"Country Doctor"
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DDA
Ltd has lost its way
David
Roberts
|
|
Lost
its way
FIP International Pharmaceutical Federation
ICCPE Irish College of Continuing Pharmaceutical
Education
NPA National Pharmaceutical Association UK
PAGB Proprietary Association of GB
PGEU Pharmacy Group EU (Public Access Only)
PSI Pharmaceutical Society of Ireland
PSNC Pharmaceutical Services Negotiating Committtee - UK
RPSGB Royal Pharmaceutical Society of Great Britain Organisations
looking after dispensing doctors – reputedly Rural
Practice sub-committee of the GPC Dispensing
Doctors Association Ltd If
ever there was an organisation
which has lost its way over the past several years it must be the
Dispensing Doctors Association Ltd. The
above list shows there to be at least eight bodies forensically caring
for the pharmacist whereas the dispensing doctor has only the GPC
rural-practice sub
committee – which has never been overly keen on dispensing by doctors
– and the DDA Ltd. First
of all there was the DDA Ltd’s response to the “loophole” in the
Clothier regulations. All
that was really needed to stop pharmacists pouring through this loophole
was either for the government to realise it was a drafting error and to
close it, or for pharmacists, under the advice of their representative
bodies, to realise the same and not use it. Then there
was the OFT Report of last year. In both cases the DDA Ltd defends
or enhances pharmacy's case. In my
time as original DDA chairman governments preferred to continue the
animosity between the professions rather than make the simple change to
the regulations to close the loophole. The
reason why was never explained. As
for the chemists, well they knew they were on to a good thing and
steadfastly refused to behave honorably preferring to blackmail
dispensing practice into giving even more in exchange for agreeing to go
to government with suggestions for a limited closure. My
DDA resolutely refused that blackmail but, following a coup, the new DDA
Ltd immediately began negotiations with pharmacy which will culminate in
the prohibition of ANY more dispensing applications from doctors in
return for a partial closure of the loophole. Before
going any further the report written by the Chairman of the DDA Ltd, Dr
M Ward, should be read. It
gives the DDA Ltd’s official position on last year’s OFT Report: “Dispensing
by doctors Dispensing
doctors, who know about their patients' health needs and have a full set
of medical records, provide a highly valued, convenient, cost effective
"one stop" provision of medicines supply for their 3.3 million
rural patients. In section 5.8 the OFT recommends that doctor dispensing
should continue but argues that the "prejudice test" should go
in line with the abolition of control of entry. In reality the prejudice
test does little to impede a pharmacy application as under the current
regulations it is very hard for a GP practice to prove prejudice to
"the proper provision of general medical services" and in any
event many if not most pharmacy applications in rural areas are
"loophole" applications where the prejudice test is not
applied. This problem was to be addressed in the revised Pharmaceutical
Services Regulations currently being drafted. The abolition of the
current regulations would leave doctor dispensing without a legal
framework. Substitute legislation might lead to a significant reduction
in the level of doctor dispensing. Deprived of dispensing revenue many
rural practices might have to reduce the level of general medical
services or even close rural surgeries. “ On
the face of it not a bad paragraph but look a little deeper.
Maybe there would be no legal framework for dispensing practice
but, looked at as a whole, the OFT changes would not be so bad for
dispensing practice.
As Dr Ward himself says in the following paragraph, after
spreading doom and gloom previously about closure of rural practices,
(Is he infected with the pharmacy bug?
Chemists always pleaded that as a defence whenever a doctor
applied to dispense.) deregulation would allow doctors to open their own
pharmacies which would more than make up any lost income from the
closure of their dispensing.
The more rural practices would continue to dispense because they
would remain unviable for pharmacy.
If they ever became viable then those doctors, too, could open
their own pharmacy in the decontrolled world. “On
a positive note for the generality of GPs deregulation would allow any
GP to open an on site pharmacy and if the OFT recommendations were
implemented in full large numbers of GPs would surely do this. This
could be disastrous for many existing and potential pharmacies. However
if you deregulate in the name of fair trade it would hardly be fair to
discriminate against doctors owning pharmacies. Indeed if the principles
of free trade are truly to predominate in a deregulated market then all
doctors should have the freedom to dispense medicines to all their
patients at their surgery premises. The old argument that prescribing
and dispensing should where possible be separate functions and performed
by separate professionals no longer holds. Pharmacists already prescribe
and dispense to patients and the pharmacist's prescribing role is to be
more widely developed as part of the NHS Plan.” An
excellent, clearly thought out paragraph.
But what about the conclusions Dr Ward comes to as the official
DDA Ltd position on the OFT Report? “Conclusion
Bullet
point 1. How
on earth can Dr Ward say the evidence is “controversial”?
There is strict regulation for the entry of pharmacists to an NHS
contract. That is fact
otherwise why did I and latterly he spend so much time on it?
That evidence is very clear cut.
The regulations are, so far as the OFT is concerned,
controversial but not the evidence. Bullet
point 2. Wilder
statements would be difficult to find outside a pharmacy defence group.
Maybe Doctor Ward has been communing too closely with the
chemists since he took office? Assuming
that doctor-owned pharmacies in one-stop health care premises replaced
High Street chemists, why would NHS costs increase?
He didn’t and the DDA Ltd couldn’t provide evidence for that. Equally
why would the quality of service be reduced in these circumstances.
The DDA Ltd does understand, I hope, that doctor-owned pharmacists would
be run by pharmacists and probably the same ones who leave the High
Street? In these
circumstances the quality of service would very likely improve – or at
least, that is what the Chairman of the DDA Ltd should
be saying. As for reduced patient access if the pharmacy was actually in the doctor’s health centre, how does that square up with reality. The DDA Ltd Chairman has, hopefully, been spreading the gospel that doctor dispensing on the premises is the best possible access for patients and doctor-owned pharmacies are a close second. Bullet
point 3. The
OFT was asked to consider the restriction of the provision of pharmacy
contracts. It did so
and found that there was gross restriction and prevention of
competition. That is
unarguable. Nobody
knows what the effects would be but it is unlikely that the effect on
NHS pharmaceutical provision would be adverse.
Patients would get their medicines at the Health Centre or in the
supermarket. Bullet
point 4. The DDA Ltd appears to be in a different world when it says that OFT deregulation would cause disharmony between the professions. The only reason there is any sort of harmony at present is because the DDA Ltd has been busy appeasing and giving way to pharmacy since its inauguration. As Dr Ward says in the first paragraph, above, most chemist applications are through the loophole still. Ask those affected doctors about harmony between the professions and the chemists’ goodwill to dispensing practice. Ask them whether they have successfully appealed to the PSNC or NPA for them to ask their pharmacy colleagues to behave honorably and withdraw their loophole application to maintain professional harmony. As
for the NHS Plan, well, it specifically demands a one-stop health care
system. The DDA Ltd should
be campaigning that that should have doctor-owned pharmacies within
those premises on an equal basis to any other pharmacy. Bullet
point 5. What
on earth does that rubbish mean? A
test-bed? Why not a test-bed with a doctor-owned
pharmacy in a One-stop Health care Centre? That is
what the DDA Ltd should be seeking. Why
is the DDA Ltd speaking in favour of the pharmacy case rather than
wholeheartedly upholding the case for doctors?
Has it lost its way? A
reading of the DDA Ltd’s recommendations cannot help but lead one to
believe it has. “DDA
recommendations:
But
should the DH decide to implement the OFT recommendation to deregulate
in the name of free trade then it is incumbent upon the Government to
continue to support dispensing by doctors to ensure that rural patients
do not see a reduction in local service for medicine supply. Given a
truly free choice there is little doubt that many NHS patients would
prefer to get their medicines from the doctor they know and trust at the
time and place of the consultation.” Bullet
point 1. As
the OFT Report adversely affects pharmacy – and that is debateable –
why is the DDA Ltd making this recommendation?
For
every High Street pharmacist who loses his job there will be a
replacement position either in the health centre or in the supermarket.
And let us not forget that, at present, there is a shortage of
pharmacists. Pharmacies
will continue to be run by pharmacists and dispensing practices will
continue to be run with their usual excellence by dispensing doctors.
I am sure that the DDA Ltd will agree with that. Bullet
point 2. This
is a complete nonsense.
It is not necessary for dispensing practice, or medical practice
in general, to give even more to avaricious and clever pharmacy
politicians to ensure closure
of the loophole. If
the government can be persuaded to implement the result of the DDA Ltd
brown-nosing then it should have been possible to persuade it to make
the simple change mentioned above.
That is what the DDA Ltd should be devoting its energies to
working for. Dr
Ward’s final comments They
are absolutely correct which makes one’s mind boggle at his earlier
efforts to put the case for pharmacy rather than for his dispensing or
medical colleagues. Pharmacy,
with its eight defending bodies, does not need the help of the DDA Ltd
– although they must be rubbing their hands with glee at having got
it. However,
with the leading members of the DDA Ltd Board having spent so much time
in the pharmacy camp since their inception it is not surprising that the
Association has gone native. Conclusion As original founder and chairman of the DDA from 1984-97 I am appalled and sickened at the direction the once proud and independent Association is taking under the current leadership. One of the most important points of the original DDA was its totally independent outlook. It owed nothing to either GPC or pharmacy but was 100% for dispensing practice. All that has been lost. One of the most senior directors (officers) of the DDA Ltd is a dyed-in-the-wool, long-term BMA politician who did and probably still does, hold high office in the GPC as visitors to the Annual LMC Conference may find. His feet are well and truly in both camps. How does that square with independence? And the chairman, as seen by his official report, above, has been so taken by pharmacy's case that he has persuaded the DDA Ltd Board to adopt it as official policy. The DDA Ltd has truly lost its way. It has lost its independence and appears to think first of chemists, then of the BMA's opinion of it and finally, and only then, the dispensing doctor. The evidence is plain to see above in their open defence of pharmacy rather than of doctors. I am sad to have to say that far from being proud of the organisation I founded I am ashamed of it. Maybe, in
future, it should undergo a name change and become: “The
Pharmacist and Dispensing Doctors Association Ltd? |
