Pharmacists and GPs have raised concerns over online prescription business Pharmacy2U's latest venture, which offers surgeries a stake in a repeat prescription service.
Both professions questioned the ethics of communication sent out to GPs, which claims they could stand to earn "significant, uncapped revenue" by partnering with the business.
Pharmacy2U managing director Daniel Lee said the part-ownership model met "all regulations" and a leading lawyer confirmed it was not against the law (see legal view).
But healthcare professionals believed there would be a "huge temptation" for GPs to make the partnership more profitable by encouraging patients to take their repeat prescriptions to Pharmacy2U – a practice that goes against General Medical Council (GMC) guidance
A letter to a practice in Essex, leaked to C+D, offers GPs the chance to establish their "own branded repeat prescription service" and generate "ongoing, uncapped practice revenue"
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A letter from Pharmacy2U to a practice manager in Essex, leaked to C+D on Thursday (June 5), offers GPs the chance to establish their "own branded repeat prescription service". It touts the potential to generate "ongoing, uncapped practice revenue, without any impact on notional rent or sub-letting contract issues". The letter does not give any details of how the partnership would work and Pharmacy2U simply describes it as an "ownership model".
Fin McCaul, chair of the Independent Pharmacy Federation, branded the tactics "very unprofessional". "It's an inducement for the practice to set up a restrictive scheme," he argued.
If GPs took up the offer, it could be to the detriment of the local population, Mr McCaul stressed. "Things like this destroy local solutions and local pharmacies – the infrastructure that's in place to support not just prescriptions, but first-line treatment for patients," he told C+D.
British Medical Association prescribing lead Bill Beeby expressed "extreme concerns" over Pharmacy2U's proposition. Although most GPs "would not be impressed" by the communication, he stressed there were already anecdotal reports of GPs directing prescriptions for financial gain.
"The money you're talking about is such a huge temptation," Dr Beeby told C+D. This was especially true at a time when surgeries were feeling the sharp end of government cutbacks, he added.
But he warned there was no excuse for GPs encouraging patients to go to a particular pharmacy for financial gain or failing to declare commercial interests. "It's against all the GMC rules, potentially deprives patients of free choice and puts pressure on them they shouldn't have," he said.
Legal view: "The challenge is to identify unlawful inducement"
Noel Wardle, partner, Charles Russell
"It is not unlawful for doctors to hold a share in a pharmacy business. There are, however, legal and ethical issues that must be considered.
"Firstly, the pharmacy terms of service prohibits a pharmacy owner from promising any provider of primary medical services - including any person employed or engaged by a GP practice – any gift or reward as an inducement to recommend that patients present their prescriptions to a particular pharmacy.
"The doctors' code of conduct does not explicitly ban prescription direction. However, doctors are required by GMC guidance to:
● treat colleagues fairly and with respect
● not ask for or accept any inducement that may affect or be seen to affect the way they refer patients
● not allow any financial or commercial interest in a pharmacy to affect the way patients are referred
● be open and honest with patients about any interest in a pharmacy that could be seen to affect the way patients are referred
● not try to influence patients' choice of healthcare services to benefit themselves (or anyone close to them).
"The challenge for pharmacists faced with a case of suspected prescription direction is being able to identify there is some sort of financial arrangement that amounts to an unlawful inducement. Alternatively, they must persuade patients to complain where the GPs have sought to direct them to use an alternative pharmacy. We have had some success in the past in persuading doctors to see the error of their ways, or persuading the parties to engage with the LPC and LMC to resolve issues."
Dr Beeby revealed there had been even more aggressive bids for GP partnerships. One pharmacy company had offered a colleague a "five-figure sum" to set up a promotional table in their surgery, he said.
Numark managing director John D'Arcy warned the "potential for commercial gain" could tempt GPs into entering a partnership with the intention of directing prescriptions. "This would be unethical and a fundamental erosion of patients' freedom of choice," he argued.
Jignesh Patel, owner of Rohpharm Pharmacy in Plaistow, said he had a good relationship with his local GPs, who had made him aware of Pharmacy2U's approaches. But he highlighted the potential dangers in other areas.
"What about all those other GPs? Those pharmacies will have no idea what's happening behind their backs and will start losing large chunks of their businesses," Mr Patel stressed.
Pharmacy Voice reiterated that prescription direction "impaired patient choice and undermined free and fair competition between pharmacies". The lobbying group said it had presented the government with a set of anonymised case studies as part of its work with other pharmacy and GP bodies to highlight the problem.
Do GPs in your locality have a share in any pharmacy business and what impact has it had on your business?