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Letters to the Editor
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Rural practice
Dispensing doctors should employ pharmacists
From Mr J. D. Thomas, MRPharmS
The dubious practices of dispensing doctors as discovered recently by
Neville Cameron (PJ, 25 November, p636) are not new to some rural community
pharmacies, as they know too well that they have been in existence since
the inception of the NHS in 1947. The regulations then applied to real
rurality but have not been modernised to apply to the present creeping
urbanisation of most “rural” villages.
In the early days of the NHS, rural doctors did actually dispense themselves,
but with the vast expansion of the numbers of so-called rural patients,
and the increase in modern clinical and diagnostic procedures, they now
do not dispense. The change from single-handed rural practices to the
multi-partnership, means that these rural practices provide a supply-only
function for NHS prescription medicines operating a Monday to Friday
weekday office hours service. I personally happen to be on a rural doctor’s
list, but after much difficulty and pressure, I am on their prescribing
and not dispensing list. Having been told that the book-keeper checks
the prescriptions, need I say more?
These modern urbanised rural patients are thus being denied the benefits
of a full pharmaceutical service as provided by both rural and urban
community pharmacists. My local village pharmacy is only 300 yards from
the surgery and every visiting patient has to pass it twice. Incidentally
this pharmacy dispenses virtually the same number of prescriptions as
the doctors’ surgery.
Over 11 per cent of the total NHS drugs bill is spent with these rural
doctors, which in reality means that tax payers, in general, and community
pharmacy, in particular, are being deprived of funding to provide, enhance
and develop the full pharmaceutical service and all its innovative new
nuances.
In order that tax payers should receive value for money in the provision
and supply of pharmaceutical services, it is my humble opinion that all
rural GP practices that dispense, should employ a registered pharmacist
and the dispensing area be subject to the full vigour and scrutiny of
the Factory and Shops Act, and Environmental Health and Safety rules,
which already apply to all community pharmacies, which dispense the vast
majority of the nation’s NHS prescriptions.
David Thomas
Patshull,
Shropshire
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RICHARD WEST, chairman of the Dispensing Doctors Association, responds:
I
am disappointed by the tone of recent letters to The Pharmaceutical
Journal. I believe that the professions had moved on and were now
trying to work together to improve the service for all of our patients.
It
was only last month that Sue Sharpe, chief executive of the Pharmaceutical
Services Negotiating Committee was warmly welcomed at the Dispensing
Doctors
Association’s annual conference, where she gave the keynote address
about working together.
There is no doubt that both professions have a small number among
them who do not provide the level of service that we would all like,
but the vast majority
provide a service which is safe, convenient and cost effective to both the
NHS and patients. We can all find anecdotes of this poor service,
but this is not
helpful in trying to improve the service. It is important that we all acknowledge
the different strengths and weakness that both professions have and look
to maximise the strengths and minimise the weaknesses.
I am aware that there are a growing number of dispensing practices that employ
a pharmacist for the skills that they bring to improve patient care. This
is around the whole area of medicines management not just dispensing. The
pharmacist
is a valued member of the team.
It is important that both pharmacists and dispensing doctors ensure that
people who perform medicines management tasks have the required competencies.
The
person’s
title is less important than their competency in performing these tasks. The
new dispensing quality scheme has tried to make this process more open to external
scrutiny than before. We need to recognise that with the changing NHS, there
are tasks that were the sole preserve of doctors that are now being competently
performed by others, including pharmacists. It is important that we have objective
rather than subjective standards for competencies.
There are no special dispensations for dispensing practices with regard to
health and safety regulations. The same standards apply to dispensaries and
pharmacies.
Although it would be nice to think that if money is removed from one service
it will be invested into another, my experience tells me that this does not
happen. There is a lot of evidence that dispensing subsidises rural medical
practice.
If dispensing were removed then other medical services would suffer. The
reconfiguration of rural services is worthy of debate but is a complex jigsaw.
It is important
we do not destroy the things we are trying to improve.
I am hopeful that both professions can move on from any past differences
and try to work together to improve the patient experience wherever that
is. |
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The
Pharmaceutical Journal