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Legal view: GPs must not direct patients to a particular pharmacy

“Prescription direction may be the last straw that breaks the back of struggling pharmacies”

If GPs direct patients towards a particular pharmacy, they will be both breaking their contract and could financially harm pharmacies, says legal expert David Reissner

I remember when my law firm got a state-of-the-art telex machine [for sending text] in 1986. Only a few months later, we got our first fax machine, which made the telex machine redundant. By 1993, we were using email. l don’t think I’ve received a fax since 2011.

I believe the general public would share the surprise expressed by health secretary Matt Hancock, when he discovered that fax machines were still being used in the UK. Indeed, he subsequently signed regulations requiring NHS trusts to stop using the machines after March.

In addition, the 2020 GP contract requires GPs to have an online presence to promote their services. Under a dispensing update rolling out this year, GPs can give a token with a barcode to a patient who has not nominated a pharmacy for electronic prescriptions, so that the patient can take it to any pharmacy.

Some GPs already promote services through apps. I’m aware of instances where these apps direct patients to a participating pharmacy, so I took a closer look at what the GP general medical services contract for 2018-19 says about electronic prescriptions and found this clause:

“The contractor [the GP practice] must:

“(a) not seek to persuade a patient or a patient's authorised person to nominate a dispenser recommended by the prescriber or the contractor; and

“(b) if asked by the patient or the patient's authorised person to recommend a chemist whom the patient or the patient's authorised person might nominate as the patient’s dispenser, provide the patient or, as the case may be, the patient's authorised person with the list given to the contractor by [NHS England] of all chemists in the area who provide an electronic prescription service.”

In other words, NHS doctors aren’t allowed to persuade patients to nominate a particular pharmacy. If they do, they will be in breach of their contracts.

Community pharmacies are already under severe financial pressure, and prescription direction may be the last straw that breaks the back of some struggling pharmacies. Right now, the focus of healthcare administrators is understandably elsewhere, but when the COVID-19 crisis has passed, NHS England needs to take action to enforce its contracts with GPs.

The healthcare system can survive without fax machines. It can’t survive without community pharmacies.

David Reissner is chair of the Pharmacy Law and Ethics Association

7 Comments

Benie I, Locum pharmacist

Maybe when Rudkin finishes his project on employment issues between locums and contractors he could turn his genius mind onto this. I remain a little baffled as I was led to belive the GPhC functions to 'protect the public'

P M, Community pharmacist

read pharmacy2u reviews ... the place should be shut down...

Oliver Staunton, Information Technology

Pharmacy2u gained over 20,000 patients this past week, according to PharmData https://www.pharmdata.co.uk/nominations.php

Could any of that be from GPs advising patients to use online pharmacies because of Covid fears? If a patient asks about options for online pharmacies, then does the contractual passage you quoted above not apply?

John Cleese, Production & Technical

The passage above always applies. DSPs are still "dispensers" in this legislation.

What the legislation covers but does not make explicit enough is that "The contractor [the GP practice] must not seek to DISSUADE a patient or a patient's authorised person from nominating a dispenser of the patient's own choice".

Oliver Staunton, Information Technology

John, that makes more sense. If a patient asks about options for a pharmacy that will deliver to their home, then you'd have to recommend a DSP, because standard contract pharmacies aren't obliged or contacted to do medication deliveries, and even if they do, they're not required to do it for free, whereas DSPs are. Also, prescription delivery in the current situation surely carries less infection risk than collecting from a pharmacy. If gov is advising public to use online food delivery, it is understandable patients would also want online prescription delivery.

Leon The Apothecary, Student

If you look up online prescriptions, guess who comes up first? That's a product of a good marketing guy improving the site's Google Ranking.

Jenny Etches, Community pharmacist

I always understood this to be the law. Although I know that it happens all the time.  In the same way community pharmacies can't recommend any particular surgery or have an opinion that might influence a patient. 

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