One of the most common enquiries I receive is about the direction of prescriptions by GPs to a pharmacy in which they or a family member have an interest.

There is nothing wrong in GPs having an interest in a pharmacy, but there is a lot wrong with using the influence they have over their patients for financial gain. The General Medical Council (GMC) guide Good Medical Practice says: “You must not allow any interests you have to affect the way you… refer or commission services for patients.”

Sometimes, the concerns I receive do not involve pharmacies in which GPs or family members have an interest, but independent third parties that might look to do some kind of deal with the practice. This, too, is covered by the GMC’s guide, which says: “You must not ask for or accept… any inducement… that may affect or be seen to affect the way you… refer patients.” A separate GMC document that deals with doctors’ financial and commercial arrangements repeats the guidance specifically in the context of having an interest in a pharmacy business.

Unfortunately, there’s a world of difference between setting out the principles and expecting all GPs to comply with them, let alone enforcing them. But before we condemn GPs alone, it’s worth bearing in mind that it takes two to tango.

The only way pharmacists can fight back is by making a complaint, which will need to be backed by some kind of evidence. Patients may tell a pharmacy owner that their GP has told them to take their prescription to a particular pharmacy, or that they have been approached by a third party, saying that a particular pharmacy has the blessing of their GP. These patients will need to sign witness statements. But this can prove difficult and, ironically, some pharmacy owners affected by the direction of prescriptions worry about whether a complaint to NHS England or the GMC will jeopardise their relationship with the medical practice.

When NHS reforms were introduced in 2013, regulations were made requiring NHS England and clinical commissioning groups to take account of patient choice, and a patient’s right to choose a GP was specifically enshrined in law. However, for reasons that have never been satisfactorily explained, these regulations do not apply in respect of pharmaceutical services.

If there is no effective control within the healthcare system, it is inevitable that the issue of prescription direction will end up being brought before a court of law.

David Reissner is senior healthcare partner at law firm Charles Russell Speechlys LLP ([email protected])

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