Dispensing physicians and prescribing pharmacists: economic considerations for the UK

Recent years have seen an increase in the number of dispensing physicians in the UK. There have also been suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed and that pharmacists should take a more active role in the provision of drugs. General medical practitioners and pharmacists have common ancestry in the medieval spicers, who dispensed medicines and offered medical advice. Rural practitioners have been allowed to dispense drugs since 1911. Physician dispensing can benefit patients via savings in time and the monetary cost of visiting a pharmacist, but it restricts drug choice, can compromise safety, and encourages overprescribing except for physicians with drugs budgets. The effects of physician dispensing on government costs are not yet clear. Over-the-counter (OTC) purchase can save patients the cost of a physician visit and reduce drug costs to some patients, but it can also provide an incentive to pharmacists to profit twice from a drug, at government expense. Switching drugs from prescription-only to OTC reduces the government drug bill, but provides an incentive to pharmacists to overprescribe, and may not be as safe for patients. Liberalising prescribing by doctors would discourage community pharmacies which provide an advisory service to patients. Liberalising OTC switches would reduce opportunistic assessment of patients by doctors and could compromise patient safety. Separation of physician and pharmacist functions is probably safer for patients. It is concluded that the current situation in the UK, whereby most dispensing is done by pharmacists, is the preferred option other than for those patients who do not live within easy access of a pharmacy. A reassessment of the legal status of drugs and subsequent OTC switch of drugs used to treat minor self-limiting illnesses is also favoured.