95% of patients in rural areas who receive their medicines directly from their general practitioner (GP) would find it “difficult or inconvenient” if their surgery stopped dispensing, the government has been told.

These findings appear in a survey conducted by the Dispensing Doctors Association (DDA) in response to proposals in the government’s Pharmacy White Paper to replace the current market entry system for pharmacists, which is based on the “necessary or expedient” test, with one based on assessment by Primary Care Trusts (PCTs) of local pharmaceutical needs.

For almost a century, patients who live more than a mile from a chemist can choose to have their medicines dispensed by their GP, says the DDA, which represents the UK’s 5,872 dispensing doctors in 1,365 practices. These arrangements have been in place for almost a century, with a proven track record of safety, efficacy and convenience, and they represent a strong foundation on which to build a closer partnership between GPs and pharmacists in rural areas, the Association adds.

However, the government’s proposals would destabilise over 700 GP practices in England, resulting in job losses, service cutbacks, millions of patients losing the choice as to where they can collect their prescription medicines and reduced access to essential services such as branch surgeries and home visits, it warns.

The UK’s dispensing doctors look after more than 8 million patients, 3.5 million of whom are dispensing patients, and patient choice should be paramount in all cases, says the DDA. However, as different PCTs would make different decisions in identical cases, this would further add to the postcode lottery in health service provision, it says, adding: “although the presumed intention is to produce an equitable and fair system, the proposed changes will not achieve this aim.”

Last week, Mark Prisk, Conservative MP for Hertford and Stortford, presented a petition to the House of Commons on behalf of more than 10,000 residents of Cornwall calling for rural dispensing to be protected.
Conservative health spokesman Mark Simmonds has also expressed his concern. “I cannot see the benefit of the government’s proposals – if a patient receives a prescription from a dispensing GP’s practice now they are able to choose to have it filled at a local pharmacy if they wish,” he said, while Liberal Democrat health spokesman Norman Lamb added: “elderly and disabled patients have reported that they would find the journey to pharmacies difficult, and there is apprehension about the possibility that this will negatively affect their healthcare.”

Moreover, the Royal College of General Practitioners (RCGP) rural practice standing group warns that dispensing patients “have a high regard for the service they receive and the threat of loss is likely to trigger widespread discontent and protest in the rural communities affected. The loss of dispensing revenue could make many rural practices non viable in their present form and is likely to result in closure of many rural GP surgeries,” it adds.

And the Pharmaceutical Services Negotiating Committee (PSNC) has told the government: “we do not support any proposal to modify the market entry test if this has the potential to reduce collaboration between the two professions, since to do so will jeopardise development of patient care and threaten the Pharmacy White Paper aspirations to make better use of pharmacists’ skills and expertise.”