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Tens of thousands of dispensing patients lose vital rural service

Only one thousand dispensing practices in England remain

November 16th 2017

Tagged: DDA news political news Rurality

By Dr Allan Tennant and Ailsa Colquhoun

Some 50,000 rural patients have lost the vital life-line of the GP dispensing service in under two years, NHS data has revealed.

Compared to April 2015, official NHS data for July 2017 also records a 4.3 per cent fall in the number of dispensing practices. Compared to 10 years ago, there are 13 per cent fewer dispensing GP practices; this equates to a fall in the number of dispensing practices of an average of around 15 each year.

England annual data 2003 2005 2007 2009 2011 2013 2015 2017
Dispensing doctors 4995 5279 5311 5731 5830 6206 6396 6675
Dispensing practices 1174 1179 1149 1139 1118 1076 1045 1000
Dispensing patients (Millions) 3.41 3.48 3.49 3.51 3.43 3.31 3.23 3.18
Total patients in a dispensing practice (Millions) 8.274 8.213 8.23 8.21 8.35

In the 2018 contract for Scottish GPs, announced on Monday, the Scottish Government pledged to consider the current dispensing arrangements and look for “mutually beneficial improvements”.

Scottish politicians acknowledge that rural GPs provide the broadest range of skills because of their remoteness. Ministers say: “They usually have smaller primary care teams… and locality services that may be available in areas with larger populations may not be available.”

They also accept that rural general practice  requires exceptional funding, due to its unique operating cost model.  Since 2014, the Scottish Government has officially acknowledged the important cross-subsidy of rural medical services by dispensing income: that year it revised the Scottish pharmacy control of entry regulations to protect specifically rural medical services provided by dispensing GPs.

Evidence provided by the BMA demonstrates that these are cost-effective investments in a service that solves the challenge of providing NHS medical services in remote and rural areas.

The DDA believes there are many reasons for the fall in the number of dispensing practices and, a result, the number of patients who can receive the dispensing GP service:

  • Mergers of dispensing practices
  • Practice closures
  • Pharmacy applications either by practices or pharmacy companies. Recently-published NHS data for 2016-17 records the number of pharmacy applications in areas where dispensing practices operate
  • Giving up dispensing as it becomes uneconomic
  • List cleansing
  • Non-dispensing patients in a non-dispensing practice, living in a controlled area who change practices to a dispensing doctor without moving address.

According to NHS Digital 202 practices closed or merged in the last year up to June 2017, equating to nearly four every week.  The rate of closures and mergers is detailed in another NHS report.

The DDA urges the Government in England to act with immediate effect on the mounting cost and other pressures in dispensing practice.

Action on reimbursement and remuneration of dispensing practice will stabilise rural general practice, and protect a vital, cost-effective NHS asset.

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