Pharmacists have argued that simple dispensing under uses their skills, others claim there to be threats from other suppliers of medicines such as supermarkets. The government has announced its intention to extend the roles and activities whilst at the same time protecting their monopoly as dispensers. Interestingly, The National Plan will dramatically alter the present separation of the roles of prescribing by doctors and dispensing by chemists. Reading between the lines, and it’s not hard to do so, that will be a one-sided change with chemists prescribing more but no more doctors dispensing.

The National Plan for Pharmacy contains not a word about dispensing by doctors but says that government wishes to offer pharmacy services which are fast and convenient, tailored to patients’ need and available when they need it at a consistently high standard. Laudable aims.

Future pharmacists and pharmacies will:

promote self care through OTCs (instantly making the pharmacist, like the dispensing doctor, both a diagnostician and a provider of medicines and, logically, neutralising the main argument against dispensing practice)
receive direct referrals from NHS Direct
provide emergency contraception and anti-smoking services.

One-stop centres of pharmacists, GPs and other NHS providers will be set up. In effect, dispensing practices with pharmacists. There will be 500 of these by 2004 mainly in inner cities. There are already over 2000 one-stop dispensing practices although GPC and the DDA Ltd are set on ensuring there will not be any more.

The main point of these are that patients will have better information about pharmacy opening times, better availability of medicines out-of-hours and that out-of-hours dispensing should be reliable. In other words, just like dispensing practice.

Pharmacist prescribing
Repeats: pharmacists will review repeats and suggest changes to regimes

e-prescribing: by 2004 e-links will be between GP-pharmacy-PPA

prescribing e-data: prescribing data will be transferable in the same way by 2008

out-of-area dispensing: will be permitted.

Self-management of medicines with the help of Action Teams will be promoted and developed by 2004. £30million has been set aside for this purpose and all PCG/Ts will be expected to have developed their own schemes.

Local Pharmaceutical Service schemes, like PMS systems, consisting of an agreement between the NHS and pharmacists, will be set up. Contracts, like PMS, will be outside national contracts and based on quality not work done. The national contract will be "renegotiated". The "control of entry rules" limiting the number of pharmacies in an area may change to encourage competition and to ensure more open in "under provided, deprived areas". The dispensing doctor’s politicians should be anxious lest these include rural areas. Finally the Plan aims to "remove the rigid demarcations between doctors, pharmacists and nurses. Another possible danger signal for dispensing practice - or another opportunity to be grasped. As this was pointed out 4 months ago on this site and as the DDA Ltd remains silent on the issue it is doubtful whether any initiative will come from that source.

Pharmacy standards are to be raised by new education schemes, local clinical governance schemes, serious incident monitoring schemes and "vetting" of pharmacists.

Conclusion
Dispensing doctors need to grasp the opportunities provided by ensuring that government is aware of the highly valued one-stop service they provide and the opportunity presented by the breakdown of the demarcations mentioned. At the same time they should be wary of the risks of the establishment of subsidised pharmacies in their areas. All this may be carried out by an effective promotional scheme designed to make politicians aware of the excellent service already provided by dispensing doctors.

I established a body to do just that in 1984, the DDA. It was snatched away from dispensing doctors in 1997 and transformed into the mediocre DDA Ltd. Now is the opportunity for that group to do something constructive for dispensing practice. It won’t.