604 policemen, and other professionals. We may longer have cigarette advertising on television, but still have a lot too many no we irrelevant s...

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policemen, and other professionals. We may longer have cigarette advertising on television, but still have



too many

no we

irrelevant smokes.


dispute between dispensing doctors and the pharmaceutical profession is rather like one of those festering border disputes in a far-away part of the world THE

that lies dormant for months at a time and then erupts into a little bombing and shooting, which hits the headlines for a day or two before it once again dies down without anything having been resolved or any progress made. As the dispute at the moment appears to be in one of its dormant phases, now may be a good time to review the situation. About 1 in 10 of Britain’s 25,000 general practitioners is a rural doctor who dispenses medicines for his patients as well as treating them.1 In Section 39 of the National Health Service Act 1946 it was laid down that pharmaceutical services would normally


provided by registered pharmacists and that, as provided by Regulations, no arrangements should be made by an executive council with a doctor or a dentist under which he would be required to The relevant provide pharmaceutical services. Regulation, permitting doctors to supply drugs in specified circumstances, is now Regulation 29 of the National Health Service (General Medical and Pharmaceutical Services) Regulations 1972. The first part of Regulation 29 reads as follows:


29.-(1) A



(a) satisfies the Council that he would have serious difficulty in obtaining any necessary drugs or appliances from a chemist by reason of distance or inadequacy of means of communication, or (b) is resident in an area which in the Council’s opinion is rural in character, at a distance of more than one mile from the premises ’

of any chemist, may at any time request the doctor on whose list he is included to supply him with drugs and appliances.

practice, it has been assumed that if a doctor wishes dispense he should be permitted to do so for all patients who live more than a mile from the pharmacy without the initiative coming from the patients, thus perpetuating an arrangement that originally dated back to Lloyd George’s National Health Insurance scheme of 1911. The one-mile rule was a rough and ready attempt to give precise expression to this intention, but it has led to anomalies. Situations can In


arise where the doctor’s surgery and the chemist’s shop are situated within a few yards of each other,but the patient obtains medicines from the surgery because he lives more than a mile from the pharmacy. The fact that he lives more than a mile from the surgery to which he has to go to collect medicines dispensed by the doctor is not taken into account. Dispensing doctors are paid on one of two systems -either by an additional capitation fee to cover drugs and dressings (with the exception of a long list of expensive drugs, which can be claimed for in addition 1.

Department of Health and Social Security. Health and Personal Social Services Statistics for England and Wales, 1972. H.M. Stationery Office, 1973.

the capitation fee), or on the basis of a tariff, like that used to pay chemists for prescriptions dispensed, but at a rather lower level. The doctor can choose whichever method will suit him better. The abolition of the one-mile rule was mooted in the 1960s during the negotiations over the Charter for the Family Doctor, but the proposal was dropped after fierce opposition from rural doctors.2 The crux of the matter is that in existing circumstances there are areas where neither a general medical practice nor a retail pharmacy is viable unless dispensing rights go with it. There is thus a clear clash of economic interest between rural doctors and pharmacists. The rural doctor looks to dispensing, not only to enhance his income while he is working, but also to provide him with a better pension when he retires. It has been suggested2 that, in the more sparsely populated areas, taking dispensing away from doctors might lead to the abandonment of some practices because they would no longer provide a viable income. Many rural doctors derive a significant proportion, perhaps up to 25 %,of their net income from dispensing. On the other hand, retail pharmacists are not only professional men; they are also shopkeepers, and the lot of the small shopkeeper has not got any easier in recent years. From the public point of view, to abolish or further restrict dispensing by doctors may be to the detriment of rural medical practice; but, if it is not worth while for a pharmacist to set up or continue in business in a rural area, the public is deprived of his other services, as well as of the safeguards implicit in the dispensing of prescriptions by a man specifically and primarily qualified in pharmacy. So the arguments appear to be evenly balanced. As far as the consumer voice has been heard, it has been on the side of the doctors. The Women’s Institutes rallied to their support in 19672 and the Consumers’ Association has criticised 4 the service provided by some pharmacists-though not in rural areas. However, although the chairman of the B.M.A. rural practices subcommittee was ready in 1966 to claim3 that doctors could provide a more efficient dispensing service than chemists, because their hours were not limited, this claim now has a rather dated sound, even in many rural areas. The public, if it is called upon to judge the issue, will do so primarily on the grounds of convenience, and nowadays there may not be much to choose between doctors and chemists as far as accessibility is concerned. If it is slightly easier to see the doctor and collect any medicine prescribed at one port of call, then this convenience may be offset by the prospect of a local chemist’s shop selling a wide range of non-pharmaceutical sundries and medicines which do not require a doctor’s prescription. In the short term, nothing must be done which will imperil the viability of rural medical practice or threaten the legitimate interests of those doctors who already dispense medicines for their patients. But in the long term the right solution will be one which lets doctors concentrate on doctoring, leaves pharmacy to the pharmacists, and finds alternative ways of ensuring the viability of medical practice in sparsely populated areas. to

2. Morgan Williams, B. D. Br. med. J. 3. ibid. 1966, i, suppl. p. 271.

4. Which ?

June, 1966, p. 204.

1973, i, 92.