GP Dispensing Group minutes: November 2018

Attendees and apologies

Chair

• Fiona Duff, Scottish Government

Present

• Chris Nicholson, Director of Pharmacy, NHS Orkney & NHS Shetland
• David Prince, SGPC
• Dr Andrew Buist, Chair SGPC
• Dr Hal Maxwell, Dispensing Doctor Association
• Fiona Howe, Scottish Government
• Alison Strath, Principal Pharmaceutical Officer, Scottish Government
• Lesley MacFarlane, Healthcare Improvement Scotland
• Ross Grant, Scottish Government

By videolink

• Maureen Firth, NHS Orkney
• Findlay Hickey, NHS Highland
• Clare Morrison, NHS Highland
• Dr Kirsty Brightwell, NHS Western Isles
• Dr Jurgen Tittmar, RGPAS Representative, Argyll & Bute

Apologies

• Andrew Vickerstaff, NHS Highland
• Jill Gillies, Healthcare Improvement Scotland

Items and actions

Welcome and introductions

1. The chair welcomed everyone to the meeting.

Overview of dispensing practices

2. Dr Hal Maxwell provided a brief history and summary of dispensing practices in Scotland. He noted that the majority of such practices were small, remote and rural and all of these practices were receiving the income guarantee under the 2018 GP Contract. Dispensing practices in Scotland were only required to dispense where there was no community pharmacy provision in the area. (In England there was more variation in the location of dispensing practices). Dispensing practices are covered by different regulations from community pharmacy.

3. He noted that many dispensing practices subsidised their GMS income with their dispensing income. This meant that they could face sustainability challenges if their dispensing income were to be withdrawn.

Challenges faced by dispensing practices

4. The group discussed challenges faced by dispensing practices, these included:

• falling profits. Drug reimbursement no longer covered the costs of some particular drugs, and without wholesaler dealer licences practices were unable to sell on unused stock. Practices could also face additional transport costs for specials, and had to manage VAT returns as they differed for different drugs. This issue would be exacerbated if the duty to dispense were removed (and possibly then given back) from practices should community pharmacies be established in their areas
• technology. Dispensing practices required additional IT provision to other GP practices (e.g. to help with stock control). Non-medical prescribers also faced difficulties using the current practice clinical systems. This was also an issue for the rollout of the pharmacotherapy service due to barriers to remote prescribing and other initiatives eg remote medication reviews etc
• dispensing practices often seemed to fall between the gap of general practice regulations and community pharmacy and in the past has not benefited from initiatives which have supported Community Pharmacy eg staff training costs, NSAID project, development of Standard Operating Procedures
• dispensing practices would benefit from more reliable Scottish guidance and professional standards. The Dispensing Doctors Association do have guidance and standards available but practices have to be members of the DDA in order to have access to them
• training. Dispensing staff needed specialist training in order to carry out dispensing duties in a safe and efficient manner. This training is currently only available through a commercial organisation and has to be funded by the dispensing practice Other staff working in dispensing practices also need to be clear of their roles and responsibility (eg Locum GPs) whilst working in dispensing practices. There were issues with recognition of training for pharmacy technicians if it were based in a dispensing practice rather than a community pharmacy
• stock control: practices have to have appropriate systems for stock control. Concerns about the impact of Brexit and the availability of some medication
• the Falsified Medicines Directive was due to come into force early 2019. This might lead to additional equipment and training costs for both dispensing practices and community pharmacy. Appropriate guidance would also be required in order to meet the regulations. This issue is currently causing significant concerns amongst dispensing GPs at the moment
• remote and rural areas were facing recruitment and retention challenges. More could be done to improve the attractiveness of becoming a dispensing GP
• 2C: it was noted that there are issues in running 2C Dispensing Practices which have an impact on the financial viability of the practice

5. It was also noted that many dispensing practices were concerned they had not received increased funding under the new Scottish Workload Formula, due to the removal of the rural weighting. This issue was outwith the remit of the group, but had been brought to the attention of the Scottish Government and the Scottish General Practitioners’ Committee.

Terms of reference

6. The group agreed to meet on a three monthly basis, in either Edinburgh or Glasgow with videoconference or teleconferencing to be made available for those who could not attend in person. [Action: Secretariat].

7. The group agreed that additional representatives (e.g from NES or PSD) would be invited to attend specific meetings of the group as appropriate. Matthew Isom (Chief Executive of the Dispensing Doctors Association) would also be approached to attend a future meeting. [Action: Secretariat].

8. The group would consider producing an end of year report on their work, and consider its links with the Remote and Rural Practice SLWG.

9. The TOR should specify that the group would consider all dispensing practices, including 2C dispensing practices.

10. The group thought it would be important to feed their advice and findings into the SG/SGPC Phase Two contract negotiations regarding the impact on dispensing practices.

Dispensing practices support proposal

11. The group discussed current funding available to support dispensing practices. It was noted that this funding was available in this financial year and therefore would need to be progressed outwith the meeting as a matter of urgency.

12. The group discussed the need to balance providing training support for dispensing practices in the short term against the benefits of developing a longer term but more comprehensive training offer (potentially through working with NHS Education for Scotland (NES). It was agreed that funding for the Buttercups course could be considered in the short term but ideally in the long term a more bespoke Scottish dispensing staff course should be explored with NES. [Action FD].

13. The group agreed that it would be necessary to survey dispensing practices to assess their staff training needs in order to plan for future staff training funding and provision.

14. The group supported the provision of NSAIDs toolkits to all dispensing practices. It was noted that the current NSAIDs toolkit was developed for community Pharmacy and may need some tweaking to make it suitable for dispensing practices. [Action LM & CM to review].

15. Dr Tittmar agreed to gain the views of the RGPAS members on areas of support that would benefit dispensing practices and to feed back to the chair out with the meeting. [Action: JT].

AOB

16. The Remote and Rural Practice SLWG was in the process of compiling case studies about how the new GP contract was working in rural areas. It was agreed that it would be useful to consider case studies of how the new pharmacotherapy service was working in dispensing practices.