Bill Hart: Let's dispense with the red tape that restricts our doctors and pharmacies

FIRST, let me put my cards on the table. I am a partner in a rural East Yorkshire practice and we have a dispensary in the surgery.

Regulations state that any of our patients living more than a mile from a community pharmacy may use our dispensary, if they so wish, but anyone living within that mile from the chemist's shop cannot; they have to get their prescriptions dispensed at a chemist, although not necessarily the one in the village.

Of course, we make a bit of money from the dispensary and much of that extra income is ploughed back into the practice so that we can fund extra staff and equipment, and we like to think we can thus improve our service to our patients.

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Every day we have to turn away disgruntled patients who want us to process their prescriptions, but who live within that magic mile; how galling it must be for the pensioner or single mother, with children in tow, to have to walk through the snow for her bottle of medicine, while the out-of-town resident glides in with his 4x4 and is able to pick up his pills on site and in the warm.

On a very basic level, it seems like crass bad manners.

So, in 2011, why don't we do away with the Dispensing Regulations and allow all GP practices, both rural and urban ones, to open a dispensary, or indeed a pharmacy?

Anticipating howls of protest from pharmacists, let me enlarge upon this idea a little.

Both GPs and traditional pharmacists are small business people, sub-contracting to the NHS to provide primary healthcare, and there has always been a rivalry between the two professions.

Perhaps the intensity of that relationship is less nowadays, with the demise of the independent pharmacists as most of the old businesses have been bought out by the large national chains, but it is still there.

GPs have skills in diagnosis and management of illness, while pharmacists dispense the prescribed medication, with advice on how to take it, side effects and so on. To a large extent, this has been a good thing since a pharmacist can provide an important check on a GP's prescription, making sure it is both appropriate and safe, so that patients have benefited from the expertise of two professionals for every episode of illness treated in primary care.

In a dispensing practice, the GP stands in for the pharmacist, so, on the face of it, there are fewer safeguards but, when the system was set up, it was thought that the advantage of having easy access to medicines for the rural community offset that disadvantage.

But times are changing: no longer does the pharmacist have to spend time blending ointments and putting them in glass jars, or counting pills to put in a little brown bottle with a wad of cotton wool in the neck.

Nowadays the community pharmacy is an easy to access portal to primary care services, with dispensing of medication as only a small part of its activity. You can get advice on minor illnesses, contraception and stopping smoking. If you are so inclined, you can exchange your used needles to support your drug habit, or the pharmacist may take you on one side to undergo a thorough review of your complicated list of repeat medications and, of course, you can buy all sorts of health related products.

In other words, there is some encroachment here on the traditional activities of the GP, which might be in the public interest, as the spreading of good health advice by whatever means must be a good thing and the community pharmacy is seen as more informal and accessible than the paternalistic GP.

The only trouble is that the pharmacist is hamstrung by being dependent on the background information provided by the customer.

If, in my surgery, I try to prescribe incompatible drugs, or a drug which would be a bad idea with a certain past history, my computer shrieks "Hazard" at me. Surely, it would be so much safer if the pharmacist had access to that same computer information, and it could also work the other way round in that the GP would be aware of what medication the patient was buying over the counter. While I have no doubt that degree of communication could be achieved on-line, how much better it would be if both GP and pharmacist were on the same site and using the same system.

My proposal, therefore, is that all GP practices should not just be allowed to dispense but be able to open pharmacies, with proper pharmacists manning them.

Old-style GP dispensing, with its lesser degree of professional supervision, should be phased out and, if a rural practice wanted to dispense, a pharmacist should be part of the practice team, with the two departments being linked through a common computer system. As is the case now, there must be no obligation for a patient to have prescriptions dispensed in house, but, in practice, few of our dispensing patients elect to go elsewhere.

In the urban setting, I can see the boot being on the other foot, with large pharmacies incorporating GP practices into their stores, again setting up integrated, one-stop primary care outlets.

Provided the doctors and the pharmacists can maintain their individual professional identities and integrity, I can envisage a more rational and safer primary care service, with the added advantage of patients being able to avoid those unnecessary walks through the snow.

Bill hart is a GP in east Yorkshire.