The DDA Podcast
The DDA has created its own series of podcasts with information and analysis of dispensing doctor matters in conversation with DDA Board Members and invited guests.
The DDA Podcast
7. Your GPCs and their dispensing negotiations
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In this episode, the DDA speaks to the three mainland Britain GPCs to find out more about their progress towards achieving a sustainable dispensing contract in Wales, Scotland and England.
DDA Communications Officer Ailsa Colquhoun spoke to:
- GPC Wales Deputy Chair Dr Ian Harris
- Scottish GPC Deputy Chair Dr Al Miles (from 13m 08s)
- GPC England Chair Dr Katie Bramall-Stainer (from 25m 40s)
Referenced in the podcast are:
The Welsh Senedd Health and Social Care Committee Report
The DDA 2026 Scottish Parliament and Welsh Senedd manifestos and supporting resources
Welcome to the DDA podcast. In this episode, we speak to representatives from the GPCs in England, Wales, and Scotland to discuss their current negotiating environments in relation to the dispensing GP contracts in their areas. In Wales and Scotland, there are parliamentary elections, and the GP negotiators there face the prospect of an entirely new health department team and potentially a new political culture as well. In England, we have local elections on May the 7th, the same day as Scotland and Wales go to the polls, and with it the potential to add more pressure to an already pressurized Labour government. All the negotiators are fully committed to addressing the long overdue reform of dispensing practice contracts across the mainland. But how likely are they to achieve any meaningful wins? Listen in to find out more from GPC Wales Deputy Chair, Dr. Ian Harris, Scottish GPC Deputy Chair, Dr. Alan Miles, and GPC England Chair, Dr. Katie Brammelsteiner. I'm Elsa Cahun, the DDA's communications officer, and this is the DDA podcast. So, Ian, thank you very much for speaking to us today. You're the Deputy Chair of GPC Wales, and we're speaking around three weeks before the Senate elections, which is the first election following reforms to the system. We've got a bigger Senate, 96 members, a new way of voting, party voting system, and reduced constituencies and a shortened term from five to four years. So what sort of difference does that make to your negotiating environment?
SPEAKER_01Well, it'll make a big difference to the makeup of the Senate, we believe. So, you know, obviously this is uh a new era for Welsh politics with an expanded Senate. The makeup of that Senate is, if you believe the polls, is likely to be quite different to that that we've had over the last 25 or so years. It's a little bit of a leap into the unknown as far as we're concerned at the minute. We don't really know what sort of government, what sort of Senate we're going to be getting. Exciting but also challenging.
SPEAKER_03When you say different, I mean what what differences are you expecting?
SPEAKER_01Well, we've been essentially a one-party state for the last twenty six years since the Senate was established. So Labour have been in government throughout that time, sometimes in coalition, sometimes as a minority government. But the polls make interesting reading currently. So it'll be interesting to see who comes out on top in the can in the next election and whether we actually see a change, because that obviously will have a significant impact on potentially on the direction of trial for general practice as well.
SPEAKER_03Just before the uh Senate was dissolved, there was a report by the Health and Social Care Committee, which adopted some quite you know revolutionary, potentially revolutionary recommendations for dispensing practices, essentially a more devolved approach to a dispensing practice contract and funding, which at the moment are are inextricably linked to an English the English negotiations. What opportunities does the new Senate offer for that?
SPEAKER_01Some of this work, I think, is stuff that we've already touched upon in conjunction with the DDA, in fact. So it's been known for some time that the situation for Welsh dispensing practices has been deteriorating. So we've seen practices struggling financially, struggling to maintain their dispensing contract. So it's it's been an ask for some time to try and reform the dispensing contract, which obviously was 2012, I think, was the last time it was reviewed. And since then we've seen a deterioration in the situation for dispensing in Wales. And obviously in Wales, we are, if anything, more reliant on dispensing practices than other parts of the UK. We've got 18% of practices having some dispensing uh element to their contracts, and about six percent of the population covered by dispensing practices. So, in some terms, we are sort of more heavily dispensing, if you like, than certainly than England, in some respects, more comparable to Scotland.
SPEAKER_03And how have you found the tying of the two contracts between Wales and England? Have you felt that Welsh practices have lost their voice, that the contract doesn't reflect the reality for Wales, which can obviously be very different from that in England?
SPEAKER_01It's an anomaly to some extent, because we negotiate our contracts on a devolved basis. So, you know, England's success or otherwise in in their contract discussions tends to bleed across to Welsh dispensing practices as a result. And we all know that the the five-year deal in England during a time of high inflation didn't end up being that successful for English GPs, and and in some respects that then bled into the dispensing contract. So in every other aspect of contract determination, we were devolved. So we'd like to see that maybe we take control of that a little bit in Wales and try and make sure that we're in control of our own destiny. And I think that's a position that dispensing doctors would approve of. Obviously, it was one of the contract mandate asks that was agreed in the last contract agreement that we would have discussions with a view to implementing a new dispensing contract for GPs in Wales by April 27. So it's down as part of the contract agreement. And obviously, politics being what it is, you never quite know what's coming next. The the process as we see it will will remain in line with the contract agreement. So that we've already started working on how we can look to create a Welsh bespoke dispensing contract.
SPEAKER_03I I guess at this stage it's impossible to know which way you're going to go. But the the recommendations that the Senate made and obviously those that the DDA were involved in as well, presumably you consider them to be quite crucial changes.
SPEAKER_01Definitely. I mean, we've we've heard very clearly from dispensing practices around Wales that they're struggling to maintain dispensing with the contract as it is. Both the remuneration and the reimbursement elements of the contract are not really working for dispensing GPs. And if we don't listen to that and act upon it, then we s we run the risk of 18% of our practices really struggling to be sustainable in the current climate. So we've already heard of practices in rural West Wales talking about handing back their dispensing contract. So, you know, that that's pretty dramatic to hear from a dispensing point of view. So I think we we really have embraced that as a committee and in close liaison with the DDA, who are, you know, we've got an excellent representative locally in Wales who we work closely with, who's actually on our GPC Wales committee meeting itself. So it was heartening to see that reflected in the Senate Health and Social Care Committee recommendations that they wanted us to have a commitment. I think the wording was commitment to continuing the work. So they they recognize that we're already somewhere along the line of reviewing arrangements for dispensing, and they want to know more about that. And hopefully we'll want to hear a report from the new administration, hopefully around June time, once the election has had had a time to run its course and any post-election coalition discussions or anything else that might be necessary have been concluded. And hopefully we'll have an administration that will want to pick up the cudgules and tell us exactly where they intend this process to head.
SPEAKER_03So Ian, in relation to reimbursement and remuneration, what do you think are the main challenges?
SPEAKER_01Yeah, I think we are looking at them slightly separately, and and one I think will be more difficult than the other to crack, if you like. So the reimbursement's got a degree of cross-border dependency, if you like, because you know, obviously people can purchase their drugs from wherever they they would like to. So the they we will always have to operate on a slightly wider footprint as far as reimbursement's concerned. So there are challenges for us in in disentangling ourselves from an an England and Wales approach from that, if you like. But remuneration is a much more simple area, we think, to try and fix. And we are we're attacking both, but ultimately it's going to be really important to try and deliver something that at least works on sustainability for Welsh practices. And I think you know, we'll get as far as we get, but we're approaching it as trying to to fix both elements, if you like, can in a in a conjoined way. These are these are very long-standing arrangements that have, I think, did not evolve as as was imagined when they were designed back in 2012. So I think it's it's it's time that these things were reviewed properly and we came up with a proper well solution.
SPEAKER_03I mean, it's high time 2012. I mean, we're in 2026 now, that's 14 years. I mean, you're marginally better than the Scottish dispensing practices who haven't seen their fee scale increase since 2002. But it's a long time. I mean, why why has dispensing kind of languished for so long?
SPEAKER_01I'm not sure there's necessarily been the focus pan-UK on it, if I'm being honest. The the voice of dispensing doctors hasn't been particularly loud in that time. I think dispensing was at in some respects was viewed as a boon. And for quite some time people viewed dispensing doctors as as being more sustainable due to the fact they had another income stream to some extent. Now that's clearly waned over time, and if anything, it's gone in the other direction now, where we're seeing quite significant pressure placed on practices because of their dispensing status. So sometimes it's it's gradual evolution and deterioration of contracts that you know weren't future-proof that leads to the point where you suddenly realize that you have to act. And I think that's certainly where we are now.
SPEAKER_03Yeah, the Senate called for reform within 100 days. Media people love a hundred days, the first hundred days. I wonder if the Senate will have the same impact in its 100 days as perhaps our friends over the Atlantic saw in the first hundred days of their administration.
SPEAKER_01That that's quite an analogy, but I I do think what they're looking for within that hundred days is some sort of update as to what's happening. I don't think anyone's envisaging that within 100 days that the work will be complete and that the landscape will have will have been completely changed by that point. I mean, we've set ourselves, in conjunction with Welsh Government, a target of something to be implemented by the start of the 27-28 financial year because we think that is more deliverable. These are complex changes. The other thing we're very mindful of with any change is that we don't want to destabilise any practices because clearly envelopes are pretty fixed. And if you move funding around, then there's a danger that you get winners and losers. So there will need to be transitional arrangements and things that you'd end up having to ensure that there are no practices that have even greater sustainability issues if you change the contractual arrangements. So these are really careful things that we have to think through thoroughly before we implement them.
SPEAKER_03One thing that we talk about quite a lot in England is the sort of urbanisation, the Westminsterisation of health policy. How important, how loud is the rural voice in Wales? Because obviously the geography is very different in Wales to perhaps it is in England in some areas, certainly. And how can dispensing practices maximise, leverage whatever ground they have?
SPEAKER_01Well, for starters, we're a more rural country generally. The other thing I'd say is that the new constituencies, which are larger amalgamations of old constituencies, with six politicians elected in each constituency, usually have some sort of rural component to them. So if you look at the constituency that I live in, for instance, for instance, which is Brigend and the Vale of Gilmorgan, the new constituency, there's a fairly rural component to that, even though there are large conurbations of towns within that, like Barry and Brigend. So each of those new Senate, the members that gets elected, is going to have, by and large, in the majority of those constituencies, a rural component or element to their representation. So I I do think the voice of rural Wales is heard probably more clearly, particularly with the electoral system that we've got, which is proportional representation on a larger footprint than your traditional Westminster footprint constituencies, if you like.
SPEAKER_03So dispensing practices that want to get involved in in having their voice heard in political agenda, there is perhaps some mileage for them to do so.
SPEAKER_01Absolutely. And and the other thing about a small country like Wales with potentially 96 politicians running the country, if you like, is they are relatively accessible. They live in they live amongst us, you know, just like your MPs do. But the ability to influence them and speak to them is probably that much more pronounced in in a small country like Wales as well. So I often find that they're very keen to engage on matters, particularly general practice and access to healthcare in particular, is obviously one of the things that tends to bulge their inboxes and and their mailbags, if you like. So working with them is something they're often keen to do. So I think you know, engaging with your the local politicians if you are a dispensing GP, I think we would welcome that that Benson GPs thought about doing that.
SPEAKER_03And we've published a manifesto for the Senate elections and reflecting very much, very closely the the recommendations that were taken up by the Senate. So we'd we'd encourage our dispensing practice members to use those. Thank you very much. I mean, the opportunity is definitely there in Wales. It's all change, there's everything to be gained. So uh it's an exciting time for Wales.
SPEAKER_01Thank you.
SPEAKER_03Al, thank you very much for speaking to us. You are the deputy chair of the Scottish GPC, and you're talking to us today about dispensing in Scotland, something of a mystery to us down in England. We're talking just under three weeks ahead of the Scottish Parliament elections, as as is happening in Wales. So it'd be great to talk a little bit about how that might change the negotiating environment moving forward. So, dispensing in Scotland, where are we?
SPEAKER_00Sadly, dispensing in Scotland's a fairly long neglected area of work. I'm sure your listeners know that dispensing fees haven't risen since 2002, and there hasn't been really any change in the regulations since then, and really things have just fallen behind. Whereas particularly compared to community pharmacy, where regulations and funding have continued to develop, that hasn't happened to dispensing. And dispensing practices, I think, are becoming more and more marginal in terms of the their economies of running a dispensary. And some dispensaries, I'm told, are now running at a loss, which really threatens the viability of these practices. And bearing in mind, these are practices who are required to offer dispensing services by the health board. It's not that they have a choice. So it is getting to really quite a dire state. So something has to change, and the DDA, amongst others, have been increasingly vocal about the need for change in Scotland, um, along with the Rural GP Association for Scotland as well. I'm a dispensing GP. So I think we're we all know this is a problem, but it's it's something that the Scottish Government started to look at pre-pandemic with a deep dive into dispensing, but then the pandemic hit and attention was diverted. And unfortunately, the recommendations from the deep dive into dispensing were never enacted. So that there is a very useful document out there that gives a pathway for dispensing in Scotland, but it needs to be refreshed and it needs to be actioned. And we've raised this with them as one of the items of work that we think is quite urgent to look at this year. So it's very timely that the DDA have published their manifesto. What's on that manifesto is exactly the sort of thing that I've been talking about with the DDA and RG Pass. And it it really helps focus the minds of Scottish Government. So thank you for letting us share that manifesto with them. Um and there is recognition from the primary care director of Scottish Government that dispensing regulations need looked at and need to change.
SPEAKER_03What were the conclusions of the deep dive?
SPEAKER_00They came to very similar conclusions as your manifesto. But that's not surprising really, because the problems are the same then as they are now. It's just that in the intervening five years, things have got a bit worse. And obviously, dispensing is it's one of these things that theoretically is supposed to run in a in a cost neutral way, but I I feel that that should be cost neutral once the partnership has taken an appropriate premium from it to compensate them for the additional risk, the additional expertise, and the additional workload that they have as GP partners. And that's not currently the case. And I think historically the profits from dispensing in certainly in rural Scotland were able to both make the job more attractive for recruitment and retention in terms in financial terms, but also funded some of the really extended scope of practice that rural GPs have that is not covered under the GMS contract regulations and it's not covered by enhanced services.
SPEAKER_03So basics first responder services, for example.
SPEAKER_00Yes, that that's absolutely right. The the impact of dispensing of well-funded dispensing is that the broader healthcare picture for patients in rural areas is much better than it would be otherwise if there weren't dispensing there. I think there's a number of reasons why things have languished for so long. One, I'm sure I don't need to tell your listeners that dispensing regulations are very complicated. Um, so it's quite a big bit of work to get into. There have been other competing priorities for government and probably for SGPC as well. And the the primary care director and Scottish Government, they are quite a small team, so they do have limited capacity, and their attention has been focused very much over the past year on the funding restoration package that we've been negotiating with them, which will in in some part benefit rural practices. And I speak as a rural GP, there will be benefits, but they will be harder for rural GPs to realise because of the economies of scale. Whereas dispensing is something that actually makes a big difference to rural GPs. And we do have an undertaking from Scottish Government to look at a rural impact assessment of this new funding deal, but also what else needs to be done to help support rural general practice to thrive.
SPEAKER_03We've seen quite a few practices handing back contracts, which is always a fairly clear sign that things are not well.
SPEAKER_00Yes, that that's absolutely right. In part that's been due to insufficient numbers of GPs to employ, so it becomes harder to recruit to rural areas. But if there's erosion of GP income, then again, and if it's if it's especially affecting rural practices, again, it makes them less attractive. And I think single-handed practice has become less and less uh appealing as well for a variety of different reasons. So, reform of dispensing, I think, to try and make the regulations more straightforward and hopefully to make the payment structure not just fit for purpose now, but but also have a mechanism to future-proof it so that we don't end up in this situation again. And that's something we've been very keen with Scottish Government on everything that we're agreeing with them, is to try and find a mechanism to future-proof it, to avoid the boom and bust that we often see with GP funding backers.
SPEAKER_03Looking forward, there seems to be in the SNP's manifesto a few items that that potentially sound of benefit to dispensing practices. One-stop shops in villages, for example, offering health services, walk-in GPs. I mean, that's a very kind of urban concept. I don't know how that works when the walk to the GP is many, many miles over mountains. Digital prescribing, that's another one that uh I think that given the process of electronic prescribing in Scotland at the moment, it seems to be quite exclusive of dispensing practices rather than inclusive. What are your thoughts on the opportunity that the elections might present?
SPEAKER_00I think we we do speak to all political parties, and they all seem to be fairly united behind the idea that there needs to be more investment in general practice in order to improve the Scottish healthcare system. I mean, that's just in line with the international evidence around high-performing healthcare services. And we in Scotland we've allowed our investment in general practice to drop in relative terms compared to the rest of the NHS in Scotland. It's almost halved over the last um 15 to 20 years. So uh you can't really have a high performing healthcare system in that situation. So more investment in general practice is is going to be welcome, and I think all parties are behind that. There is a cross-party effectively equivalent of the English 10-year plan. So we would hope whichever party or parties form a government in Scotland, they would still be behind the idea of shifting care and resource into general practice and the community. In terms of the digital prescribing and dispensing, that that's been a long time coming in Scotland. We're a long way behind England. But my my colleague Chris Black, who's the other deputy chair of SGPC and I, have had meetings with the programme team behind digital dispensing and prescribing. And we're hopeful that we will get dispensing practices shifted into the minimum viable product as opposed to being excluded from it, which they're not as complicated as was thought. So we we don't see there being any any reasonable barrier to that. We've raised with Scottish Government or the civil servants anyway, prior to the election perda period, about the the potential need for emergency payments to dispensing practices to stop them from handing back their contracts. Once a contract's handed back to a health board, and the health board has to run a practice, it's it's not great for patient care necessarily because you can see a reduction in continuity. They're also significantly more expensive for the health boards to run than independent contractors. You know, prevention is better than cure in this situation, and making sure that the dispensing practices are viable in the way that has been done for. Community pharmacies as well. And I would be pretty hopeful, as I say, whoever forms the next government, we can just carry on where we left off because we have a very good relationship with the Primary Care Directorate, with the civil servants. And they, on the side of general practice, they want to see general practice succeed. They are a pleasure to work with. They're highly motivated individuals. And I'm very hopeful that we can get dispensing review and change to at least funding, if not regulations, underway within the next or within the first parliamentary year.
SPEAKER_03But I mean Scotland's always had a completely discrete system. Is being devolved, completely devolved, a benefit or an obstacle?
SPEAKER_00I think it is a benefit, generally speaking. You can watch and learn from the mistakes other countries might have made, although that's not always the case. And you did mention walk-in centres, and you know that they are largely discredited based on the evidence. And as you pointed out, it's it's pretty impossible to deliver walk-in services across the whole of Scotland, especially when you start to look at rural areas. And we have 40% of Scotland's landmass and 7% of the population. And to all intents and purposes, we already have walk-in centres scattered across that area. They're called GP practices. I think the money could be much better spent on supporting core GP services, including dispensing.
SPEAKER_03Scotland obviously does have a very rural landmass. Do you find that the rural voice carries a bit more weight?
SPEAKER_00The rural voice is reasonably vocal, but you need people to be listening. And I think that we are in a lucky position now where government are listening to the rural voice, and they are listening to the deep end voice. Deep end practices and far end or rural practices have largely been neglected, I would say, over the last eight years under the GMS contract arrangements in Scotland. You know, we've got agreement within the team at SGPC that this is one of our priority areas, and we think it's time that the inequality of that was addressed. And for rural practices, dispensing is one of the significant elements of addressing the inequalities that exist.
SPEAKER_03So in these uh crucial three weeks until the parliamentary elections, what what can dispensing practices do to help you?
SPEAKER_00Yeah, I I think if dispensing practices were to write to their candidate the candidates in their areas, and I know the DDE has produced an excellent draft letter which can be adapted by practices for that purpose. I uh you know, it highlights the issues around dispensing in Scotland and what needs to be done. And I think that would be very helpful because then that would have the next round of MSPs primed on this topic.
SPEAKER_03We've put links to our resources on the website and they'll be on this podcast as well. Listeners, do feel free to download those and use them in these crucial three weeks and afterwards when the the newly elected politicians are in post and feeling very enthusiastic and shiny about their new role. So thank you very much, Al. That's been brilliant. It's a great update on what's happening in Scotland and uh and the best of luck for the negotiations once the new parliament's formed.
SPEAKER_00Thank you very much, Elsa. Nice to speak to you.
SPEAKER_03Finally, we're speaking to Dr. Katie Brammelsteiner, Chair of GPC England. And we're talking around three weeks ahead of local elections across England. Where does that leave the negotiating environment for GPC England and the Department of Health? What difference does that make? It's interesting, isn't it?
SPEAKER_02I think there's going to be many hundreds, if not over a thousand council seats available and large swathes of some city meralties and Greater London Assembly, for example. And there's a lot of jeopardy out there because I think the traditional party structures and memberships and voting patterns are changing and demographics are changing, and of course, the geopolitical landscape is enormously volatile right now. So I'm sure there will be big changes to councils, and that in themselves will create further volatility in our structures, and that's on the back in England, of course, of amalgamation of ICBs into clusters, the loss of particularly a lot of expertise around primary care and specialist knowledge of GMS and, of course, of the dispensing regulations as well. So I think it's just throwing more balls into the air again. It all feels rather chaotic at the present time and very difficult to predict what's going to happen. Now, of course, the elections might even tip the Prime Minister to change. He's under a lot of pressure at the present time. Other senior figures in Parliament are watching very carefully from the sidelines. I don't think huge changes because the government is quite committed to certain paths. However, I think a lot of the agenda around neighbourhood healthcare is very poorly defined, almost coming up to a year since the publication of the 10-year plan, which was roundly criticized by so many of us. And nothing around dispensing.
SPEAKER_03I was looking at the NHS 10-year plan today. I mean, it's 169 pages, eight mentions of the word rural, no specific mentions of dispensing at all. And the example that they give of a case study of rural excellence is uh a practice in Whitstable, Kent with uh with 45,000 patients. And uh and I'm thinking, well, Whitstable, Kent is very different in terms of connectivity and demographic to many of our rural dispensing practice members. I I mean, equally given the last election, the the Labour government was very proud of its rural walls that uh it had broken down and the many extra rural MPs. Why is rural proofing so difficult?
SPEAKER_02I think you're right there, and that's a really good spot about Whitstable, that well-known rural bucolic haven on the HS1 line straight into St. Pancras after about 20 minutes.
SPEAKER_03Known as London by the Sea, by those of us who live in that county.
SPEAKER_02I think it's really interesting, isn't it? I think the rural voice does carry strategic importance in English politics, because I think there is that electoral leverage. The rural constituencies are numerous. I grew up myself in a profoundly rural constituency, was the patient of a dispensing practice until I moved to medical school. And I think rural constituencies are often politically decisive, especially in marginals. And I think governments are quite sensitive to policies that can be framed as damaging rural access to healthcare or pharmacies. I think dispensing practices are explicitly recognised by government as being important in meeting the needs of rural communities. And I think rural healthcare in particular is politically salient because it ties into those broader themes that Labour wish to own in terms of the narrative around leveling up, around health inequalities and around infrastructure gaps. But in reality, of course, that we're we're not seeing any move to correcting any of that. I think this is where bodies like the DDA have have an excellent track record of influencing those sorts of policy debates around morality. Rural GP services are essential. They underpin care for millions of patients who are geographically distant from pharmacies. You can't ignore them politically.
SPEAKER_03Dispensing doctors would argue, would say that they don't see much progress. DDA doesn't seem warm welcome from NHS England to discuss the dispensing contract. Why is that, do you think, given given the rural sensitization that there is?
SPEAKER_02I think it's due to the economic climate, in all honesty, because everything's clamoring for so much after 15 years of austerity, it's hard to decide what is more deserving. But I think strategically we've got to frame dispensing as not a perk or a mark of affluence, but as an essential rural piece of infrastructure that's a critical access point for medicines, that's a safeguard against rural health inequalities. And that then better aligns with government priorities. It strengthens the case for funding reform. And I think using the impact of the patient voice could be critically important here. It's not just a financial argument. I think there's evidence that will resonate politically. The travel distances to pharmacies on public transport, the delays in medication access and vaccination access, the risk to vulnerable populations, the demography and the age and the morbidity of rural populations. And I think that shifts the debate from GP income towards patient safety and access, which I think is much more important.
SPEAKER_03So, how important is revising the dispensing contract to GPCE? Where does it rank in the GPCE priority list?
SPEAKER_02Oh, it's essential. It's not optional, it's a must-do for the sustainability of dispensing practices. Income's not marginal, it's a core financial pillar for many of these practices. It significantly contributes to the financial stability and enables them to actually keep the doors open. The current system isn't fit for purpose. The reimbursement mechanisms, the the clawback, the price concessions, the serious shortage protocols, the ICB whims of medicines optimization, changing branding and changing, you know, like you know, Foster to Bebecfo is one example. You know, that that causes some practices to dispense at a loss. And we've got we've got we've got conference policy. You know, we've got explicit conference policy calling for a new dispensing contract, calling for reform of fees and reimbursements. Put it bluntly, without revised dispensing contract that properly funds the activity, dispensing practices would would struggle to remain viable. And that in turn is going to risk access to medicine for millions of rural patients in often marginal constituencies, which brings us back to our earlier debate.
SPEAKER_03Can you put a timescale on when we might see some movement?
SPEAKER_02Well, I think we've been hampered in with the contract variation of last October and how discussions broke down a year ago. And now, of course, we're in some sensitive conversations, intensive negotiations, trying to seek sensible compromises around the two key areas that GPC England has highlighted. One around advice and refer and the risk of blocking GP's right to refer. And secondly, the uncapped, unlimited access. Big things are so critical. Yeah. It's got to be in a position where you've got over the hump of disagreement and dispute, and you're in that, you're in the phase of proper substantive changes to the GMS contract. That is the space in which the new dispensing contract would be feasible to discuss. Could happen as soon as, as soon as, just over a week's time, or it could take a lot longer. It's entirely dependent on the government and how willing they are to be sensible.
SPEAKER_03A week's time would be lovely. I I mean I'm not sure I'd like to hold my breath, but hopefully be able to share good news soon. I mean, how can dispensing practices help you to raise their voice to achieve the change that that they want that you know that they need?
SPEAKER_02I think it's it's acting collectively, it's providing support. If we are forced into taking collective action, it's it's following through with our guidance. It's it's sharing the resources that we'll make available with patients, it's it's having that conversation with patients in every encounter we can. I know it might feel awkward and difficult, but actually that's the strongest advocate you've got is your patients. And if we think that we're seeing over half the England's population every single month, think of those opportunities to address the understanding and the knowledge position and insight of the public as to what's going on. And I think it's keeping those messages really simple that all we want is safeguards and something that's reasonable. And we want a new contract that's going to enable partnerships to thrive and dispensing practices to stay open, that's going to provide fair remuneration for all GPs.
SPEAKER_03Great. Well, thank you very much, Katie. It's been a pleasure, and uh, we look forward to hearing more from GPCE.
SPEAKER_02Thank you ever so much for having me.