Empowering Rural Healthcare—Dispensing Doctors and the Value of Real-World Evidence

In the most remote corners of the UK, dispensing doctors—GPs authorised to both prescribe and supply medications—are lifelines for communities where pharmacies are scarce. Their dual role delivers critical healthcare access, but also exposes significant financial and operational pressures. At Real World Scientists (RWSci), we see their expertise and value, and we’re passionate about supporting their sustainability through evidence, innovation, and strategic collaboration.

Dispensing Doctors: Rural Champions with Dual Responsibilities

Dispensing doctors serve approximately 9.9 million rural patients, including around 3.5 million who live beyond easy reach of a pharmacy  . Only about 7% of all prescription items in the UK are dispensed by these practices—but the impact is far larger than that implies  .

These practices offer invaluable convenience and continuity—medicines and care under one roof. Surveys show they consistently outperform non-dispensing GP practices in patient satisfaction, access, trust, and continuity of care  .

Financial Challenges: Clawback, Fees, and Systemic Disadvantages

Yet, dispensing practices carry heavier cost burdens:

• They face a clawback (discount abatement) of 11.18% on all dispensed items, which cannot be waived—even on products exempted for pharmacies  .

• Unlike pharmacies, they can’t claim exemptions on “Discount Not Deducted” (DND) or price concession items, resulting in significant lost revenue—average practices lose around £30,000 a year due to this inequity  .

• Dispensing service fees haven’t kept pace with inflation since 2019, which has eroded their profitability and threatened workforce retention and patient safety  .

• NHS efforts like the 10-Year Plan often overlook rural needs—rural dispensing practices still lack access to cost-saving tech like the Electronic Prescription Service (EPS), leaving them on paper-based workflows  .

Manufacturer Discount Schemes (MDS): A Crucial Financial Lifeline

Because of these pressures, Manufacturer Discount Schemes (MDS) can be a lifeline:

• MDS are special discounts offered directly by manufacturers, often up to 40%, delivered via wholesalers or rebates  .

• These discounts are vital; without them, practices can operate at a loss—even on reimbursed items  .

• Some schemes are opaque—tiered, volume-based, or capped—so transparency and clarity are essential  .

• Several manufacturers, including Lucis Pharma, Lupin, Ridge Pharma, and IQORO, offer dispensing-doctor-specific schemes—but practices need to stay informed to make the most of them  .

Innovation Gap: Rural Practices Need Support—and Evidence

Rural dispensing practices are highly innovative by necessity, yet often lack funding or recognition:

• They already deliver many services central to the NHS 10-Year Plan, but without the funding or infrastructure to scale safely and effectively  .

• Technology like integrated EPS, barcode scanning, or digital workflows can boost efficiency and safety—but uptake is limited without targeted support  .

Turning Challenges Into Opportunities—with Real World Evidence

This is where Real World Evidence (RWE)—built from real-world experience—can play a transformative role:

• RWE helps demonstrate the clinical, economic, and community value that dispensing practices deliver: reduced travel, faster resolution of medication queries, enhanced patient satisfaction.

• By capturing and presenting these outcomes, practices can make a compelling case for additional funding, updated fees, and tech investment.

• RWE, combined with strategic use of MDS, improves financial resilience and supports better-informed conversations with the NHS, commissioners, and manufacturers.

Real World Scientists—Your Partner in Evidence-Driven Sustainability

At RWSci, we help dispensing practices:

• Design and conduct real-world studies: measuring patient outcomes, cost savings, efficiency gains.

• Interpret data to make cases for service fee updates, MDS uptake, or tech investments.

• Frame findings in ways that resonate with funders, policymakers, and manufacturers.

Final Thought

Dispensing doctors are pillars of rural healthcare—balancing clinical excellence with business realities. In today’s health landscape, where every penny counts and access matters, their work needs recognition, reward, and support.

With Real World Evidence and smart use of Manufacturer Discount Schemes, we can strengthen this vital sector—ensuring rural patients aren’t left behind.

Real World Scientists cares about Rural Health needs.