In our practice, for example, we provide 24-hour a day medical care to a sparsely populated rural area over 100 sq miles. Our surgeries are fully booked until late each evening. Home visits to patients unable to undertake a 5- to 25-mile round trip to the surgery are increasingly common and very time-consuming. We are 'on call' every fourth night and weekend, and also look after patients in two cottage hospitals for negligible remuneration. There is little prospect of sharing these burdens with neighbouring practices because of the distances involved. As a result our patient lists are kept at less than 50 per cent of some other practitioners in the Bath area.
The Government's insistence on pegging the remuneration of practitioners to the size of lists (and to payments such as vaccination and cervical smears related to patient numbers) means that without our dispensing income, we would receive less that two-thirds of the intended average net remuneration for GPs.
Were a chemist to move to our village, the implications for our practice would be dire. We would be forced to shed one of our three principals and curtail investment in staff, equipment and premises. The service we offer would inevitably decline.
The Royal Pharmaceutical Society and Dispensing Doctors Association are arguing over the pros and cons of dispensing doctors. However, it seems unlikely that there is any real difference, in either quality or in overall cost to the taxpayer, between chemists and dispensing doctors.
At a time when fewer and fewer young doctors are applying to train as GPs (most areas are reporting a decrease in applications by 80 to 90 per cent) newly accredited principals are in demand. Already most wish to work in the well-remunerated, pleasant pratices based in market towns. Should this trend continue, rural practice will be set to join that other Cinderella area of general practice, the inner cities.
Dr Bill Irish, Dr Piers Jennings, Dr Sam Knott
The Mendip Country Practice