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Prescription direction is hurting patient care

Prescription direction fetters choice, is anti-competitive and serves as a barrier to inter-professional collaboration between pharmacists and doctors, writes John D'Arcy


The issue of direction is not new, but falls into the box labelled ‘too difficult'. In the case of the electronic prescription service, there is a bar on direction – regulations are in place forbidding doctors from persuading patients to nominate particular pharmacies.


But no such bar exists in the case of paper prescriptions. That said, General Medical Council (GMC) ethical guidelines make it clear that patients should be free to go to the pharmacy of their choosing and doctors must not allow financial or commercial interests to influence the way in which they advise patients. Nice words, but nobody seems to want to get involved in enforcing them.


I spoke to a pharmacist recently who is seeing his business disappear as a significant number of prescriptions are being diverted away from him to a competitor. Following unsuccessful attempts to resolve the problem at local level, he complained to NHS England, which referred him to the General Pharmaceutical Council, which told him to complain to the GMC, which in turn advised him to complain to NHS England! Nobody, it seems, wants to deal with this issue.


But somebody must. Patient care is based on choice and competition. It will also work best when there is collaboration between healthcare professionals. Prescription direction fetters choice, is anti-competitive and serves as a barrier to inter-professional collaboration between pharmacists and doctors. If left unchecked, it will harm patient care.

John D'Arcy is managing director of Numark

One of the key concerns expressed about putting GPs in control of commissioning in the reformed NHS in England was whether there would be sufficient probity in the process. As GPs were to become both commissioners and providers of services, there was an obvious question about how this conflict of interest would be managed. To get the bill through parliament, a number of probity measures were drawn up to assuage criticism.


Pharmacy was active both in expressing concern about the potential for abuse of this position and in seeking assurances there would be sufficient probity to ensure equity and fairness in the commissioning process. Pharmacy's concerns were based on experience of direction of prescriptions: the exercise of undue influence by a medical practitioner over the choice of where a patient has their prescription dispensed.


The number of complaints about this practice has escalated recently. These accusations come hot on the heels of a series of complaints related to GPs opening exempted pharmacies in direct competition with existing pharmacies or blackmailing them for a share in their business with the threat of opening in competition.

Prescription direction fetters choice, is anti-competitive and serves as a barrier to inter-professional collaboration between pharmacists and doctors



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