What’s all this about then?
Well, if you live in a rural area in England or Wales and your doctor’s surgery has a dispensary attached the law says you cannot collect your prescribed medicines from it if there is a community pharmacist (i.e. a dispensing chemist) within a 1.6km radius (as the crow flies) of your own house.
Recent countrywide strict enforcement of the law, by local Primary Care Trusts, has lead to worry, irritation, annoyance and disbelief on behalf of patients, formerly able to use their doctor’s dispensary. Now, an inferior service has been forced upon them, often after many years of trouble free use of their doctor’s facilities.
Furthermore, there will be others of you reading this blog who are unaware of the rule but have often wondered why you could not use your doctor’s dispensary whilst others could. This was because you were unlucky enough to be spotted and get caught in the 1.6km net much earlier on.
What! I hear you saying – who dreamt up this barmy rule?
The answer is Lloyd George in 1911 when the National Insurance Act 1911 came into being.
Why, I hear you saying, did he do that?
For the full history and current status surrounding this whole ridiculous state of affairs read on.
The Story in more detail
Over 100 years ago, The National Insurance Act 1911 was passed under the guidance of Lloyd George and it stated that doctors should prescribe and only chemists should dispense.
Why was this so?
Well, in those days, there was a fear that if doctors were allowed ‘carte blanche’ to dispense as well as prescribe there would be collusion between doctors/patients and inappropriate medicines and/or quantities thereof would fall in to the wrong hands. However, bearing in mind that back then we were pretty much in the days of the horse and cart, an allowance was made for doctors to dispense in those situations where a chemist was not nearby and this is the origin of the 1.6.km as the crow flies rule. A hundred years on I feel it was time to relegate such fears and concepts to where they belong (the dustbin) and get this silly out of date law repealed so that a service fit for patients of the 21st century might be made legal.
Recent enforcement of the Law
For those who are interested the law is embodied in Regulation 60(1) (b) of the NHS (Pharmaceutical Services) Regulations 2005. These have recently been updated in 2012 but with no change to the 1.6km rule.
The recent enforcement of the law in the area where I live, (Sussex) but also in many other parts of the country, of this hitherto rather obscure law is having the effect of replacing a very popular fast, efficient, effective patient choice orientated system, with a clumsy less efficient or desirable one. Indeed, it is jeopardising the future of many excellent modern facilities that are available in rural areas at doctor’s health centres where a dispensary is attached and run by the doctors rather than a pharmacist. Local Primary Care Trusts (PCT) are responsible for enforcing the law and whilst they might say the alternative pharmacy based systems are just as good we all know that there is nothing like walking into your doctor’s surgery, for a consultation and walking out a few minutes later, pills in hand. Even in the case of repeat prescriptions, a surgery can normally turn these around in about 24 hours as opposed to the 48/72 hours one generally has to wait if using a chemist.
In a recent exchange of letters I have had with the Amanda Fadero (CEO Sussex NHS) there now seems to be recognition that enforcement of the law does have the effect of providing an inferior service to patients.
Quote taken from my reply (19th Oct 2012) to Amanda Fadero letter to me (15th Oct 2012):
The concession in your letter that you now “understand that it may be more difficult for me and other patients to have our prescriptions dispensed by a community pharmacist rather than our GP’s practice,” is at least, a step in the right direction. It is certainly far removed from Ms. McGonigle’s statement, in her letter to me dated 2nd July 2012 when she commented, “I am confident that any new arrangements that are made will maintain the same standard of care that you have previously received.”
I think we can all now agree that this is nonsense.
The Duty of Care Point
I can understand why, at first blush, a PCT may think its remit only extends as far as seeing that this cranky out of law is obeyed but they are wrong. Their duty is far more comprehensive and is best described by this extract of my reply letter to Amanda Fadero dated 19th Oct 2012:
Surely, your overriding remit must be to see to it that the best care possible is provided to your patients in Sussex. As it stands, the current law prohibits that from happening so, it is your duty to make your views and those of your patients known to the authorities. A failure not to do so is a breach of the duty of care you owe to your patients in Sussex. The NHS Sussex and its PCT must be far more than just a law enforcement officer in these sorts of circumstances.
Some Crazy Effects of the Law
Apart from the obvious poor service it inflicts upon the patient consider this:
If you are suffering from a new ailment and you live next door to your dispensing doctors surgery, but there is a chemist exactly 1.6km as the crow flies from your house you would have to drive to it to get your newly prescribed medication or arrange some other method of collection rather than pick it up from next door! How barmy is that?
The NHS crow is able to fly directly to the nearest chemist but you have to drive or bus it there. This could easily involve a road journey of say 3 to 4 miles – maybe more!
You live say 5 miles away from your doctor’s surgery/dispensary but there is a chemist in the opposite direction just 1.6km away. So, you have to get to your doctor for a consultation, be told what is wrong with you, be given a prescription and then drive back again, past your front door to the chemist to get it made up. You have then drive home again. This adds a minimum extra 3.2 km to the whole operation and maybe more if the chemist can’t make it up on the spot and you have to go back to collect it because it’s urgently needed. If that doesn’t demonstrate that the law is an ass I don’t know what does!
Furthermore, how does the governments declared policy/aims of reducing greenhouse gases fit in with such a fiasco?
One important point to make is that nobody is suggesting that chemists should be precluded from their right to dispense and it is perfectly understandable, that for logistical, preference or convenience based reasons a patient may prefer to take that option. As time has moved on from 1911, more and more chemists have started businesses in villages/rural areas. This is to be welcomed but it does have a knock on effect of triggering the ancient 1.6km rule thus causing all the distress and inconvenience/less-effective service this blog is addressing. All parties should work together but those who wish to should be allowed to choose whether to use their doctor’s dispensary, or, if they prefer a local community pharmacist.
At the end of next month (November), Francis Maude (my MP) has agreed to meet me. At that meeting I will be accompanied by Dr. David Baker who is the recently retired CEO of the Dispensing Doctors Association (he remains on the board) and he will be able to help provide the historical support.
After that meeting, I intend to update this blog with the result of that meeting but in the meantime, I would like to thank all of you who have signed the petitions and urge anyone who has not, to do so. Don’t forget any UK resident can sign the e-petition so please tell all your friends family, acquaintances anywhere in the country about it as it could be affecting them.
Spreading the Word
If any of you are familiar with Twitter or Facebook please use these or any other media orientated vehicle to direct people to this site and urge them to sign the petition.
In addition, I give below a link to an article, which appeared in my local paper The East Grinstead Courier and Observer. It is largely accurate (although the law is not a new one as stated). In addition, I’m pleased to say that following the article, the blind one-legged patient featured in it has now had his re-appeal granted and all his original surgery based services are reinstated. At least one triumph for common sense!
Doctors in rural areas, with dispensaries attached, have 8.2m patients on their books. For whatever reason only 3.3m use or are permitted to use their doctor’s dispensary which means that up to 4.9m more may be able to use the service. 100,000 signatures or only 2% of that number are required on an e-petition to force the government into considering having a debate in the House of Commons on the matter.
This law has frustrated thousands of doctors in rural practices for decades because they know it prevents them from offering what they believe is the best care possible to their patients. They do not mind if a chemist opens up in their locality so long as doing so provides the patient with a free choice of whether they use their dispensary services or go to the chemists. The law eliminates this freedom of choice.
Some cynics argue that it is all about money and while there is no denying dispensing charges provide a revenue stream for both doctors and chemists many doctors just genuinely want to offer the best to their patients.
Whilst thousands of doctors have been frustrated by the law, millions of patients have been disadvantaged by it and in many cases without even realising it.
Patient choice and the best care that can be made available to them should rule the day and not a law first formulated over 100 years ago to cope with the way the world was then.
Given a freedom of choice Patients are perfectly capable of deciding what best meets their needs. They are not stupid single celled organisms with no minds of their own who have to be told what is best for them. They deserve a service fitting for the 21st century and not one more appropriate for the beginning of the 20th.