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Health: Prescribing and Dispensing

House of Lords written question – answered on 2nd June 2008.

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Photo of Baroness Cumberlege Baroness Cumberlege Conservative

asked Her Majesty's Government:

Whether the practice of general practitioners both prescribing and dispensing medicines affects the Government's policy of maximising patient choice.

Photo of Lord Darzi of Denham Lord Darzi of Denham Parliamentary Under-Secretary, Department of Health, Parliamentary Under-Secretary (Department of Health)

All General Practitioners (GPs) may prescribe for their patients. GPs may also dispense medicines to their patients in certain circumstances including that the patient would have serious difficulty in obtaining because of distance or inadequacy of communication or that the patient lives more than 1.6 kilometres from the nearest pharmacy.

The principle of GPs dispensing has historically been seen as an exceptional measure, normally where there may not be a convenient community pharmacy and patients have no choice but to travel a considerable distance to the nearest pharmacy.

The choice of having medicines dispensed by a GP is currently one that is available to less than around 7 per cent of patients. As part of the consultation promised in the White Paper Pharmacy in England: Building on StrengthsDelivering the Future we will be consulting on proposals making changes to the control of market entry for dispensing medicine that will examine options for improving services and patient access. Consultation over any proposed changes will be carried out late in the summer. Copies of the White Paper are available in the Library.

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Annotations

Paul Gowers
Posted on 12 Jun 2008 8:51 am (Report this annotation)

Slowly and surely our rural lives are being affected by all these changes... disappearing. Post offices and the demise of village shops... not to mention the appalling transport systems & the seeming lack of concern for the large elderly population here (highly dependent on GP dispensing).
Why should doctors who have dispensed for decades and provided a fantastic service for their patients be made to wind down and stop? Surely it is up to the patient where they go for their prescriptions to be dispensed... ie what this government is always promoting. CHOICE!
The National Plan for Pharmacy contains not a word about dispensing by doctors but says that government wishes to offer pharmacy services which are fast and convenient, tailored to patients’ need and available when they need it at a consistently high standard.
• Promote self care through OTCs instantly making the pharmacist, like the dispensing doctor, both a diagnostician and a provider of medicines.
• receive direct referrals from NHS Direct
• Provide emergency contraception and anti-smoking services.
However for some reason they would seem to decline choice on this occasion as no doubt it does not suit them politically.
The control of entry rules may well completely destroy our dispensing practices which will be devastating to patients.

Pharmacists have argued that simple dispensing under uses their skills; others claim there to be threats from other suppliers of medicines such as supermarkets. The government has announced its intention to extend the roles and activities whilst at the same time protecting their monopoly as dispensers. Interestingly,
The National Plan will dramatically alter the present separation of the roles of prescribing by doctors and dispensing by chemists.
Future pharmacists and pharmacies will:
One-stop centres of pharmacists, GPs and other NHS providers will be set up. In effect, dispensing practices with pharmacists. There will be 500 of these by 2004 mainly in inner cities. There are already over 2000 one-stop dispensing practices although GPC and the DDA Ltd are set on ensuring there will not be any more.
The main point of these are that patients will have better information about pharmacy opening times, better availability of medicines out-of-hours and that out-of-hours dispensing should be reliable. In other words, just like dispensing practices.
Pharmacist prescribing

Repeats: pharmacists will review repeats and suggest changes to regimes
E-prescribing: by 2004 e-links will be between GP-pharmacy-PPA
Prescribing e-data: prescribing data will be transferable in the same way by 2008
Out-of-area dispensing: will be permitted.
Self-management of medicines with the help of Action Teams will be promoted and developed by 2004. £30million has been set aside for this purpose and all PCG/Ts will be expected to have developed their own schemes.
The national contract will be "renegotiated". The "control of entry rules" limiting the number of pharmacies in an area may change to encourage competition and to ensure more open in "under provided, deprived areas". The dispensing doctor’s politicians should be anxious lest these include rural areas.