Although dispensary managers play a vital part in running a practice dispensary, there remains a role for a GP.
This may simply involve being the named doctor for the Dispensing Services Quality Scheme (DSQS), which requires a nominated partner or salaried GP, but in most practices one doctor is required to provide more active input.
At my surgery, I am the lead partner for dispensing, although nearly all the day-to-day administration is done by our dispensary manager, including ordering of medicines, training of dispensers and the staff rota.
While there is a trend for this role to be undertaken by a pharmacist in larger practices, we have kept these tasks with an experienced, senior dispenser.
I can see the benefits of involving a pharmacist, with their expertise in this area. However, our practice's management structure includes a senior dispenser, assistance from a finance manager and the involvement of a GP partner, and I feel adding a pharmacist into the mix may simply cause strain.
I meet with the dispensary manager on a formal basis occasionally, when there are major decisions to discuss such as a new practice formulary or refurbishment of the dispensary. The majority of our discussions occur on an ad hoc footing.
The input I provide includes meeting pharmaceutical representatives to discuss the discounts on medicine purchases that some companies offer.
Wherever possible, I try to see the regional discounting manager as many of the usual representatives have little control over discounts.
Since the DoH assumes we have at least an 11 per cent discount on our drugs and reduces any reimbursement by this amount, we have to try to negotiate discounts of at least this level, to avoid losing money.
I also help to develop our buying policy, which is important given the rise in the use of generics. Monitoring these trends is a significant task.
Once a drug comes off patent, there will often be at least three or four companies vying to supply it and having a competitive purchasing price will benefit the practice.
We try to reduce the number of lines on the shelves, helping to reduce wastage of unused medicines and the consequent cost to the practice. A practice formulary supports this and highlights, on occasions, which medicine in a group is the most cost-effective.
Our practice formulary only lists a relatively small number of medicines, covering two sides of A4. I do a major overhaul of this every six months, also making regular minor adjustments through internal email postings, depending especially upon the latest Category M prices.
I was surprised to learn how many dispensing practices do not participate in the DSQS; we signed up from the start. While the dispensary manager ensures compliance with the standard operating procedures, dispensing training and staff appraisals, we are slightly unusual in that the doctors generally complete the patient reviews.
My role is to ensure medical staff participate in this, completing a sufficient number of reviews. The audit element tends to be a shared task.
I usually spend several hours a week on dispensing issues, occasionally more. For example, I recently spent time meeting different mainline wholesalers to discuss a potential change to a new supplier.
In our case, the change was purely for financial reasons, secondary to the changes inflicted through the imposition of Direct To Pharmacy. Following an information-gathering process, we discovered we could not improve on our existing local wholesaler.
Trying to maintain profitability is tough and I scrutinise all areas to achieve this.
I maximise the reimbursement of dispensing fees by ensuring all personally administered (PA) items are claimed and that there is a good distribution of dispensing prescriptions across all doctors, including non-principals. I use prescribing searches to identify which PA items are losing money for the practice and try to ensure these are sent to a pharmacy instead.
At the moment, I am also looking at a potential extension to our dispensary, along with other changes in its working, including the potential for robotic dispensing and monitored dosing systems.
Information exchange via the internet helps considerably. We meet with our mainline wholesaler only once or twice a year but are able to raise queries quickly via emails.
I check the Dispensing Doctors' Association website several times a week; check our ePACT data monthly; and receive the Primary Care Commissioning newsletters. I also frequently read prescribing.org's discussion forums, where dispensing doctors and their staff share information on patient services and profitability; and attend meetings and conferences.
Other (time-consuming) tasks come up sporadically, as with the publication of the Pharmacy White Paper. However, acting as the conduit between the dispensing business and my partners is the most important task I perform in my role as the practice's lead for dispensing.
- Dr Phipps is a dispensing GP in Lincolnshire
- Liaising with the dispensary manager and acting as the conduit between the dispensing business and GP colleagues.
- Maintaining the dispensary's profitability, for example, maximising the reimbursement of dispensing fees by ensuring all PA items are claimed.
- Helping to develop the dispensary's buying policy and meeting with pharmaceutical representatives to discuss discounts on medicines.
- Responsibility (as named doctor) for DSQS, ensuring medical colleagues participate in patient reviews.
- Overhauling practice formulary every six months and making ongoing minor adjustments.
- Keeping in touch with the latest dispensing news and updates and considering new and improved ways of working.