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I have just found out that there was recently an open meeting of the PPA. Why were we not more widely informed about this? I am particularly annoyed because they have persistently not paid me - and any of my colleagues, so far as I can tell - for certain personally administered items. I would very much have liked to have heard their justification for this.

My understanding of Regulation 19 is that patients may have provided for them all non-scheduled items which are "personally administered" by the doctor i.e. me, and that they will be free of prescription charges. I seem to recall that there was a legal case which proved this and that the Appeals Authority agreed with the findings.

The PPA have been disallowing sutures and dressings etc. when the scripts are endorsed "Personally Administered". This is of major importance to my practice. .My partner and I are rural dispensing doctors, over twenty five miles from any hospital, and we provide a first rate casualty service as well as a very well used minor surgery clinic which far exceeds the maximum quota of 15 permitted to allow payment under the Minor Surgery Scheme. Consequently, dressings and sutures feature strongly in the treatment of every such patient. The majority of patients may need eight or nine items each.

The result of the illegal PPA action is that my practice has to fund, say, eight prescription charges (8 x £6.10 = £48.80) per patient treated, plus the cost of the dressings and/or sutures etc. And, to add to the insult, we receive no fee whatsoever from the NHS.

The total annual loss to my practice is enormous and, I would think, the total loss to dispensing practice must run into millions. Some may say that we are indirectly repaid for the dressings through the "Expenses Pool" - eventually. But that does not cover prescription charges which are cavalierly deducted, without explanation, by the PPA at source.

The only way I can avoid this is to write prescriptions for each item used, send the bleeding patient to the nearest chemist, 25 miles away, where, if they have not previously exanguinated, they may collect the items, after paying £48.80p, and return to be treated. 

There is another alternative, I can cease providing any casualty and minor surgery service and ensure that both patient and NHS are inconvenienced. The patient by having to go to A & E and wait - or to the surgical out-patient clinics eighteen months later - and the NHS by having to pay for the vastly more expensive hospital treatment. Quite what will happen to the government's waiting lists, I cannot imagine.

As a final alternative, I am proposing that as many dispensing doctors as possible join me in a highly publicised class action against the PPA as this state of affairs clearly cannot be permitted to continue. There are many firms of solicitors out there who should be easily persuaded to take up what appears to be an open and shut case of maladministration by the PPA on dispensing practice. The effect on the PPA and government should be quite dramatic. If the legal advice, however, is that fraud is being committed, then perhaps the constabulary would be interested.

Dispensing doctors who wish to join this action should contact me through this site's FEEDBACK service. I have asked the Editor to relay all responses. It would be very useful if any colleague who has the nuts and bolts of the legal action mentioned earlier would pass these details on as soon as possible.

If you do not wish to e-mail, please write to the site (address on the opening page) marking the envelope PPA ACTION. The letter will be forwarded unopened.