Andrea Leadsom: We must dispense with Labour's proposal to take medicines away from GPs

Andrea Leadsom, parliamentary candidate for South Northamptonshire, says the Government's proposed changes to the dispensing of medicines would create more work for GPs whilst cutting the income of their practices.

What more punishment does Labour have in store for us? I would have thought Gordon Brown would leave the family doctor well alone. The one professional in the UK that people trust is the local GP – those of us with young children have got to know our GP pretty well through many years of blood pressure tests, smears, inoculations, kids with chicken pox and sore throats.

Well, Labour has come up with a new plan that will pull the rug from under your local doctor. Their White Paper deviously entitled Pharmacy in England in fact proposes dramatic and far reaching changes to the way GP services are currently run in England.

The plan, put simply, is to stop GPs dispensing medicines from their surgeries. This will force pharmacies to assume control over dispensing medicines, in return for which the Government wants them to start offering a wider range of services, including diagnosing minor ailments and managing chronic illnesses such as diabetes and asthma.

On the face of it, this might appear positive from the point of view of patient choice and accessibility. But there are two fundamental problems with stopping doctors dispensing.

The first is obvious. The 3.5 million dispensing patients in England will no longer be able to pick up a prescription from their local surgery. Patients will have to go to their nearest Chemist which (because of the ‘distance’ rules on dispensing – a GP can only dispense to a patient who lives more than 1.6 miles from the nearest Chemist) will certainly be more than 1.6 miles from their home.   

The second problem is more subtle. Between a quarter and a half of total income of a dispensing practice comes from dispensing medicines. This income enables a practice to have more GPs than they could otherwise afford, and in many cases, subsidises the cost of running branch surgeries, particularly in rural areas.

In total there are over 5,500 dispensing Doctors in England, working from 1,135 dispensing practices.   

The loss of income from dispensing would mean inevitable closures of hundreds of surgeries across England and a reduction in the number of GPs in many of the dispensing practices that stay open.

With fellow Northants PPCs and MP Tim Boswell, I met with a group of GPs on Saturday from a Dispensing Doctors Advisory Panel (DISPEX). A lady GP told us that she had recently recruited a new Partner for her GP practice. He had only been working for one week when the White Paper was issued.  When he saw it, he resigned his new job with immediate effect. His view was that there would not be a job for him in one year’s time if the dispensary was to go, and therefore it would be better to pursue his career elsewhere.  This lady GP told us his analysis of the surgery’s financial position was quite correct.

In South Northamptonshiree our rural communities would stand to lose out in a big way. Most villages do not have a chemist. Our dispensing practices tend to have branch surgeries in smaller villages that are paid for by the income from the dispensary. In as short a time as one year, local doctors could be faced with a huge loss of income and the prospect of closing down services to the local community.

But that’s not the only effect of the Government’s White Paper. The second part of their plan is to have Pharmacists diagnosing and treating so called ‘minor’ ailments.   

What happens when you take your child to the chemist because she has a cold and is running a fever?  The professional pharmacist will do one of two things: either tell you it’s a cold and to give her paracetamol and an early night; or, if it appears to be something worse than a cold, tell you to go to your GP for medical advice.   

In the case of the latter, you’ve now got to get to the surgery, which you may as well have done first time round... you will also be feeling anxious that it may be something serious, because the pharmacist had no choice but to express his concern.   

In the case of the former, all is fine if it is just a cold. But what about the rare occasions when what appears to be a cold in fact is early stage meningitis? Many pharmacists fear that they will be pressured to undertake new tasks that are outside their comfort zone and training. The pharmacist is being put in an invidious position. As one GP at the DISPEX meeting put it to me – 29 out of 30 patients in a GP’s waiting room are the ‘Worried Well’; the other one patient has a serious health problem, and it is experience and years of training that enable the GP to identify which is which.

The fear of the GPs and pharmacists is that we will end up with a new and worse version of what they have nicknamed ‘NHS Re-Direct’. In other words, NHS Direct has been a waste of money because it has ended up re-directing so many patients to their GP. If pharmacists take on a complimentary professional role, they too will be forced to re-direct the majority of queries to a GP because they do not have the medico-legal insurance cover, (costing up to £6,000 per annum), of their GP colleagues. The workload of a GP will end up remaining the same while the income stream to pay for it will no longer be there.   

The loser will be patient care and patient choice.

Comments

[Louise Bagshawe]

Andrea is to be congratulated for flagging up this issue. I predict it will become massive on the doorstep.

I attended the meeting with other local Conservatives. Listening to the doctors present was dispiriting. At the end of it, I asked if this was a fair summary: the lost income from dispensing would mean

1. Rural branch surgeries could shut altogether and
2. Urban GP surgeries would lose doctors, so that a town surgery with three doctors would now only have one and a half, to treat the same number of patients.

As well as the direct threat to GP surgeries, there are the further issues Andrea highlights: patients, including the elderly, having to travel for prescriptions, and the health risks of having non-doctors diagnose "minor ailments" which may well not be.

The doctors' group gave me a map of the surgeries affected in Corby & East Northants. There are ten of them - two in Corby proper, one in Weldon, one in Irthlingborough, several in the rural villages and other market towns. This white paper will plague the entire seat.

PPCs and MPs across the country will find themselves equally affected.

This is a nationwide NHS cut from Gordon Brown. In Corby & East Northants, local Conservatives including councillors at all levels will be fighting it.

[Perdix]

The Government set up systems such as Quality of Outcomes Framework (QoF) so that they could monitor the GPs' activity and reward them accordingly.Unfortunately for the Government they priced the activity in a way that merely confirmed that the GPs were doing desirable activity anyway and "overpaid" the GPs for their work. Having been embarassed by this, the Gov is seeking to undermine GPs and seemingly wants to make them all direct employees of the State,rather than independent providers,so that they have more control.
It will all end in tears for all of us.

[sanjay]

i am a dispensing GP- well done Andrea a politician who understands the predicament this current govt is putting Gps under. Not a week has gone by in recent months when i have not sat down with my wife to consider alterantive careers or to take our skills abroad. i love my job, i enjoy the relationships i have with my patients and the ability to care for whole families with continuity. I despise change that wastes tax payers money for political gain e.g polyclinic. nhs IT system, choose and book and extended hours. If someone does not stop this constant GP degredation, healthcare will suffer. I would gladly get paid half of what i do to have a job with a protected lunch break, no life or death responsibility and not at the mercy of this givernments idiocy.....the only problem is i would miss my patients

[Dr Irene Bainbridge]

Congratulations, Andrea, for your brilliant article highlighting the imminent dangers facing rural dispensing practice and what it would mean for patients.
We at the Dipensing Doctors' Association, need the support of MPs like yourself to help our campaign in Parliament to expose the disastrous consequences of the Government's White Paper on Pharmacy, which you have spelt out in such grim detail.
Please take this as far as you can.