‘I couldn’t see us purchasing a dispensing service from pharmacy’

Dr Stoate,

Clearly you present a very one dimensional picture of Pharmacists and GP's. I also understand your vision for pharmacists doing more than dispensing, however, economic reality will dictate what role we undertake. It's simple for you to say to pharmacists, to supervise staff to dispense, but then what about patient safety and duty of care. We don't merely dispense, we check GP prescribed dosages, we council patients, we provide a legal check for doctors, rather like a safety net. Would you want pharmacy staff to undertake these roles?

You must also understand that GP and Pharmacists have not felt equal pain, mainly because whilst your colleagues were enjoying ludicrous remuneration, we never ever benefited from Labour's free give away. Therefore your colleagues and you will never feel our pain.

As for suggesting that if dispensing services were in clinical commissioning groups scope of control, then you would look at other providers of dispensing services, for cost effectiveness, then you are kidding yourself. You would need to lobby government to change legislation.

Furthermore, if GP's had managed to be cost effective over the boom years, the health service may have been in a better more equitable state. I therefore suggest, clinical commissioning groups should start by looking at the cost effectiveness of GP services.
This is where the majority of savings can be made, especially ludicrous pension deals your colleagues have secured.

It should not be forgotten that GPs were sitting in Clinical Executive Committees (CEC) or their forerunners PECs in PCTs for many years contributing to decisions on the commissioning of enhanced pharmacy services such as minor ailments, smoking cessation, etc, most of which we have seen withdrawn around the country in recent times. This even happened where evidence showed that they were successful. If pharmaceutical services did come under the control of CCGs I would not be confident for GPs to perform any better. Also the DOH and clinicians seem to have conveniently forgotten the general failure of practice based commissioning. Lets hope for the sake of patients the same mistakes are not allowed to happen again! With the knowledge that I have of the way general practice finance works I am sure I could easily and quickly deliver efficiency savings by highlighting to the DOH where taxpayers are not getting efficiency and value for money from the way General Medical Services and Personal Medical Services have been set up. Maybe on a commission only basis!

Agreed, GPs on the whole (not all) do not place enough value on the quality dispensing services provided by community pharmacy. We save patient's lives and safeguard their health day in day out by spotting GP prescribing errors and intervening in countless ways. Sadly just like the Department of Health our dispensing role is undervalued particularly with the ever diminishing remuneration. How many GPs face would we have left practicing if they faced their regulators for every prescribing error they made or faced criminal prosecution for a 1 in 100,000 dispensing error? Many GPs do not wish to diagnose and I am sure Pharmacist and Nurse prescribers could replace GP prescribing for minor ailments at a fraction of the cost!!! We do not require any more belittling Mr Stoate, the PSNC and DoH have done enough of that. Ignore the fact that 1000's of community pharmacists have stood for 10-12 hours a day and seen hundreds of patients every working day for their whole careers do not qualify for a NHS pension unlike some GPs who have 3 hour lunches and see a handful of patients a day from their comfy armchairs knowing they will retire on an annual pension more than double what any pharmacist will ever earn working.

Spot on Rajive. It’s rather unfortunate that many of our Pharmacy colleagues have allowed GP politicians, PSNC and the DoH to take our dispensing service for granted. At the end of the day, Pharmacists during clinical checks have saved many lives from Doctor's prescribing errors for nearly half a century now. Pharmacists must now make it a duty to keep records of all such interventions, as I believe the lack of such records allows for many individuals to make uneducated comments regarding our role.
The dispensing process as quick as it might seem to the uninformed outsider involves a highly demanding mental task of developing a 'SOAP' format Pharmaceutical care plan and ensuring safety before issuing medication out but this is mostly done mentally and as mentioned Pharmacist have not been systematically documenting this process. At the end of the day, Mr. Stoate is a GP and will play politics with other health professional's relevance so he can grab more for his colleagues. His statement “I couldn't see Bexley purchasing a basic dispensing process from community pharmacy, at least not at the price the NHS is currently paying" is so shortsighted and can only come from a system run like a communist state. The end user of Pharmacy service i.e. patients in other western countries appreciate and pay well for dispensing service. Therefore fellow Pharmacist, do not let anyone rubbish your dispensing service. It’s the core AND MOST IMPORTANT of all Pharmacy service and as such adequate remuneration should be provided for it before even talking of secondary services advanced or enhanced. Wait a minute! How did Pharmacists come to accept 90pence to deliver a service/procedure that can send them to prison in one tiny twist? Forgive me but this is terrible negotiation.

Colleagues

I'm wondering how may of you have jumped to (prejudiced?) conclusions without reading what Howard has actually written.

Howard is exceptional among GPs - a true champion of pharmacy - frequently arguing against the anti-pharmacy tide of his own colleagues. What Howard is saying, and I for one agree is that, if we want a decent future, we should "added value" based around our core dispensing role . MURs (if done properly) and the New Medicines Service are examples of exactly that.

We don't have enough external champions for pharmacy and we sure as hell can't afford to alienate those (like Howard) who are our "critical friends"

Graham

Naturally Graham, you must be in the business of Charity!