GPs Demand Action To Protect Services In Scotland's Rural Communities

Main Category: Primary Care / General Practice
Article Date: 02 Oct 2007 - 2:00 PDT

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Doctors warned that rural GP services are increasingly under threat as new pharmacies are introduced into small rural communities in Scotland, without local consultation into the consequences for patient services in the area. The warning comes at the start of Rural Health Week (1 - 6 October 2007).

GPs in some of the most isolated communities in Scotland offer pharmacy-type dispensing services and are known as 'dispensing doctors'. They combine GP and dispensing services in the practice, often in communities where no pharmacy or chemist is available. This ensures that patients have local access to essential pharmacy services and for GPs, the additional income from dispensing allows them to provide a wider range of services locally.

Changes to the national pharmacy contract enable pharmacists to provide a number of additional services as part of their business making community pharmacies more viable in smaller communities. However, a consequence of this is that existing GP practices lose their dispensing rights and subsequently the loss of income limits their ability to deliver additional medical services to patients and could impact upon the provision of services and clinics locally.

Dispensing doctors believe that this represents a change to local service delivery and as such, requires full public consultation under the arrangements set out in the NHS Reform (Scotland) Act 2004.

Dr Andrew Buist, Deputy Chairman of the BMA's Scottish General Practitioners Committee and lead on rural health issues, said:

"We can appreciate the desire of NHS boards to approve new pharmacies in some areas previously serviced by dispensing doctors, but careful consideration must be given to the impact this will have on the provision of GP services. Generally dispensing practices use income from dispensing to provide a wider range of services for their patients, often employing additional staff such as nurses or extra GPs. Consequently, the withdrawal of dispensing income may pose a serious threat to the sustainability of these services. It is clear that, without financial protection, a practice could be destabilised by the loss of a substantial portion of its income over a short period of time.

"Residents in local communities may welcome the establishment of a new local community pharmacy however if they were made aware of the impact that this could have on their ability to access a wider range of healthcare services from their local GP practice, then they may not be so enthusiastic. We therefore believe that NHS Boards should be obliged to consult with local residents to establish their views before approving pharmacy applications."

Dr Susan Taylor, Chair of the Rural Practitioners Association in Scotland, said:

"Rural dispensing GPs currently provide excellent services to their patients, but cannot access the new income streams available to community pharmacists under the new contract. Destabilisation of these rural practices by the introduction of a new pharmacy could mean communities will lose access to a local GP service."

1. Dispensing doctor practices exist in areas of Scotland where the population density is considered too low to support a pharmacy.

2. There were 278 dispensing doctors in post at 1 October 2006, numbers have been gradually increasing since 1999. (Source: Scottish Health Statistics, Information Services Directorate, NHS Scotland at http://www.isdscotland.org/isd/

3. The highest numbers of dispensing doctors are located in the Highlands, Argyll and Clyde, Grampian and Dumfries & Galloway.

British Medical Association