Environment, Food and Rural Affairs CommitteeWritten evidence submitted by the Dispensing Doctors’ Association

The Dispensing Doctors’ Association (DDA) welcomes this inquiry and is pleased to respond. The DDA is a member organisation that promotes the interests of Dispensing Doctors and the excellence of doctor dispensing for the benefit of patients. There are some 5300 dispensing doctors in England working in 1100+ rural practices. Dispensing doctors provide primary healthcare to 8.8 million rural patients in the UK. The regulatory framework under which dispensing doctors work ensures that all our 3.5million dispensing patients live in rural areas of the country.

Our response addresses the following topics which the Committee set out in the scope of its inquiry:

Government Policy.

The approach of the Rural Communities Policy Unit.

We should be very happy to expand further on these themes in oral evidence or further written evidence, should the committee deem it useful.

Government Policy

The Government is preparing a Rural Policy Statement. What should be in it?

1. The DDA welcomes the Government’s Rural Policy Statement which seeks to promote a prosperous rural economy and thriving rural communities. As health responsibilities are increasingly being devolved to a local level the policy statement should take into account the importance of a healthy rural population and contain a commitment to champion the need for rural populations to have access to local health services.

Ministers’ stated rural priorities are housing, broadband, services, transport and fuel. Are these the correct priorities for the Government to focus on?

2. The DDA agree that housing, broadband, services, transport and fuel are priorities, to which we would add “funding inequality”. However, if “services” does not specifically include health service provision, then that must be added.

If not, what others should the Government prioritise?

3. In the current government there is not a minister with specific responsibilities for rural health, as had been the case with previous governments. Dispensing doctors are concerned that issues being faced by rural communities are likely to be overlooked without a minister championing them.

4. Responsibilities that should fall within a Minister’s portfolio and that the Committee might consider include the following:

(i)Patient choice in rural areas:

Patients do not necessarily have a choice of hospitals in small towns and rural areas, due to there often only being one option. They do, however, have a choice in how they can receive their primary care.

In terms of secondary care providers, for instance hospitals, rural areas can suffer a “market failure” as there is often only one provider.1

Due to regulations that many patients perceive as unfair, patients are able to switch from a dispensing service to a pharmacy but not vice versa.

Achieving QIPP:

The QIPP agenda applies as much to PCTs in rural England as to their urban counterparts. It has been argued that rural PCTs experience particular funding pressures.2

Dispensing doctors provide a dual service. Due to the sparsity of rural populations dispensing doctors provide a service that other providers would struggle to do.

Pharmacies will not open branches where not financially viable.

Organisations such as the Rural Services Network and NHS Confederation could be called to submit evidence to an inquiry on these topics.

(ii)Public Health in rural areas:

Public health is to be driven out locally and local health authorities will have different requirements in terms of delivering public health to their populations.

Dispensing doctors would play in a vital role driving out the Government’s public health agenda to harder to reach communities in small towns and rural areas.

Dispensing doctors would have a view as to how public health budgets could be spent within the areas in which they operate eg leisure and sports facilities.

(iii)Social care in rural areas:

Rural areas have more aged populations (on average six years older) than do urban areas and dispensing doctors have a key role in serving these.

The Government is seeking for greater integration between health and social care, dispensing doctors will have a role in helping to facilitate this.

The Approach of the Rural Communities Policy Unit

How effective has the RCPU been in engaging with rural communities?

5. The DDA has had no experience of engagement with the RCPU. With 3.5 million patients in rural areas of the country we feel that we might have had some contact with the unit.

Has the RCPU done enough to ensure the voices of the hardest to reach can be heard?

6. Please see previous response. As many dispensing patients live in the most sparsely populated and hardest to reach parts of rural Britain the DDA would provide a useful network for the RCPU to access these communities.

How effective has the RCPU been in engaging with other government departments, for example, providing challenge and ensuring policy is “rural proofed”?

7. The Rural Communities Policy Unit will need to be very robust in its insistence on rural proofing for all policies; from the perspective of dispensing practices (as a proxy for rural general practice) little account has ever been taken of the views or needs or the 8.8 million patients that they care for.

8. As an example, the New Medicines Service—introduced last year as a “notable advance in patient care”, is available only through pharmacy—the 3.5 million rural patients who choose to receive medicines from their doctor are unable to access the service.

9. Similarly, the Electronic Prescription Service (EPS) has, despite numerous approaches over the last five years to Connecting for Health (CfH), failed to extend its provision to meet the needs of dispensing practices. Dispensing Practices are responsible for 7% of all prescription items so there is no reason whatever why software suppliers should not have been instructed to include an integrated dispensing/clinical program as part of EPS development especially since as a group we have been running a version of electronic prescribing for more than 25 years. Electronic prescribing as practised by dispensing doctors meets the requirements of the Medicines Act but is not recognised in the GP contract.

10. The DDA is happy to inform the Committee that the Institute for Rural Health is currently updating the Rural Proofing for Health Toolkit. The new Toolkit has been commissioned by Defra and will update the themes and format of the old Toolkit in the light of current proposals for commissioning structures and changes in other roles such as Public Health. It will also update the evidence base around rural health/rural proofing and incorporate case studies highlighting good practice and innovation to meet rural needs and circumstances.

11. The new online Toolkit will be web based and will provide a resource for commissioners and providers covering rural areas in England. It will promote a rural proofing approach. The aim is to ensure that “rural” is firmly on the agenda for Clinical Commissioning Groups and others in the new health structure. The project is funded by Defra as part of their rural services programme and is supported by the Department of Health’s Inequalities Team and the NHS Confederation.

September 2012