dispensing services.

Scottish dispensing practices may not have been facing the potential 'Armageddon' that threatened their English counterparts in the form of the Pharmacy White Paper, but there are common issues and concerns that affect our viability.

For example, pharmaceutical industry discounts have enabled practices to provide facilities and expertise without additional cost to the NHS, but now the schemes are changing.

We are affected by clawbacks, category M-related reductions in payments and industry changes to wholesaler independence.

These changes are reducing practice incomes and threaten staff and services.

While not directly affecting Scottish dispensing practices, England's Pharmacy White Paper could have damaged all aspects of our business north of the border.

Training, education and the development of qualifications are driven by the scale of dispensing in England.

Our influence, when conducting business with wholesalers and manufacturers, would have been weakened and supply lessened. The political profile and voice of dispensing would have faded.

Thankfully, the sensible representations and sound arguments of the Dispensing Doctors' Association have prevented these damaging proposals coming to pass.

However, in Scotland, we have seen our own political developments with the 2005 Health Act creating a 'Community Pharmacy Contract'.

New income streams are now available to the pharmacy companies which make outlets in small communities viable.

This income is not available to the dispensing practices which continue to provide these services.

Economic uncertainty has led lenders to prefer 'safe' and sizeable businesses like the high street chains.

Purchasing medication
In addition, centralised purchasing of medication and appliances has been introduced in Shetland and promoted by other boards. This is conducted by the board pharmacists, relieving dispensing doctors of stocking work, negotiating and accounting, potentially enabling boards to get better deals on the bigger orders.

However, GPs lose control of their businesses and income can drop making services unviable.

All of these are threats to our patients and their services, threats to our staff and to the future of comprehensive medical care in rural areas.

Therefore, the Scottish GPC (SGPC) is striving to start negotiations on dispensing with ministers and the Remote Practitioners' Association of Scotland (RPAS) held a forum covering such topics as part of its annual conference in November.

At this event, Stirling GP Dr Anne Lyndsay spoke about the difficulties faced by a practice under threat of becoming unviable and Aultbea and Gairloch medical practice's manager, Andrew Vickerstaff, highlighted the facts and figures supporting the cost-effectiveness of dispensing.

Dr Alexander Sutherland, a Lothian GP who sits on the SGPC, led a discussion on dispensing practices' development with a view to future discussions with the government. Representatives from the RCGP, BMA and dispensing practices offered their thoughts in presentations and discussions.

Scotland's dispensing doctors, concerned about threats to their livelihoods, are developing a co-ordinated view to defend their profession.

Though our days are filled to the brim with patient care plus the endless paperwork of our low trust, high surveillance contract, we must fight for what we think matters.

This happened in Stirling, where the Aberfoyle practice was saved by the co-ordinated action of the community and the dedication of the practice team to learning and using the 'control of entry' legislation to defend services.

We hope to ensure that dispensing practices in all four UK countries can continue their valuable services, and that each system can learn from the others.

Perhaps prescription charge changes will be an indicator?

  • Dr Iain McLean is a dispensing GP in Dumfries and Galloway

Key threats to Scottish dispensing practices

  • Community Pharmacy Contract - new income streams available to pharmacies (but not to dispensing practices) making outlets in small communities viable.
  • Changes to discount schemes - clawbacks, category M reductions in payments and industry changes to wholesaler independence reducing practice incomes and threatening staff and services.
  • Centralised purchasing of medication and appliances by health boards leading to potential income drops for GPs.

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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