Two sets of data published by Scotland's Information Services Division reveal the nonsense of current NHS rural policy: one acclaims the superior patient experience offered by Scottish rural dispensing practice, the other the decline in the number of dispensing practices in Scotland.
The former reports how NHS Orkney has topped the all-Scotland league for overall care provided by GP practices – in NHS Orkney, the majority of practices dispense.1 The latter reveals a dramatic reduction in the number of dispensing practices in Scotland. These figures are echoed in the earlier analysis of rural patient satisfaction in England, published by the Dispensing Doctors' Association.2
UK Governments are spending more and more time and money on understanding and quantifying patient satisfaction with medical services, and from the Treasury's point of view the most deserving practice to dispense is the remote, rural practice serving a small, sparse population. Income from dispensing cross-subsidises the rural practice's small, sparse patient list, delivering cost-effective pharmaceutical services and creating practice viability at no extra cost to the taxpayer. This situation is replicated all over the UK. So why do Governments north and south of the border persist in destabilising the exact same services highlighted by patients as the most desired?
When given a choice, patients invariably prefer to obtain their medication from their doctor. The loss of dispensing sees a reduction in medical services to patients.
In rural areas, cross-subsidy of medical services is a reality.3 Also, some newly opened rural pharmacies are sold on. Government subsidy of the Essential Small Pharmacy Scheme is used to protect pharmacies that are not economically viable because of their location. As purchase margins decline, will this prompt more pharmacies in rural areas to lobby for government subsidy?
In these times of austerity, it begs the question: why does the Government allow pharmacy applications which, actually, may not be wanted or even needed – particularly when these pharmacies cost more than a practice's dispensing service and damage the same medical service that records the highest patient satisfaction levels?
Dr Allan Tennant is a GP in North Lincolnshire
References
1. http://www.scotland.gov.uk/Publications/2012/05/8250/0
2. http://www.dispensingdoctor.org/comments.php?id=2102
3. http://www.dispensingdoctor.org/content.php?id=1374
