DDA dispels dispensing inequity myth

The DDA has responded to an article exploring the impact of NHS dispensing practice on equity in NHS payments to GPs.

Exploring the impact of dispensing practicing on equity in NHS payments to general practices concludes that general practices serving the most deprived populations receive less funding per weighted patient than those serving the least deprived.

It states that “inequality is driven by a higher concentration of dispensing practices in more affluent areas”.

The article states that across all practices, those in the least deprived 20 per cent received £182 per weighted patient in 2023, compared to £166 for those in the most deprived 20 per cent – a gap of £16. When dispensing practices are excluded from this analysis, the gap is only £1.

The article also notes that in 2023, 79.2 per cent of patients described their overall experience with dispensing practices as ‘good’ versus 71.6 per cent of patients of non-dispensing practices.

In response, the DDA can acknowledge that dispensing practices receive higher payments (funding) than practices in more deprived areas. As the article itself confirms this is because 99 per cent of GP practices in the most deprived quintile are non-dispensing practices. As you might expect, only dispensing practices receive payments made to fund the NHS GP dispensing service. These payments account for reimbursement for drugs purchased by the practice and a dispensing service fee.

Moreover, when comparing costs of areas predominantly served by dispensing practices with non-dispensing practices, the article fails to consider the NHS costs (fees and allowances) paid in more deprived areas to NHS pharmacies for providing NHS dispensing services ordered by non-dispensing GPs.

In terms of the comment that “dispensing practices are only likely to dispense enough medicine to be sufficiently profitable in rural areas”, ithe DDA would highlight the strict controls on the profitability of NHS dispensing both by pharmacies and dispensing GPs. Due to additional financial controls on NHS GP reimbursement, many drugs are, in fact, loss-making for NHS GPs.

Other points that the DDA would like to highlight are as follows:

Given recent increases in staff and operational (utilities) costs associated with running a dispensary – plus the well-documented additional costs of recruitment and retention in rural areas – the DDA would like to ask whether a £12,000 pre-tax, per annum difference between income for dispensing and non-dispensing practices seems that unreasonable. As in any business staff costs are the largest (and rising) area of expense.
Most dispensing practices recycle any additional income into additional clinical services, which are provided to offset difficulties rural patients encounter in accessing external local specialist NHS services. This may exert some influence on the cited higher patient satisfaction scores achieved by dispensing practices. In a deprived area where dispensing practices do not operate, the costs of these external services as well as those of pharmacies must also be considered in an overall calculation of ‘equity’

Concluding, DDA Chairman Dr Richard West said: "While we laud your ambitions for equality and equity of care across the whole population, the specific costs of the NHS dispensing GP service, as well as the specific needs of rural populations deserve equal consideration when considering the holistic costs of service provision."