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Dispensing doctors make strange demands


Dispensing doctors make strange demands

The BMA’s recent representations to Parliament are enough to raise any community pharmacist’s blood pressure

Dispensing doctors. You’ve got to love them. Or hate them. It’s a free country – you can decide. Apart from when you can’t because you are one of the 9.3 million people that live in a community so rural you have no access to a community pharmacy.

The British Medical Association recently submitted evidence to the health select committee’s inquiry into community pharmacy services.

They argue that patients in rural areas are underserved because they don’t have access to the same services as patients with access to community pharmacies. Specifically, they bring up the hypertension case-finding service, but they take care to make their point across the board. 

Community pharmacy, according to the BMA, should have its role expanded so it can see more people and relieve workload on other parts of primary care. Patients should have medicines reconciliation post discharge from hospital at a community pharmacy. And pharmacists should be able to manage medicines shortages by making substitutions without the need to go back to the originating prescriber.

Sound familiar? I refer you back to Pharmacy In A New Age, re-released this summer in the form of a new Community Pharmacy England ‘Vision’. Let us for a moment take the medics at their word and give serious consideration to the points they raise. Actually, before we do that, they mention one other thing: they want access to pharmacy records in a contemporaneous manner.

Your eyes haven’t malfunctioned. You do not need to go to a highly franchised high street optician. The BMA is demanding real time access to community pharmacy records.

This is the same organisation that ran a coordinated campaign with the national press back in the 1990s to prevent medical records being computerised and held by hospitals (or nationally) as opposed to general practices.

This is the organisation that has fought its corner to be the gatekeeper to medical records – now arguing that it’s a problem that records can’t be easily accessed across care sectors.

Let us consider the argument for equitable access to pharmacy services from dispensing doctor practices. In my experience, local authority commissioning is relatively equitable across the board. If a contraception service is needed, a variant will be offered via a specialist service provider and alternative access provisioned from general practice and community pharmacy.

The same principle applies to tobacco harm reduction programmes. Other public health services such as weight management and health checks seem to be primarily provided by general practice over other primary care settings. It would be difficult for the BMA to complain about that.

What about medicines reconciliation? This has been a mainstay of lobbying by community pharmacy bodies over the last 28 years and interoperability of medical records (or the lack of) has always been the main sticking point. Even the imperative of a national service with funding has failed to deliver in many areas.

Then there is the hypertension case finding service. The BMA is petitioning for it to be available from dispensing doctors. I have good news for them – it already is.

They are doctors. They have a patient list, with postcodes, dates of birth, ethnicity and probably BMI numbers. A graduate student with a list of SNOMED codes and half an hour on the internet could run a query against the patient list that would highlight those who would benefit from a blood pressure check.

The community pharmacy hypertension case-finding service is designed to capture those who are not accessing other medical services. If you’re lucky enough to live in the rural commuter belt, your dispensing doctor isn’t going to be open when you get home. The pharmacy by the train station, or next door to the Pret at lunch might be.

It is easy to sympathise with the plight of these poor dispensing doctors – who receive more than twice the dispensing fee per item than community pharmacies. 

Before you get too distressed for the long-suffering GPs, I have to remind you they have been the commissioners for the last 20 years. Twenty years. They have commissioned not just hospital care but dentistry, optical, pharmacy, and yes – dispensing doctors. 

I spend a lot of time criticising the national negotiators at CPE Towers for their rather poor performance over the last few years. However, to read the BMA submitting evidence to Parliament that it is unfair that they have not commissioned a hypertensive case-finding service from themselves or that their obsession with being the gatekeepers of patients records is harming their ability to provide care… well, it warms parts of the soul that don’t normally get warmed this time of year.

Outsider is a community pharmacy commentator

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