One of the most common enquiries I receive is about the direction of prescriptions by GPs to a pharmacy in which they or a family member have an interest.

Of course, there is nothing wrong in GPs having an interest in a pharmacy, but there is a lot wrong in using the influence GPs have over their patients for financial gain. The General Medical Council’s guide, Good Medical Practice, says “You must not allow any interests you have to affect the way you…refer or commission services for patients.” Sometimes, the concerns I receive do not involve pharmacies in which GPs or family members have an interest, but independent third parties who might look to do some kind of deal with the practice.  This, too, is covered by the GMC’s guide, which says “You must not ask for or accept … any inducement… that may affect or be seen to affect the way you … refer patients….”.  A separate GMC document that deals with doctors’ financial and commercial arrangements repeats the guidance specifically in the context of having an interest in a pharmacy business.

Unfortunately, there’s a world of difference between setting out the principles and expecting all GPs to comply with them, let alone enforcing the principles, but before we condemn GPs alone, it’s worth bearing in mind that it takes two to tango. Before a complaint can be made, some kind of evidence will be needed. Patients may tell a pharmacy owner that their GP has told them to take their prescription to a particular pharmacy, or that they have been approached by a third party, saying that a particular pharmacy has the blessing of their GP. Ironically, some pharmacy owners who are affected by the direction of prescriptions worry about whether a complaint to NHS England or the GMC will jeopardise their relationship with the medical practice. More difficult still is the challenge of asking patients to sign witness statements.

When NHS reforms were introduced in 2013, Regulations were made requiring NHS England and CCGs to take account of patient choice, and specifically enshrined in law a patient’s right to choose a GP. However, for reasons that have never been satisfactorily explained, these Regulations do not apply in respect of pharmaceutical services.

If there is no effective control within the healthcare system, it is inevitable that the issue of prescription direction will end up being brought before a court of law.