Island faces having no GPs as doctors protest new pharmacy
All three Cumbrae GPs have threatened to quit the island over the opening of a pharmacy. Picture: Robert Perry
THREE island GPs are threatening to resign at the same time in protest over the opening of a pharmacy which, they claim, will destroy their livelihoods in what’s seen as a test case for many rural Scottish areas.
Husband and wife team James and Elizabeth Bryson have both worked on the Clyde holiday island of Cumbrae for almost 30 years and with their colleague, Prabhu Ravangave, for the last eight.
The three doctors say their income of around £430,000 annually from dispensing medicines to the island’s 1,300 population and visitors are ploughed back into running, staffing and developing their surgery.
But they fear a health board decision to allow a branch of a mainland pharmacy chain to open up near their surgery in the island capital, Millport, will slash the income they need to run a viable business.
The plight of the Cumbrae doctors is being echoed in rural and island areas all across Scotland, where many other dispensing practices are at risk of losing crucial income, says the The Dispensing Doctor’s Association.
They are currently awaiting a decision from Ayrshire and Arran Health Board on when they must stop distributing patients’ prescription medication, at which point they say they will resign together, leaving the island temporarily without medical cover.
Patients who voted overwhelmingly for the GP dispensing service to continue have written to health ministers outlining their support for the doctors and concern about a potential gap in medical services.
James Bryson, who began work on the island in 1984, said: “We made a profit (from dispensing medicines) that subsidised a health practice and paid for locums to cover weekends. Funds from the dispensary go back to the island, but all that’s about to be destroyed.
“The pharmacy opened at the end of October and we are awaiting the Health Board’s decision on whether or not to instruct us to cease dispensing. This would render our practice non-viable and all three doctors will resign.
“Around 40 per cent of residents on Cumbrae are over 60, so there’s a lot of illness, especially at night. Safety would be compromised.”
Jean Kerr, chairperson of the Elderly Forum on Cumbrae, said a consultation held by the health board on opening the pharmacy had produced widespread opposition. “We were supposedly consulted on this,” she said. “Three people voted for the pharmacy and 322 for keeping the status quo. Yet the licence [for the pharmacy] was awarded by the health board. The doctors weren’t allowed to speak at an appeal and we were incensed. Why change something that is working perfectly? ”
Around 150 dispensing practices still exist in Scotland, mainly in rural areas which are now being targeted by chains of pharmacy shops. Scottish Government policy is to open commercial pharmacies within easy reach of all NHS patients to cover gaps in services and reduce costs.
But doctors claim pharmacy managers are using Freedom of Information legislation to discover the most profitable areas before applying to open up potentially-lucrative new branches.
Surgeries in Carstairs in Lanarkshire, Chirnside in the Borders, and Leuchars in Fife have already had to reduce GP numbers and alter services after losing out to pharmacies.
Helen Russell, a patient who organised a campaign against a new pharmacy in Carstairs, said: “The dispensing GP service has served the area wonderfully for decades and has just got increasingly better over that time due to the practice ploughing money into it, with a great deal from dispensing revenue.
“It is lamentable that our government seems to be shying away from the obvious conclusion, the one reached in England a few years ago, of allowing dispensing surgeries and pharmacies to co-exist.”
Health boards say they have to consider applications from pharmacies under government legislation. But Dr Hal Maxwell, the Scottish representative of the Dispensing Doctors Association, said: “Health boards are very narrow in their view of this issue without looking at the overall picture.
“I’m concerned we have a situation in Scotland where there is no protection for dispensing doctors”.
Pharmacists insist they provide a better service for a lower cost, leaving GPs to concentrate on treating patients. James Semple, the superintendent pharmacist of the Gourock-based TLC group, which has opened 13 branches in Scotland since 2002 – including Millport, Leuchars and Tarves in Aberdeenshire – said: “Pharmacists who make applications to open pharmacies in areas where services are inadequate are performing an important public function. They are not ‘predatory’. They are doing the job they have been asked to do by the NHS.”
He added: “Gradually, people begin to realise that the sky isn’t going to fall in – and they begin to enjoy the benefits of having a pharmacy.”
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Comments
There are 59 comments to this article
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BowlingJean
Monday, January 30, 2012 at 01:15 AMDear Alan 365, I assumed you knew what you were talking about when you told me that the relevant regulations had been 'overhauled'. Now I'm far from sure. You now talk about "narrow minded repetition of the regulations" but that's a very different claim. I have no particular interest in the Cumbrae situation - I was merely giving my opinion based on my personal experience. I really don't want to get involved in an argument, so this is my final contribution. One last thing I would say - you appear to base your entire 'argument' on the fact that you have been told that “a GP could continue dispensing no matter how many pharmacies opened in the area”. Perhaps you missed it, but that's exactly what I said. There is no contradiction. If a pharmacy opens next to a GP dispensary then there is no law which says that the dispensary *must* cease to operate, or that a dispensary *cannot* continue. What the law says is that the NHS Board must reassess the accessibility to a pharmacy of each patient on the practice list. Those that continue to have a "serious difficulty" in getting to a pharmacy should continue to have the option of a GP dispensing service. Those that don't have no option - the GP can no longer dispense medicines to them. In Scotland there is no set formula - it is for NHS Boards to determine 'serious difficulty'. In England the rules are different, but we don't live in England. Alan 365 - you really are a dilettante.
alan 365
Saturday, January 28, 2012 at 09:09 PMDear oh dear, I am afraid that ‘House of Fun’ is not quite up to date with the position. In addition to the Scottish Minister for Health saying that GPs could continue dispensing he also said at the same meeting that “a GP could continue dispensing no matter how many pharmacies opened in the area”. No mention of accessibility as a restriction. He made the point that dispensing GPs in Scotland had the same protection as English GPs and it is understood that the latter continue to operate alongside pharmacies under similar legislation. The fact that Ayrshire and Arran Health Board are now deliberating so long and so widely on the very real difficulties faced by this island community due to weather delayed ferry services and the possible cessation of 24 hour availability of prescriptions, which may be brought about by resignation of the island GPs, indicates that there is more to the situation than can be met by a narrow minded repitition of regulations which in themselves are lacking in clarity and patient focus. High time they were revised to reflect the realities of life in a community. But there is nothing to stop Ayrshire and Arran Health Board deciding to keep dispensing going. ‘House of Fun’ will not like to hear that said but it is now a distinct possibility. ‘House of Fun’ is only concerned with seeing certain pharmacists,( because not all pharmacists by any means support what is being done to Millport), retain a monopoly on the profits from dispensing . Profits which GPs, as in Millport, plough back into their practices for the benefit of their patients. I rest my case and we should all now await the impending decision of the local health board. If there is any justice in this world Millport will keep its dispensing GPs
BowlingJean
Friday, January 27, 2012 at 11:55 PMAlan 365, do you intend to respond to HouseOfFun, or has he shown you up to be nothing more than a dilettante?
HouseOfFun
Thursday, January 26, 2012 at 11:09 PMBowlingJean, don't stand corrected just yet - Alan 365 clearly hasn't a clue what he's talking about. The regulations which changed in 2010 were the Pharmacy 'Control Of Entry' regulations. This was a welcome tightening-up of these regs, but most importantly gave no comfort to dispensing GPs who were lobbying to be recognised as providing a 'full pharmaceutical service'. The regulations which provide for dispensing by GPs to patients on their list who have a 'serious difficulty' in getting to a pharmacy are the General Medical Services regulations. These have not been changed, and your understanding of the situation is bang on. The law prohibits dispensing by GPs to any patient other than those described above. You were also correct to point out that a GP dispensary and a pharmacy can operate next door to each other - but only where there is a cohort of patients on the GP's list who still have a serious difficulty in accessing the pharmacy, and the GP dispensary can only dispense to these specific patients.
BowlingJean
Wednesday, January 25, 2012 at 06:53 PMAlan 365, I stand corrected. I was not aware that the GMS regulations have been changed.
alan 365
Wednesday, January 25, 2012 at 09:22 AMBowlingJean the regulations have indeed been overhauled since you last visited them. In 2010 as result of public consultation in which I was involved I am sorry you have not looked at the whole situation regarding Millport as you would then see what is in danger of being lost forever.
BowlingJean
Tuesday, January 24, 2012 at 06:44 PMI do apologise again - I said " it is absolutely true that a dispensary must close when a pharmacy opens". I should have said "it is absolutely true that there is no rule which says that a dispensary must close when a pharmacy opens". Goodness - this does get complicated!
BowlingJean
Tuesday, January 24, 2012 at 06:40 PMAs a long-retired NHS administrator, I wonder if I may be so bold as to comment. I do so with the benefit of some experience, however it's been a long time and I do not know if the regulations have changed significantly since the days when I was involved in such matters. Alan 365 and Budice both make excellent points, but I fear that neither have properly grasped how the regulations work. Let me begin with Budice. Heshe believes that when a pharmacy opens (in an area where there is a dispensing GP) then "the dispensing doctor is required to cease dispensing and make way for the pharmacy." This is not true. When a pharmacy opens in close vicinity to a Dispensing GP then the NHS Board must reassess the need for any specific patient to have their prescription dispensed by their GP on the grounds that they CONTINUE to have a serious problem in accessing the new pharmacy. If a patient lives, say, ten miles from the new pharmacy, then the GP surgery may be requested to continue dispensing to that patient. (No matter where the surgery is located). This is where Alan 365 gets confused. Just because the GP (in the example above) continues to operate a dispensary in close vicinity to a pharmacy does not mean that he can legally continue to dispense to ALL of his patients. Whilst there is no rule that the dispensary MUST close, a dispensary which remains open on the opening of a new pharmacy can only dispense to those patients registered with the practice who continue to have "a serious problem in accessing the new pharmacy". The regulations do not allow for 'choice' - that isn't their purpose. In conclusion, it is absolutely true that a dispensary must close when a pharmacy opens. However, it is wrong to believe that there should be 'competition' between the pharmacy and the surgery. That is not the intention of the regulations, and is (as I understand it) contrary to the law. I hope that helps, and if I have missed any changes since I retired a decade ago I do apologise!
alan 365
Tuesday, January 24, 2012 at 11:03 AMBudlice, if you know anything about Millport's situation you should know that Millport representatives together with their MSP and other protesters against these commercial pharmacy applications met with the Scottish Minister for Health on 9th November, 2011 at Hollyrood. At that meeting the minister conformed what I have told you. Health Boards are perfectly able to allow dispensing GPs to continue ad infinitum when a local pharmacy opens. In one instance in Scotland I understand this amounted to a period of many years. I hope that Ayrshire and Arran Health Board will recognise this and do the right thing by Millport which is to give its patients the right of choice. After all the NHS ( Scotland) Reform Act of 2004 makes it mandatory on NHS organisations to consult patients BEFORE any changes are made to their local services patients. Something which NHS Boards have not adhered to
BudIce
Monday, January 23, 2012 at 10:44 PMAlan 365 - I didn't say that existing dispensing doctors had to stop dispensing. You in fact agree with the only point I made - that the Health Board can approve a new NHS dispensing contract for a community pharmacy. As you raised the question of what happens to a dispensing doctor's contact to dispense once a community pharmacy opens up I've tried to find the answer. I haven't found any Scottish Government policy or legislation from a quick search. I did find an OFT report from 2003 that states "the dispensing doctor is required to cease dispensing and make way for the pharmacy. However, this is a gradual process allowing the dispensing doctor to phase out dispensing, normally over a period of 12 months. The length of the ‘gradualisation’ period is not prescribed by the regulations." Feel free to point me to something from the Scottish Government if this is wrong or has been superseded. Interesting read the OFT report.
Not anonymous June
Monday, January 23, 2012 at 04:22 PMNAF - that's the best laugh I've had in ages. Talk about crying foul when you're caught out. There is nothing to stop you posting under yur real name - look back at the example of other posters. Millport Curler revealed he was Sandy Morton so what's your point? Thanks for the giggle.
Never A Fake
Monday, January 23, 2012 at 04:11 PM"not anonymopus" - you need to re-read the site rules and regulations regarding harassing people, poster anonymity and confidentiality. These are the rules and regulations you signed up to on becoming a poster on this site, if you can't abide by them, maybe you should just go away.
Not anonymous June
Monday, January 23, 2012 at 03:44 PMComment removed by moderator
Never A Fake
Monday, January 23, 2012 at 03:31 PMComment removed by moderator
Not anonymous June
Monday, January 23, 2012 at 02:50 PMp.s. NAF I'd read comment 36 if I were, you may learn something re pharmaceutical ethics.
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