The Problem – Would you like to get your medicines from your doctors dispensary but can’t?

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years on I feel it was time to relegate such fears and concepts to where they belong (the dustbin) and get this silly out of date law repealed so that a service fit for patients of the 21^st century might be made legal.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 2^nd 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?

or

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!

or

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?

The Chemists

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.

The Politicians

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!

http://www.thisissussex.co.uk/Patient-launches-petition-medicine-shake/story-16944920-detail/story.html

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.

Conclusion

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.

Peter Dodds

Once again Earl Howe refuses point blank to accept that Patients Views are worthy of consideration – House of Lords Debate 8th July 2014

He’s done it again! The only thing that matters to Earl Howe is that the parties with vested secular interests, namely Dispensing Doctors and Pharmacists are happy with the situation, it matter not one jot what we, the patients, should be heard or our views be taken into consideration.

In a debate in the House of Lords on the 8th July 2014 Lord Crondall asked the following question:

The questioner, Lord Lea of Crondall, said that the closures were against a background of the operation of the one-mile rule covering new free-standing pharmacies, and the phased withdrawal of the minimum practice income guarantee.

Health minister Earl Howe replied:

“We are not aware of significant closures of rural dispensing practices. The ‘one-mile rule’ is a long-established precept under NHS pharmaceutical services legislation, which determines whether patients in designated rural areas remain eligible to receive dispensing services from their GP. We have no plans to review or amend that precept.

Countess Mar said:

that there is “extreme unrest” among patients who are forced to go to a pharmacy when they have been used to a dispensing doctor. “Does the Minister intend to continue subsidising what are known as essential small pharmacies and not give patients a choice?,” she asked.

Lord Howe replied:
“that it was not a case of opposing choice against the “very long-standing” rules that have been agreed between medics and pharmacists and which are in place: “I do not think that there is an appetite on either side to open those rules up for renegotiation. A balance has to be struck somewhere and the professions are content with the balance that has been struck.”

So there you have it – a complete refusal to consider anyone other than dispensing doctors interests and pharmacists and hell with the patients! After all the are only the ones who are most effected by the stupid rule, who pay their taxes and vote to put these people in power and even pay their salaries so why should we be taken notice of!?

Peter Dodds

Why is the Government wasting £38.6m of Taxpayers money by enforcing the 1.6km Dispensing Pharmacy Law

Figures have emerged that demonstrate enforcement of the law which outlaws those of us who live within a 1.6km (a mile) of a community pharmacy from using our doctor’s dispensary service is wasting taxpayers money up to the extent of £38.6m per annum.

The reason is that the doctor’s dispensary system provides a cheaper way for the NHS to get our medication to us but, of course, they can only supply 40% of their patients because of the ridiculous law which is not only unjust, antidemocratic and unfairly selects against only those living within the 1.6km radius of a community pharmacy, by forcing them to support it with their prescription business, but also eliminates their right to patient choice.

For full details of the figures click on this link to the DDA website; http://www.dispensingdoctor.org/comments.php?id=3149 and then write to your MP and ask him/her why, in the current climate of cuts in the NHS budget, is the Government/NHS England/D of H deliberately wasting £38.6m of taxpayers’ money? (If your MP is Frances Maude he has written to me in the past maintaining his and the governments support for keeping the law as is).

Also you can follow this link to sign a new e-petition aimed at having the law repealed; http://epetitions.direct.gov.uk/petitions/60645

I have gone on record many times in saying that I support the existence of community pharmacies and believe they provide a valuable service to rural communities but the system as it stands is a nonsensical shambles.
Peter Dodds

A New e-petition is launched by a Bedforshire located former Dispensing Patient

Unrest continues to spread across the country concerning the undemocratic discriminatory 1 mile rule enforced and supported by Pharmacy Minister Earl Howe.

The latest areas of focus are in North Yorkshire and Bedfordshire where Mrs Pam Fisher, secretary of her local PPG (Lower Stondon Surgery) has launched a new e-petition.

The petition reads as follows:

A discriminatory 100 year old law exists affecting between 5-7 million NHS patients living in rural areas who live within a radius of 1.6km, as the crow flies, of a community pharmacy. These patients are being unfairly discriminated against by being denied the facility of using their Doctors Dispensary.

“This antiquated regulation is clearly anti-democratic being selective against a section of the rural patient population depriving them their right to “patient choice” and goes directly against the policy of “no decision about me without me” as enshrined in the Health and Social Care Act 2012. We have one rule which is giving us the right to have a choice and the other taking it away!
“We the undersigned request the government repeal the Regulation.”

Click on this link to sign the petition: http://epetitions.direct.gov.uk/petitions/60645

Click on this link to read the DDA website article on the subject: http://www.dispensingdoctor.org/comments.php?id=3055

Patients in Bedfordshire are up in arms after losing their Dispensing Doctors Service

Pharmacy openings in rural Bedfordshire have angered patients, and have prompted a local GP practice to open its own pharmacy.

Click here to read the full story: http://www.dispensingdoctor.org/comments.php?id=3012

The 2014 ‘Dispense with the Law Campaign’ gets under way.

On 15th January 2014 I wrote to 230 MPs and 22 Peers all of whom are either on the All Party Parliamentary Group (Rural Affairs) or who represent and/or have expressed an interest in rural matters and specifically GP dispensing.

Below is the text of what I have said:

Dear Rural Members of the APPG (Rural Affairs)

This email is being sent to all 93 of you and a parallel one to 160 members of both Houses who represent rural constituencies or who are known to have an interest in rural affairs and GP dispensing.
I am reduced to contacting you in this manner as Earl Howe refuses to discuss the matter with me any further and Francis Maude, my own MP supports him.
The aim is to bring to your attention an undemocratic law which affects between 5-7million patients living in rural areas where their home is within a radius of 1.6km of a community pharmacy.
Some of you, I know, are already aware of the situation and have tried to get it rectified but I suspect many of you do not, a condition which you share with lots of patients in rural areas who simply do not appreciate how their rights are being infringed.
However, patient awareness is growing along with their anger and there are now ‘hubs’ of discontent supporting “The Dispense with the Law Campaign” in Bedfordshire and North Yorkshire.
The situation persists where a doctor, in a rural area, runs a dispensing practice and patients are forced by a Regulation, [the current one being NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013], to use the pharmacy for dispensing purposes rather than having the right to choose their doctor’s dispensary, if they prefer, simply because they live within a 1.6km radius of the community pharmacy. The regulation has its origins in an Act now over 100 years old (The National Insurance Act 1911 section 15) which is clearly past its ‘sell by’ date.
In order to gain an understanding of the frustration, irritation and in some cases unnecessary hardship the regulation causes please read this blog :
https://dispensingdoctorscampaign.wordpress.com.
The reason the government enforces this law is to guarantee and safeguard a prescription income stream for rural chemists. Countess Mar was able to get Earl Howe to admit to this in a debate in the House of Lords on 16th May 2013. In letting the cat out of the bag, when answering Countess Mar’s oral questions he said, “Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas”(emphasis added). When taken in the context of the debate it is crystal clear that he was referring to ‘economic’ viability.
I have nothing against community chemists and welcome their existence in rural areas but funding them in this manner is completely anti- democratic and deprives patients of their right to “patient choice” and “no decision about me without me” as enshrined in the Health and Social Care Act 2012.
The bottom line is that it is apparent that the current Government, and its predecessors have, for decades, been practicing a policy of ‘selection against’ a minority section of the population, i.e. those burdened by the imposition of the1.6km rule which forces them to provide community pharmacies with their prescription income in order that they can be financially viable.
This is an anti-democratic and possibly illegal, (under the Human rights Act or other appropriate legislation), way of funding community pharmacies. It is time a better and fairer way was found to achieve the objective and in so doing provide real ‘patient choice’ to those currently denied it.
It is your job as Parliamentarians to see that this change is brought about.

Peter Dodds
Organiser of the Dispense with the Law Campaign
https://dispensingdoctorscampaign.wordpress.com

The Debate Hots Up Both North and South of The Border

The rules are a little different in England and Wales from those in Scotland but one important effect of them is the same.  Both sets of rules, in one way or another, deny the right of patients to choose whether to use their doctor’s dispensary service rather than a chemist. 

In England and Wales the government continues its cavalier, big brother knows best stance of allowing ‘patient choice and no decision about me without me’ to prevail only when it suits them.

But, as I warned Earl Howe and Francis Maude would happen, the worm is turning and more and more MPs are beginning to see the unfair absurdity of the regulations as they currently stand.  With an election coming in 2015 the pressure will continue to mount.

Follow this link;

http://www.dispensingdoctor.org/comments.php?id=2944

to read the views being expressed by some MPs in a House of Commons debate on the 20th November 2013 concerning Pharmacies
and the NHS.

MPs want to hear what GPs have to say;

Follow this link to read the views of Thirsk & Malton Conservative MP Anne McIntosh when she spoke to DDA conference delegates recently.

http://www.dispensingdoctor.org/comments.php?id=2938

Up and Down the Country people are becoming more and more active about the current state of affairs:

Follow these links to read some views emanating from Yorkshire:
http://chooseandbookit.co.uk/public/article/when-patient-choice-denied-when-you-live-within-1-mile-rural-pharmacy
and
http://chooseandbookit.co.uk/business/news/beware-pharmacists-are-looking-tilt-playing-field-their-direction

Lastly and by no means least our friends in Scotland are beginning to get their politicians to see some sense at last:

Follow this link to read about their story:

http://www.dispensingdoctor.org/comments.php?id=2942

Time is beginning to be up for the enclave of Government Ministers and NHS officials who support this ridiculous anti – democratic law.

Having Lost All The Arguments The Government Refuses To Engage Further

Having admitted that:

Patients have never been represented at the table when the 1.6km rule was drawn up

and

Earl Howe having admitted in the House of Lords on 16th May 2013 that the rule is there so that community pharmacies can survive financially

and

Having cleverly avoiding confessing to his statement by the way he answered Countess Mar’s House of Lords follow up questions to him

the Governments has decided the only course of action left open to it is not to talk to me or anyone else on the subject anymore!  (see the attached letter, 8th August  2013, from D of H’s Tim Marshall).Marshall to PD 8th August 20130001

Well, I’m sure they would like to regard the matter as closed but it doesn’t work that way.  Sticking ones head in the sand, especially when you are accountable to the general public/electorate, is not an option and it is shameful that they should try and do so!

Needless to say further Campaign moves are being planned.

 

How Earl Howe managed to avoid admitting he let the ‘Cat Out of The Bag’ on the 16th May 2013

This is very clever!  You will have to read these two letters carefully because they contain some admirable, (if you like that sort of thing), Department of Health ‘Sir Humphrey Speak’!

Marshall to PD 24 June130001

To Marshall 27th July 13

So, as you can see, the question was never answered and the ‘Cat remains out of the Bag’ where it will be forever!

I am awaiting a reply – stand – by!

Francis Maude again says “NO” and abandons at least 231 petition signing constituents at The Crawley Down Health Centre

In the House of Lords, on 16th May, Earl Howe made this statement:

“My Lords, there is a balance of interests here, not least the interests of the patient. We therefore need a set of rules which reflects those interests. Patients who live in a rural area can be dispensed to by their GP if there is no pharmacy within 1.6 kilometers of where the patient lives, or within 1.6 kilometers of the GP practice. Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas” (see Earl Howe lets the Cat out of the Bag post).

Despite this crystal clear evidence being put before Mr Maude, in this letter to him To Maude 4th July 13 proving, that the Government is and has been practicing ‘selection against’ a minority section of the population, i.e. those burdened by the imposition of 1.6km rule in order to make community pharmacies financially viable he answered with this reply from maude 22nd July 20130001 in which you will see he says “I read your comments very carefully but I did not see anything that has led me to change my position on this matter.”

That is why this post is entitled Francis Maude again says “NO” and abandons his constituents at The Crawley Down Health Centre! 

Unbelievable but true!

Earl Howe Lets The Cat out of The Bag on 16th May 2013 in House of Lords Debate

On 16th May 2013, during a House of Lords Debate which took place in answer to a question tabled by Countess Mar and then later in answers to written questions also tabled by her, the true motive behind the continued imposition of the 1.6km rule became apparent.

In summary, this is what has been said starting with oral questions by Countess Mar  to Earl Howe in the House of Lords on 16^th May 2013:

Qu. ‘whether Her Majesty’s Government  will review the rule that prevents patients of dispensing doctors who live within 1.6 kilometres of a pharmacy from collecting their medication from a doctor’s dispensary’.

Earl Howe replied in part as follows:

‘Without these rules, it would rarely be viable for new pharmacies to open to serve rural areas’.

The debate led Countess Mar to table further written questions to Earl Howe including:

The Countess of Mar to ask Her Majesty’s Government whether economic benefits to pharmacists were a consideration when deciding their pharmaceutical needs assessment policy. [DH]   HL464

Amongst a rambling reply Earl Howe made this statement:

‘The question of economic benefits to pharmacies was not a material consideration in the development of this policy’.

The clear contradiction between the two statements led Countess Mar to raise the following question:

The Countess Mar to ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 5 June (WA 192–4), how the statement “the question of economic benefits to pharmacies was not a material consideration for the development of this policy” is reconciled with the answer by Earl Howe on 16 May 2013 (HL Deb, col 524) that “…without these rules, it would rarely be viable for new pharmacies to open to serve rural areas”. [DH]   HL854

Earl Howe answered this as follows:

‘My answer of 5 June 2013, Official Report, columns WA 192–4, referred to the
rationale behind the move to a regulatory system of market entry for National Health
Service pharmaceutical services based on local assessments of needs. At Oral
Questions on 16 May 2013, Official Report, HL Deb, column 524, I set out the
circumstances under which patients are eligible to receive dispensing services from
their general practitioner’.

 This last answer from Earl Howe is classic civil service Sir Humphrey obfuscation employed in a vain attempt to dodge the bullet when Earl Howe let the cat out of the bag during oral questions on 16^th May 2013 in the House of Lords.

Consequently, what is now apparent is that Her Majesty’s Government, and its predecessors have, for decades, been practicing a policy of ‘selection against’ a minority section of the population, i.e. those burdened by the imposition of 1.6km rule which forces them to provide community pharmacies with their prescription income in order that they can be financially viable.

This is an anti-democratic and may possibly be an illegal (under  the Human rights Act or other appropriate legislation) way of funding community pharmacies.  It is time a better and fairer way was found to achieve the objective and in so doing provide real ‘patient choice’ to those currently denied it.

I have written to Earl Howe and Francis Maude pointing out the absurdity of the position they are continuing to adopt. In my letter Francis Maude I have asked him to reconsider his abandonment of 231 of his constituents in his 1st March 2013 letter to me who had signed a petition, (he has a copy of it), urging him to represent them in lobbing for a change in the law.

In my letter to Francis Maude I have said:

‘I cannot see that you can stand aside any longer because, in so doing, you are tacitly supporting an injustice being suffered by a section of your constituents and so I must urge you to reconsider your position.  The matter is so grave that it may well constitute an infringement of rights under the Human Rights Act or other appropriate legislation and consequently is a matter that ought to be subjected to a judicial review.  This is something I am looking into.’

Peter Dodds