Recent changes to the Scottish pharmacy contract could adversely affect Scottish dispensing doctors and reduce the range of services they can provide for their patients. Around 270 dispensing doctors operate in Scotland, almost exclusively in rural areas where, historically, it has been uneconomical to open a pharmacy.
Now that changes to the pharmacy contract include the provision of additional services such as minor illness services, which can bring in additional income, a rural pharmacy becomes a viable business option.
However, the opening of a village pharmacy will almost certainly mean that the local GPs will be required to stop dispensing, a change that can reduce a practice's income by as much as 30 per cent.
For many dispensing practices, this income is often used to finance additional medical services within the practice or to recruit an additional part-time GP. So, while patients in remote communities could gain a pharmacy, they risk losing a choice of GPs or access to a local medical service.
At present, the NHS Board's Pharmacy Practices Committee (PPC) decides if a pharmacy is necessary, a decision that must be based only on the need for a pharmacy rather than on any consideration of the wider impact on local healthcare services. It cannot consider the consequences of the decisions on the provision of primary medical services, nor can it take into account the views of patients and the local community.
Support from local community
The small village of Aberfoyle, near Stirling, is a recent example of how a Scottish dispensing practice threatened by a pharmacy application worked to enlist the support of its local community.
The two-partner practice of Dr Anne Lindsay and Dr William Pollok operates from twin surgeries in Aberfoyle and nearby Buchlyvie. Both have a small list size but the funding from dispensing allows them to maintain both surgeries, but the loss of dispensing income would have seriously threatened the continuation of both surgeries.
The doctors took action and, at a public meeting in the local community, highlighted the threat to the local services if a pharmacy were to open nearby.
The community took on board what was at stake, a patients' group was quickly established and a petition stating their satisfaction with the current dispensing arrangements gathered over a 1,000 signatures.
The PPC also received more than 100 letters in support of the dispensing doctors and was left in no doubt that the local community understood the implications of gaining a pharmacy only to lose a doctors, surgery. The PPC, however, was obliged to ignore the views of the local people.
Local opinion to be considered
Fortunately, on this occasion, the PPC concluded that a pharmacy was neither viable nor desirable and unanimously rejected the application, even without considering the petition. But other dispensing practices may not come out as well.
The BMA's Scottish General Practitioners Committee (SGPC) believes that situations like this represent a significant change to local service delivery and as such merit public consultation under the arrangements set out in the Scottish NHS Reform Act 2004.
SGPC is calling on the Scottish Government Health Directorate to issue clear guidance to NHS Boards to ensure that the PPC is required to take account of local opinion when considering pharmacy application and for the Scottish Health Council to consider reviewing this situation as part of its development of standards for public involvement.
SGPC would also encourage all dispensing GPs in Scotland to write to their local MSP and ask them to support the necessary changes to ensure that their local community's views are considered by the NHS Board whenever pharmacy applications are made.
Dr Buist is deputy chairman and rural lead of the Scottish GPC
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