Once again the dispensing GP is virtually being accused of fraud or sharp practice simply because he dispenses the medicines he prescribes.   It is particularly insulting when it comes from the pen of a CHD lead who should know better. (Pulse, 10/9/05)

Apart from anything else, the world is a-changing.  

For reasons best known to itself this government is about to accede to the request from the pharmacists to prescribe from the entire pharmacopoeia and the pharmacists themselves presumably feel capable of making the appropriate diagnoses.

That, of course, brings the High Street chemist on a par with dispensing doctors.  So, why do I hear no screams of a “conflict of interest” about this? Could it be because their politicians are fully behind them rather than carping in envy?  Whereas GP politicians remain on Zog, so far as dispensing is concerned.

But let us get back to dispensing practice.

As Dr Malcolm Ward of the DDA Ltd, says, there is no evidence whatsoever from the Prescription Pricing Authority that dispensing doctors prescribe more branded medicines.

But what if there were?   It would be of little consequence because dispensing practices – according to Written Parliamentary answers and PPA figures – actually prescribe more efficiently, and less expensively, than their non-dispensing colleagues.

The figures are there for all to see, should they care to look (Box 1)

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BOX 1.

Net ingredient cost (NIC) per item  (£)  less VAT

      Dispensing doctors      Non-dispensers    NHS saving/item

1985        4.62                       4.88                        26p

1986        4.92                       5.17                        25p

1987        5.28                       5.55                        27p

1988        5.79                        6.01                       22p

1989        6.09                        6.32                       23p

1990        6.54                        6.74                       20p

1991        7.11                        7.27                       16p

1995        7.49                         7.75                       26p

1999        9.91                         10.04                     13p

2000        9.96                          10.18                     22p

2001        10.24                         10.46                    22p

2002        10.76                         11.14                   38p

2003        11.09                         11.60                   51p

2004        10.28                         11.73                    45p

None of the figures have been conjured up by the author.   The figures between 1998-2003 came from a written Parliamentary Answer by Rosie Winterton MP, Minister of State, to Peter Bradley MP (Lab), dated 17 March 2005.

The figure for 2004 is quoted on the DDA Ltd web-site.     

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Consistently, over the past two decades, the net ingredient cost of the dispensing doctor has been significantly less than his non-dispensing colleague.   Multiply that saving per item by the number of items and you arrive at a multi-million pound overall saving for the NHS by dispensing doctors.   What the figures certainly do not show is what some dumb-cluck, ignorant medical politicians would like to have you believe, that dispensing doctors are expensive prescribers to be stamped upon and made an example of.

So, let us have no more of this grossly insulting talk from those who should know much better.

However, dispensing doctors have to assume that their non-dispensing detractors would be glad to take over all dispensing without remuneration and, by extension, that of the High Street chemist, too.   Why should dispensing doctors be paid?

Let us look at what the dispensers do for their money.

First of all they do exactly what the chemist does.     That is, they accept the full responsibility for the dispensing of medicines to their patients.  Those who think that is a sinecure, simply sticking labels on boxes, should pay a visit to a chemist and a dispensing practice – and grow up.

Do these fools believe that the GMC will not take a serious interest in errors in dispensing practices? They must but the one who takes the blame for those errors is indeed the dispensing GP.  In short, he has double jeopardy – for both the prescribing and dispensing of medicines – and he will face the wrath of the authorities and the media in full force if he gets it wrong

Then, why should he accept that jeopardy at a cut price?   There is a very strong argument for saying that the dispensing doctor should be paid the full rate for the job for both services he provides, that of a GP and that of the High Street chemist.

In my opinion, and that of the above figures, the conflict of interest argument is fallacious but it is easily and reflexly trotted out by the ignorant.    So easily that it has now become politically correct for unthinking medical politician to have a go at dispensers in this way at every opportunity.

They should put their brain in gear and think carefully, after responsibly learning the facts, the next time the subject arises.

Dr Fellowes is correct, (Pulse, 10/9/05) the whole payment system may need addressing – to allow the dispensing doctor to be properly remunerated for the exceedingly onerous and responsible and onerous service he provides.   That payment should have nothing to do with the size of the practice or the GMS remuneration received but have everything to do with the service provided and be common with the High Street chemist.

Those who disagree with me and who believe dispensing to be money for old rope maybe should answer one of the many advertisements for rural dispensing practices in the back pages of PULSE and join a dispensing practice.

And I have restrained myself from entering the debate over the variable merits between generic medicines and branded medicines.  In these days of an extreme downward pressure on generic prices by a heedless government the tendency to “get what you pay for” becomes more likely.  Dr Macleod (PULSE, 10/9/05) may contemplate on that in these days of increasingly counterfeit and fraudulent drugs.

(19/9/05)