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Dispensing Doctors' Association - The digital divide exposed by COVID-19

COVID-19 has exposed many shortcomings in the health and social care system, and for dispensing patients in England, large among these is the implementation of the Electronic Prescription Service.

For several decades, GPs and pharmacies have been making a slow transition towards digital prescriptions, that is a digital infrastructure to support – and ultimately replace – the green prescription form that for years has been physically handed from doctor to patient, and then to pharmacy and back to the NHS for pricing. It’s been a journey through several digital iterations but, finally, patients can now ask their GP to electronically send their prescription ‘order’ to the dispensary of their choice, from where the medicines can be delivered straight to their front doors.

If the patient is a dispensing patient – a group that numbers around 3.6 million people across the UK – they are fortunate enough to be able to use the GP dispensing service. This is a service that exists for people who would otherwise find it difficult to access a pharmacy. It also benefits the practice by providing important income to cross-subsidise the additional costs of providing rural health services and local skilled employment opportunities.

During the past few months, GPs in England have been encouraged to use the EPS, in particular for its benefits relating to infection control. For those most vulnerable of patients shielding in their own homes, the EPS seems like a technological development that cannot come quickly enough – and the Dispensing Doctors’ Association, which represents rural GP practices that have their own dispensary – could not agree more. So why does the Association currently advise practices to hang fire on implementing the system?

For reasons best known to the wise heads in Richmond and Quarry Houses, when the EPS was conceived over a decade ago, dispensing doctors were excluded from the scope of the project. Until very recently, dispensing practices have been unable to switch on the EPS for their dispensing patients. The technology to allow dispensing patients to exercise their right to use their GP dispensary via the EPS simply didn’t exist. In other words, using the EPS actually curtailed the dispensing patient’s right to choose (specifically, the GP dispensing service).

Now, however, a piece of ‘retro-fit’ kit has been developed for dispensing practices. The problem is that NHS England says that dispensing GPs must pay for it themselves, despite funding for this equipment being made available to pharmacies, and that for all other GP IT, including dispensing, the NHS assumes all financial responsibility.

The DDA and our members consider the GP dispensing service to be a core part of NHS activity and at the centre of reducing inequalities in rural areas. The experience of the past few months also shows how vital the GP dispensary service is to rural resilience and in supporting infection control. There is no doubt that the EPS could benefit rural GPs and their dispensing patients. But without NHS funding, this advance remains stubbornly outside their reach. 

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