Country Doctor - "on-cost" replacement

Russell Walshaw, Chairman of GPC Rural Practice Sub-committee

GPC and the DDA Ltd appear to be of a mind to agree with government that the "on-cost" method of payment should be abolished in favour of an enhanced dispensing fee.

These organisations appear to have succumbed to pharmacy propaganda which says that doctors are profiting from the drugs which they dispense and that that influences their prescribing. This is also, not surprisingly, one of pharmacy's arguments against doctor dispensing. Oddly, the undoubted fact that chemists profit greatest from selling the most expensive OTC preparation to customers does not appear in their logic. Nor does the Crown Report which last year actually recommended that chemists should be allowed to prescribe and dispense prescription only drugs. What has been pharmacy's parrot cry for years? "Prescribing and dispensing must not be in the same hands".

An extension of this argument is that doctor dispensing costs the State more. In fact, for each of the past 16 years analysis of PPA figures far from confirming that actually demonstrates the opposite and with all the downward pressures on GP drug spending, as a whole, it is likely to continue that way. Each doctor has a budget and his PCG makes sure that he is constantly aware of that - dispensing doctor or not.

I believe very strongly that the move away from "on-cost" should be very strongly resisted for a number of reasons.

The replacement of "on-cost" with an enhanced dispensing fee leaves the doctor's income at the mercy of the DoH.
No government, not just this one, can be trusted to properly enhance that fee. Just recall all the brutal tinkering with GP pay awards over the years.
dispensing doctors' income - even without overprescribing - is, at present, to some extent automatically enhanced as the cost of the medicines increases.
excess "profits" are removed by the regularly enhanced doctors' dispensing discount surveys.

It seems, therefore that the change from "on-cost" owes more to the political manoevering of pharmacy than any logic or call from dispensing practice. It is my understanding that GPC is there to look after the interests of doctors - not pharmacists, government or the NHS. Sadly, the reverse seems to be the case - and the same would seem to be true for the DDA Ltd. Once again dispensing doctors can expect for little realistic support from either body.

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