Dispensing Doctor Myth Buster
A number of myths perpetuate about dispensing practice. The most common are explored below
1. Conflict of interest – Myth
Dispensing practices have been prescribing and dispensing subject to the scrutiny of our local primary care organisations for years. Thanks to this external scrutiny of our NHS dispensing activities, there is ample evidence that dispensing doctors do not prescribe expensive products to make extra profits.
2. Incentives received by dispensing doctors – Myth
It is important to distinguish between (public-private) partnerships, which are allowed – even encouraged – in the NHS, and industry incentives – which are positively and proactively discouraged by all parts of the NHS supply chain.
The new code of practice for the pharmaceutical industry, published by the Association of the British Pharmaceutical Industry in 2012 specifically tackles the issue of ‘inducements to prescribe’
Excessive prescribing – either by cost or quantity – is regulated by GPs’ contractual regulations and measures are in place to deal with breaches and assure accountability to the Treasury.
Annex 8 of the revisions to the GMS Contract 2006-07 addresses ‘excessive or inappropriate prescribing: guidance
for health professionals on prescribing NHS medicines’. NHSBSA data would suggest the safeguards and sanctions in place are effective in ensuring all GPs use NHS resources wisely and not for profit.
3. Doctor dispensing is more expensive for the NHS than pharmacies – Myth
- Tariff pricing is the same whoever dispenses
- Dispensing doctor clawback is 37.5% higher than pharmacy clawback.
- The average fee per item (overall) is lower in dispensing practice. Between April and October, 2011, the spend per patient by dispensing doctors (and this includes personally administered items whilst pharmacy data does not) was £85.25 per patient; the comparable figure for pharmacy was £95.26.
4. Compared to pharmacies, there is a lack of supervision – Myth
Patient safety is assured (and prioritised) in both practice environments by the use of standard operating procedures, a robust dispensary staff training programme and the on-site presence of an accountable, registered healthcare professional to take ultimate responsibility for the safe operation of the dispensary.
There is no evidence that doctor dispensaries are any “less safe” than pharmacy dispensaries.
5. GP dispensing takes no account of population growth- Myth
Population growth and its effect on dispensing rights has been addressed since 2005 and enshrined in law in the NHS Pharmaceutical Services Regulations. The agreement between pharmacies and dispensing doctors that led to these regulations still stands and has been carried forward unchanged into the
6. Patients prefer the convenience of pharmacies – Myth
Patient choice is at the heart of the NHS – particularly its latest incarnation shaped by the Health and Social Care Act 2012. When patients are eligible to choose to receive dispensing services from their GP the overwhelming majority choose to do so. The 2008 DDA Patient Survey demonstrates patients’ preference for GP dispensing services.