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Avon Valley Practice has been a feature of rural Wiltshire life for well over the past 60 years, but, in the view of Practice Manager Anna Morton, it is the past five that have left some of the most lasting marks on the practice. Only cost-efficient thinking by the practice management has saved patients from feeling the full extent of what has been a 25% cut in dispensing income over this time.
Since 2006/07 the practice has gradually had to reduce services - first by closing its Netheravon branch surgery, and most recently - in November, 2011 - by transferring repeat dispensing out of its only remaining branch surgery at Durrington. Staff rotas have been amended to take account of the changes at Durrington and consequently a Full Time Equivalent dispenser post has been lost.
For the practice, the tipping point has been the 2011 third quarter Category M reductions. Although these were anticipated and planned for, a flood at the main Upavon building and other emergency building maintenance repairs were not. Add in reductions to discount, and the resultant 25% reduction in dispensing income has proved a cut-back too far.
Great efforts have been made to mitigate the impact on patients of the changing financial environment of dispensing, and Anna Morton believes that for the 800 dispensing patients who use the Durrington surgery, there have been few interruptions to the normal quality of the service. The practice has employed a delivery driver to transport medication between the main and branch surgeries. This enables patients to continue to pick up medication from their preferred surgery without having to take a seven-mile trip up the valley to the main surgery. The practice has also introduced a remote medicines drop-off point half way between the two surgeries. She says: "We know we have changed our service offering, and that our patients are used to having more, but what else could we do? We can't keep everything going. We can only spend what we have got."
Finding workable solutions for its 5,950 patients, of whom 55% (3,282) are dispensing, has become a familiar task at the three-doctor practice over the past five years. Efforts have been focused on retaining clinical service quality despite falling income; over the past five years, the practice has reviewed its administrative systems to ensure that medicines go where patients want to collect them. It has also introduced an all-day telephone medicine request service, alongside SMS messaging and on-line services, to give patients multi-channel access to the dispensary. Another demonstration of the practice's on-going commitment to patient care is the recent refurbishment of the Durrington surgery, which is now complete. However, as pressure on dispensing profitability continues, it is clear to the practice that some things will still have to give; from May this year, the home delivery service has been redesigned, with reduced eligibility criteria, and this has reduced the number of patient receiving this service by over two-thirds.
The practice mitigates the impact on the clinical service where it can because it believes that dispensing practices provide unique standards of care. Ms Morton says: "In a practice dispensary patients don't get shunted from pillar to post. They are seen quickly and they receive their medicines quickly, with minimal distances to travel. Their problems are resolved quickly."
Her only wish is that the practice could do more. "Our situation seems hard to reconcile with all the rhetoric about patient-centred care, but this is a constant battle to achieve without sufficient money to do it."
A "fantastic asset"
Avon Valley dispensing patient Mr Oldfield typically uses the dispensary at the main Upavon surgery, although he has also visited the Durrington branch surgery, which he describes as a useful "back-up".
Like other patients at the practice, he considers himself very lucky to have such a fantastic asset so close by.
Over many years of using the surgery, Mr Oldfield has found the staff extremely accommodating, often supplying medicines at short notice. He feels that the on-site location of the dispensary contributes immensely to the very high level of care. He says: "Staff bend over backwards to get my medicines. More importantly, they know me, and greet me by name. When you are worried about something, this goes a long way to calming the situation down. Go into a pharmacy, and you can be little more than a name on a piece of paper."