Pharmacy leaders have raised fresh concerns over the ethics of pharmacies with financial ties to GP surgeries, arguing that commercial interests could make it difficult for pharmacists to remain truly independent.

GPs holding a stake in pharmacies and looking to boost profits and rental income were ensuring prescriptions stayed on their premises, pharmacists reported.

The comments come after a C+D poll of more than 570 readers found that 39 per cent were against locating more pharmacies in surgeries, citing fears over losing their professional autonomy. And 23 per cent said pharmacy should maintain a strong presence on the high street.

"As superintendent, you should have total freedom to control the business, but you can feel intimidated by an assertive GP director" Nick Hunter, Doncaster and Nottinghamshire LPCs	More on surgery pharmacies GPs eye surgery pharmacies despite 100-hour demise IPF slams RPS for 'inappropriate and wrong'       comments on GP in-house pharmacists Working with GPs
	Nick Hunter, secretary for Doncaster and Nottinghamshire LPCs, said he had seen some pharmacists resign from surgery pharmacies because of fears over commercial conflicts. Despite disagreeing with the direction of prescriptions, some felt too intimidated to speak out about the practice, he told C+D.

"I know from talking to pharmacists who have worked in those environments that they feel in an impossible situation and need to make very difficult decisions," Mr Hunter said. "As superintendent, you should have total freedom to control the business, but you can feel intimidated by an assertive GP director who runs the business."

The Independent Pharmacy Federation (IPF) also voiced doubts over whether pharmacists could maintain professional independence in a surgery setting. "If you're employed by the GP or a company owned by a GP, there's a risk there may be an adverse effect," said IPF chief executive Claire Ward.

There was often "some form of encouragement" from GPs to use the on-site pharmacy, Ms Ward told C+D, potentially damaging the surrounding pharmacy network. "We're concerned that the growing number of pharmacies within GP surgeries may lead to a loss of patient choice and the undermining of the community pharmacy network," she argued.

Pharmacists in GP surgeries often felt under "a lot of pressure" to turn around high script volumes, said Dilip Joshi, chair of Lambeth, Southwark & Lewisham LPC. He argued that the "unequal relationship" between doctors and patients made it easy for GPs to influence their patients' choice of pharmacy.

"In the short term, you're looking at commercial issues but, in the long run, you're looking at healthcare being affected if you haven't got proper distribution in the pharmacy network," he said.

But Kevin Cottrell, general manager of SG Court Group – a group of 20 pharmacies in south-east England – argued that surgery pharmacists could assert their professional independence. The SG Court Group owns seven surgery-based pharmacies, and Mr Cottrell said they had helped to build a good working relationship between the two professions.

"We have pharmacists that work very closely with GPs in surgeries and have a lot of respect from GPs," he said. "If you're going to lose your autonomy, it's your fault. I think it's down to you, not your location – if you're a strong, professional person you will get their respect."

Do you think pharmacy's future is on the high street or in the GP surgery? Comment below or email us at [email protected] You can also find C+D on Twitter, LinkedIn and Facebook