Myth: Dispensing GPs are profligate prescribers
It is impossible to generalise about GP prescribing as it is unique to each GP, their patients, their practice and their locality. Therefore, all GP prescribing is accountable to the local primary care commissioning organisation (PCO), which is best placed to understand the local prescribing environment.
At the national level, safeguards are in place to prevent excessive prescribing by GPs either by cost or volume.
However, there are influences that specifically influence prescribing in rural areas.
Rural demography: Rural areas have a higher proportion of older people compared with urban areas. In 2019 in rural areas, people aged 65 and over accounted for 25.1 per cent of the population, compared with 17 per cent in urban areas.
In rural areas, the most prominent age groups are 50 to 54 and 55 to 59-year-olds, accounting for 7.9 per cent of the rural population, while in urban areas age groups 25 to 29 and 30 to 34-year-olds account for 7.2 per cent of the urban population.
Rural areas also have the highest average life expectancy with rural people expected to live two years longer than their urban counterparts.
In broad terms, use of prescribed medicines increases with age, and has been found to peak in the oldest age group (75 years and over). A pan European study finds that prescribed medicines use ranges from 2-33 per cent in the youngest age groups, and between 68-96 per cent in people aged 75 and over.
Improved adherence: The GP contract Quality and Outcomes Framework lists a number of clinical outcomes that are medicines dependent. Dispensing and non dispensing practices have been compared for their performance in nine such areas in a paper in the British Journal of General Practice. This found that adherence to prescribed medicines (and thus the medicines-related clinical outcomes) was better in dispensing practices.
The study hypothesises that the streamlined access to medications offered by an onsite GP dispensary in a dispensing practice may contribute to improved adherence relative to that seen in non-dispensing practices.
Many factors affect a person’s adherence to a prescribed medicine regime, but one of these is access to medicines. Between 11-19 per cent of prescriptions are not actually dispensed to the patient, due to barriers at patient, doctor, and healthcare system levels, including prescription charges, and distance to an open pharmacy.
As prescription costs and volumes per GP can only be calculated once the prescription is dispensed, it follows that if a dispensing practice improves access to medicines, they will also report increased prescribing volumes and costs – as well as clinical outcomes.
For more information
Statistical Digest of Rural England – December 2020
EuroStat [online] Medicine use statistics
British Journal of General Practice (2021) Medication adherence and clinical outcomes in dispensing and non-dispensing practices: a cross-sectional analysis
Myth: Dispensing GPs favour prescribing the most profitable drugs
As a cost-containment measure, all NHS GPs are encouraged to prescribe generically and generic prescribing rates are among the prescribing indicators measured by the GP’s local primary care commissioning organisation (PCO).
However, there are clinical factors that may prevent a GP from prescribing a generic version of a drug, for example, when bioequivalence between different generics cannot be assured.
Equally, a GP’s prescribing may be influenced by the strategic policy of their PCO.
Myth: Dispensing GPs will prescribe an over-the-counter medicine on the NHS rather than ask a patient to visit a pharmacy
All GPs in England are discouraged from routinely prescribing certain over-the-counter (OTC) medicines. However, dispensing GPs’ full compliance with this guidance is confounded by their duty of care to patients in need of that medicine for two main reasons:
- By regulation dispensing surgeries only exist in locations where access to a community pharmacy is difficult or non-existent. Equally, rural locations often have poor access to shops where open-access medicines may be sold.
- NHS GMS regulations prevent NHS GPs from charging patients for items that can be prescribed on the NHS, and this includes many items that are also available over the counter.
The DDA has to date unsuccessfully requested that the regulations be changed to allow dispensing GPs to charge their patients for OTCs.
For more information:
NHS England: Guidance on conditions for which over the counter items should not routinely be prescribed in primary care
Myth: Dispensing GPs will poach patients from pharmacies
There are strict regulations covering to whom a dispensing GP may dispense, based on the patient’s place of residence, their choice of dispensary service provider, and availability of local pharmacies. A dispensing practice is unable to ‘poach’ patients who are ineligible for, or who choose not to use, its dispensing service.
Myth: Dispensing GPs earn more than non-dispensing GPs
Comparisons of £ per £ GP earnings may suggest that dispensing GPs earn more than non-dispensing GPs. However, the two data sets are not comparable: unlike non-dispensing GPs a dispensing practice bears the costs of, and is paid for, providing two services: the GP medical service, and what equates to the ‘essential services’ element of the community pharmacy contract. In many scenarios, and given the increased costs of providing rural medical services, it is acknowledged that the income from the dispensary cross subsidises the provision of what otherwise would be an uneconomic GP practice.
For more information
NHS Digital: GP Earnings and Expenses Estimates