A range of measures are in place to protect patients and the NHS from excessive prescribing by dispensing GPs:

Inspection: Dispensing practices are subject to inspection by appointed experts in pharmaceutical services. The regulator for England, the Care Quality Commission (CQC) has conducted research that concludes that dispensing practices receive a disproportionate number of ‘outstanding’ ratings.

NHS contractual obligations: “Excessive prescribing” is defined within the GP contract with the NHS, as set out in NHS General Medical Services Regulations (Part 8).

Regulations state that practices can be in breach of their contract by prescribing drugs, medicine or appliance whose cost or quantity, in relation to any patient, is, by reason of the character of the drug, medicine or appliance in question in excess of that which is reasonably necessary for the proper treatment of that patient.

Primary care commissioning organisations (PCOs) are authorised to manage excessive prescribing and any health professional believed to be prescribing excessively may be subject to challenge by their PCO and required to justify their prescribing behaviour.

For further information, visit British Medical Association [online] information: Prescribing in general practice  

Reimbursement controls
‘Clawback’. A system of deduction from reimbursements paid to dispensing practices is automatically made by NHS prescription pricing authorities to account for assumed profits made on drugs purchases.

In dispensing practice, these deductions (known as ‘clawback’) are applied to all reimbursements (irrespective of the actual purchase price) whereas in community pharmacies a number of drugs are classified as ‘Discount Not Deducted’ (DND) and thus, have no clawback applied to the reimbursement the pharmacy receives.

For further information, visit the Pharmaceutical Services Negotiating Committee website information on discount deduction and items classified as DND.