Uncertain future for dispensing doctors

The number of dispensing GPs in Ireland has fallen sharply, raising concerns about access to medicines in rural communities. Niamh Cahill reports

Dispensing doctors have been an essential part of rural healthcare in Ireland for decades. Working in remote, rural areas across the country, they have provided countless older and vulnerable patients with access to critical medicines in a safe, convenient, and timely way.

The service exists because, as a spokesperson for the Department of Health told the Medical Independent (MI), “dispensing doctors provide access to necessary medicines where they might not otherwise be easily obtained.”

However, the number of dispensing GPs has decreased significantly in the last decade. A lack of support, inadequate resourcing, and staffing shortages are among the difficulties faced.

The 39th Annual Rural, Island, and Dispensing Doctors of Ireland (RIDDI) Conference recently took place in Co Mayo, with around 75 delegates in attendance. The declining number of dispensing doctors was highlighted in a presentation by Prof Peter Hayes, Limerick GP and Lecturer at the University of Limerick.

A lengthy motion had already been unanimously passed at the Annual General Meeting (AGM) of the RIDDI in June, which called for action to sustain and protect GP dispensing in remote areas.

Motion

The motion called for urgent engagement with the IMO GP committee and the HSE to protect and restore dispensing where pharmacy access is limited by “distance, transport, age, or vulnerability”.

It included a call to ensure that dispensing doctors were not “unfairly disadvantaged by administrative delays, refusals, or policy inconsistencies that threaten the viability of rural general practice”.

Recognition that sustainable rural practice requires dispensing support and locum cover formed another part of the motion.

The proposals reflect the growing concerns among those working in general practice about the future of GP dispensing and the need for greater supports if the service is to continue into the future.

Dispensing doctors are GPs who routinely issue medicines to patients in isolated areas where pharmacies are located more than three miles away from a GP practice. They issue medicines to patients who would otherwise be unable to access them due to their location, age, and health status.

Dispensing doctors are GPs who routinely issue medicines to patients in isolated areas where pharmacies are located more than three miles away from a GP practice

Dispensing GPs are paid a fee for the service by the HSE under an agreed contract.

Numbers

In 2016, there were more than 100 dispensing GPs in Ireland. In 2018, there were 85 and, as of July 2026, there were 39, a Department spokesperson told MI.

The spokesperson said fees for dispensing doctors were increased by 28 per cent under the 2019 GP agreement with the IMO.

According to the Primary Care Reimbursement Service (PCRS) Statistical Analysis of Claims and Payments 2025 report, the number of “eligible GMS persons at year-end included 10,839 persons who were entitled and had opted to have their medicines dispensed by their GPs”.

Under the 2019 GP agreement, since 2022, the per annum payment for an opt-in GP has been €48.48 and €56.05 for a pilot GP. Based on the agreement, the monthly fees range from €4.04 for an opt-in GP and €4.67 for a pilot GP.

According to PCRS data on GP payments, payments totalling €187,404 were made to dispensing GPs in the first five months of 2026. In 2025, a total of €469,000 was paid to dispensing GPs.

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One reason given for the decline in the number of dispensing GPs is the opening of pharmacies in rural areas.

However, some GPs have questioned whether the actions of the HSE are also having an impact on numbers.

This is because in some cases when a dispensing GP retires, their GMS medical card list is advertised without the dispensing element.

It is also understood that some applications to provide dispensing in rural areas, where the criteria to provide dispensing under the contract are met, have been rejected by the HSE.

Dr Aonghus Flavin, Chair of the RIDDI, told MI that dispensing is a very important service for patients in rural and remote areas and greatly valued by them.

He pointed out that approximately 1 per cent of GMS GPs are dispensing doctors.

Dr Flavin, a dispensing GP at Roundstone, Co Galway, said that some newly vacant GMS lists previously with dispensing were being advertised by the HSE without dispensing included.

“I know of two cases where there were GMS lists advertised without dispensing that were formerly dispensing practices, and these GPs were willing to dispense. There is a feeling among some dispensing GPs that the HSE are not supportive of dispensing GPs,” Dr Flavin said.

I know of two cases where there were GMS lists advertised without dispensing that were formerly dispensing practices, and these GPs were willing to dispense

Dr Flavin added that dispensing GPs were not included in the initial 2019 agreement where there was a reversal of cuts previously made under the Financial Emergency Measures in the Public Interest Act. However, following representation by the IMO, dispensing fees were increased.

Dr Flavin explained that increases made in the agreement were conditional on GPs using the drugs dispensing module integrated into the GP practice management system and forwarding monthly updates of dispensed medications to the HSE.

There was also the need to actively participate in quality improvement in relation to Health Products Regulatory Authority recalls as required.

“Capitation fees were increased by 48.5 per cent over the same period. RIDDI members have had motions passed at the IMO AGMs in 2024 and 2026 advocating that dispensing fees are increased in line with capitation,” Dr Flavin argued.

“The failure of dispensing fees increasing in line with capitation, along with the advent of chronic disease management (CDM), makes dispensing less attractive to some prospective dispensing GPs. CDM is much better resourced and there is a feeling among some dispensing GPs or prospective dispensing GPs that this makes dispensing increasingly unattractive.

“While there does not appear to be a specific policy by the HSE in reducing the number of dispensing GPs, there has been a sustained reduction of dispensing GPs in the past 10 years and the reasons for this need to be researched to ensure any barriers to dispensing are addressed.”

A spokesperson for the IMO said that specific issues related to rural general practice form part of the strategic review of general practice, which is expected to be published later this year. The Organisation “will be engaging in this process and subsequent negotiations”.

The spokesperson did not comment on GP dispensing specifically, but highlighted the IMO’s ongoing and continued support for rural general practice more generally.

They pointed out the Organisation “has long advocated for and negotiated targeted supports for rural GPs”.

The spokesperson added the IMO has recently been successful in securing “much improved processes” to enable rural GPs to secure locums for annual leave and financial supports for those practices that have employed an international medical graduate (IMG) through the IMO Rural GP Programme run by the Irish College of GPs.

“The IMO recognises the value of a sustainable and thriving rural general practice,” the spokesperson stated.

Applications

Dr Cristian Stefan Cimpoeru is a GP practising in Swanlinbar, Co Cavan. Recently elected to the board of the RIDDI, Dr Cimpoeru took over the practice in the rural village in 2024.

“I applied to restore the dispensing service that had historically operated there under the previous GP. The service had existed for many years before the previous doctor retired. Following his retirement, the dispensing element was not renewed,” Dr Cimpoeru told MI.

“Recognising the difficulties many of my patients face in travelling to collect medication, I submitted an application to the HSE requesting that the practice once again be permitted to dispense medicines. The application was supported by a petition signed by approximately 220 local patients, demonstrating significant community demand. Despite this, the application was refused.

“If Swanlinbar previously had a dispensing practice that served the community successfully, why should that service disappear when local patients clearly wish to have it restored?”

There is no pharmacy within a five-kilometre radius of Swanlinbar Medical Practice. The nearest pharmacy in the Republic is approximately 16 kilometres away in Ballyconnell.

Dr Cimpoeru is still trying to restore dispensing at his practice. He has written to the IMO and local political representatives seeking their assistance with his case.

MI understands that when a dispensing doctor resigns or retires the dispensing arrangement is reviewed by the HSE in line with criteria set out in the PCRS document Information and Application Arrangements for General Practitioners.

The local primary care pharmacist is consulted and a decision is made locally as to whether the dispensing part of the contract is renewed.

When asked about Dr Cimpoeru’s situation, a spokesperson for HSE Dublin and North East said that the Executive does not comment on individual cases.

They confirmed, however, that, when a dispensing doctor resigns or retires, the dispensing arrangement is reviewed.

“The practice in most areas when a dispensing doctor retires is in consult with the primary care pharmacist, who would be familiar with the dispensing activity levels, stock usage as well as local knowledge of pharmacies in the area,” according to the spokesperson.

“A decision is made locally as to whether the dispensing part of the contract will be renewed.

“The HSE routinely reviews prescribing performance objectives for general practitioners who have a dispensing status. In cases where there is a clear and demonstrable need for GP dispensing services the HSE is supportive.”

Pandemic

Dr Els Gillis, a GP practising in Annascaul, Co Kerry on the Dingle Peninsula, was unable to continue dispensing after she took over the practice in 2020, she told MI.

The practice is located in the small, rural village, situated around 35 kilometres west of Tralee.

Originally from Belgium, Dr Gillis has worked at the Annascaul Health Centre since 2013. After Dr Patrick Myers retired in 2020, Dr Gillis took over the dispensing practice.

The Covid-19 pandemic created significant challenges in relation to dispensing, the University of Limerick graduate explained.

“The dispensing was still ongoing in the surgery but, with Covid, did not work well, as people were avoiding leaving the house and pharmacies would deliver to the house if required,” Dr Gillis said.

“In addition, I really did not get time to learn what was going on and felt it was unsafe to continue with some medicines being present in our dispensary and others not.

“You would really want to have a preferred medicine practice list and make sure you stock to that. If consultants added new meds and we did not have them, [patients] were collecting some here, some elsewhere, which I felt was risky.”

Dr Gillis said the practice was assessed and passed an audit by a community pharmacist.

However, she ultimately decided the practice was not in a position to continue to deliver the dispensing service safely.

Locums

As is common across rural practices, securing locum cover has been very challenging for Dr Gillis. She outlined how a lack of support can isolate rural GPs and hinder their ability to participate in teaching.

“I got involved in the GP training scheme to be less isolated and keep up to date and to inspire other GPs to become rural GPs,” Dr Gillis said.

“But it was a struggle to get locum cover for those Wednesdays. I had someone doing a GP Fellowship in rural medicine with me for a year and he covered Wednesdays but, unfortunately, he did not stay on, so I had to give up the teaching,” Dr Gillis said.

However, in the past year, a GP assistant joined the practice, which Dr Gillis said has been a strong support.

Requirements

The Department spokesperson told MI that the GMS scheme supports GPs to dispense medicines in areas where there is no pharmacy, subject to approval and ongoing requirements.

The spokesperson said a dispensing GP must ensure that they dispense a minimum of 70 per cent of the items prescribed for patients on his or her dispensing panel in a calendar year.

Where a dispensing doctor does not achieve the minimum 70 per cent dispensing/prescribing level in three successive years, they will no longer retain a dispensing status.

They pointed out that GMS GPs working in rural areas who meet the qualifying criteria receive the annual rural practice support allowance under the Rural Practice Support Framework. The 2019 GP agreement increased the practice support package for rural GP practices by 10 per cent.

Practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking, according to the spokesperson.

The spokesperson said the strategic review is examining the issues related to GP capacity, and will consider further possible mechanisms to attract GPs to rural and underserved areas.

“Significant progress has been made under the review and the review is to be completed this year,” according to the spokesperson.

“Following its completion, a report will be presented to the Minister for Health outlining the findings of the review and setting out recommended actions for a more sustainable general practice into the future. The review will be published subsequently.”