Being a White paper on pharmacy it is not surprising that pharmacy is the most important and most mentioned topic.   The other providers of “pharmaceutical services” do, however, get a look in although not always to their advantage.

The first mention of dispensing doctors comes in Chapter 3.42 where it is acknowledged that they

“meet the need for dispensing in places where a pharmacy may otherwise be unviable”.

It goes on to state that this meets the

“needs (for) prescribed medicines (but) it can leave some rural communities travelling substantial distances to access OTC medicines.  This is a barrier to self-care and leads to increased pressure on GP appointments…”

3.45 incorrectly goes on to state that GPs are prevented from selling OTCs.   That may have a germ of truth in it but the remedy has been in the hands of successive governments but has been fought tooth and nail by the chemists.

However, it is a fact that since the original DDA campaigned against Kenneth Clarke’s “Limited List” in 1984, on just this point, dispensing GPs have been permitted to sell black-listed medicines to their dispensing patients. Few have taken advantage of this and there has been no publicity about it since the take-over of the original DDA in 1997 other than by myself.  

GPC certainly has shown no interest nor has the new DDA Ltd..   However, t is all described in The Complete Dispenser.

This government’s attitude, as quoted in 3.45, is that GPs are prevented from selling OTCs

“primarily because the sale of such medicines could be seen as generating a profit linked to a course of treatment recommended by the GP”.

May God save me from the feeble minded!

That is exactly what pharmacists have been doing from time immemorial and what this government is urging them, through this White paper, to do in future.

When a customer enters a pharmacy with a “cold” he asks the pharmacist for a “diagnosis”.   That is given and the chemist then

“generates a profit linked to a course of treatment recommended by the pharmacist”.

Frequently the decision of the pharmacist as to which product to recommend is influenced by competitions and other blandishments offered by the pharmaceutical company to himself or his staff

Curious that GPs are treated as less trustworthy if not potential fraudsters.

Interestingly, this “evidence” was given by the Secretary of Dorset LPC, Mr Roger King” when opposing the pharmacy application of one of my clients recently.

The paper then states, 3.46, that these procedures

“offer an element of protection for people”

from those nasty, evil, criminal GPs, I presume.

It then goes on to state the bleedingly obvious that relaxing these restrictions would provide a better service for patients

3.48 then refers readers to the real meat and two veg for chemists re dispensing practice, in Chapter 8.

Chapter 8

The government, apparently, commissioned a review which came to the astounding conclusion that even in deprived areas

“99% of the population could get to a pharmacy within 20 minutes” (8.3)

despite not many rural patients having their own choppers.

The Chapter then rambles on about pharmacy services, mainly under the new contract and during all this the penny drops for the author.  Pharmacists may, after all, not be whiter than white:

“Community pharmacies are commercial businesses as well as healthcare providers.  In some areas this has led to an over-emphasis on the quantity of services provided – such as MURs – rather than their quality and relevance to local health needs” (8.42)

The Chapter then goes on to discuss remedies but that is not relevant here.

Back to dispensing practice which is quietly tucked away at the very back of the Paper on page 115, 8.67.

The following sections are not the clearest to understand but the overall meaning is clear.  Commercial businesses (chemists) are good and nasty, evil, potential fraudster dispensing GPs are bad.

No matter that, as the Paper says elsewhere, dispensing is less important these days.  Nor is there any discussion, research or evidence as to whether the pharmacists are better at dispensing than GPs or even that GP dispensing is greatly valued by patients.

In the White Paper the patient’s opinion is not even mentioned let alone canvassed.  All that matters to the government is the existence between the doctor’s practice and the pharmacy.   After all, it says…

“some people who receive dispensing services from their GP walk past a community pharmacy on their way to and from the surgery, particularly in  market towns”.

And if they don’t now, it implies, then we are going to make damn sure they do in future.

The White Paper effectively states as its intention that the 1-mile (1.6km) rule will be abolished under new control of entry rules.

The effect of this will be that the only criteria for dispensing by doctors will be if the nearest pharmacy is an indeterminate distance from the surgery.

If there is a pharmacy within the town or village, then forthwith all patients of the one-time dispensing practice will be compelled to use it and the practice to cease dispensing.

Some colleagues have raised the existence of branch surgeries but nothing is mentioned about them.

As I interpret the proposals, their patients,, too, must use the nearest village pharmacy under the same “logic”.   If patients from village A can get to a pharmacy within 20 minutes (8.3), so can those in village B.

Considering the appalling, unevidence-based bias of this paper, it would be a foolish practice which assumed that all would be well for their branch patient dispensing.  Nor do I believe, as one or two colleagues have suggested to me, that it would be possible to transfer their dispensing to the branch surgery

Pharmacy is obviously calling the shots and that is too obvious a ploy to allow.

The government are proposing (8.70)

“a single condition relating simply to the distance between the surgery and the nearest pharmacy.  This might appear more logical, as the person will usually travel to the surgery to see the GP.  If a prescription is provided, they are likely to have it dispensed during that same trip.”

The government’s “logic” does not apparently run to evaluating the standard of the services provided by both pharmacy and dispensing practice.

It has not dawned upon M/s Primarolo (Pharmacy Minister) that before eliminating an important service, it would have been an excellent idea to do some elementary research into that service.

Does dispensing provide value for money?  Yes, very much.   Do dispensing doctors over-prescribe to line their pockets?  No.  There is absolutely no evidence of this. And, in any case, the Primarolo has all the evidence for this at hand via the PPD Annual Reports.

Is the service valued by patients?  Most definitely.  But you didn’t ask!

Is the service efficient and safe?   Yes.   There is no more evidence of error than in pharmacy.

Evidence was given to this Paper by the DDA Ltd but they have failed pathetically to get the point for dispensing by doctors even heard.

Back to the future!

The only dispensing practices which will continue to exist will be those were there is no pharmacy nearby and where there is no possibility of pharmacy viability.  This is called “the single criteria”.

The only dispensing patients remaining will be the exceedingly rural ones.    All the rest will be herded through the local pharmacy doors no matter what the standard of service it provides.

And the only beneficiaries will be the pharmacy and, as most of those are in large chains, only the shareholders of Lloydspharmacy, Alliance Boots etc will be large gainers.   

And, perhaps, M/s Primarolo’s pension fund if she follows the example of Milburn et al. into private health related organisations such as the board of Alliance Boots.

As a sop to the few remaining dispensing practices, they will be allowed to sell OTCs – most of which they could do already, as mentioned previously.

Interestingly again, that same paragraph, 8.71 has the utter gall to state:

“No patient would be forced to have their medicine dispensed by their practice (the choice to go elsewhere must reside with the patient”.

Unless, of course, that choice has been eliminated by the government compelling the dispensing practice to close.  In that case, the pharmacist would begin rubbing his hands at the government definition of “choice” as dispensing practices…

“will have to accept that they will need to wind down their dispensing role”.

No mention here about compensation, by the way.   If the government compensates doctors this time, it will be the first.   Back in the ‘90s there was a compensation scheme where doctors paid into a fund to compensate chemists when a dispensing practice opened and chemists did vice versa.  It collapsed when the chemists refused to compensate all the dispensing practices they poached.

These, then, are the proposals for dispensing practice in this fifth-rate, extremely biased, ill-researched but perfectly up-to-standard for this government, White paper.

If you are a dispensing practice with either scope for a poaching chemist or already have one in your town/village.  Think very seriously about opening your own – NOW!