PARLIAMENTARY BULLETIN

DISPENSING DOCTORS

There is still considerable concern and much public confusion about the implications of the Department of Health's proposed new regulations on the dispensing of medicines by private medical practitioners. This Bulletin seeks to clarify the issue.

The Background

The Department of Health has announced plans to change the way that medicines are dispensed to patients by private doctors. These changes will only come into effect once the 1974 Medical, Dental and Supplementary Health Service Professions Act is amended, which will allow an open process of consultation on the issue. Currently, more than 8,000 private doctors are registered to dispense medicines.

This practice came about to improve health care in underprivileged townships and rural areas that were neglected by the health service under the National Party Government.

Doctors have therefore been providing a valuable dual service, with diagnosis on the one hand, and dispensing the medicines they prescribe on the other.

The Proposals

The Department of Health has proposed to rationalise the dispensing of medicines by doctors to improve safety and control. The proposals are that:

• all doctors and dentists will have to apply for a licence to dispense medicineS
• licences will be granted in areas where there are no pharmacies available
• all doctors and dentists applying for a licence will have to complete an additional course in dispensing medicines, approved by the Interim Medical and Dental Council of South Africa and the South African Pharmacy Council
• all doctors and dentists granted a licence will have to dispense the medicines personally or have qualified staff trained in dispensing to perform this task
• all doctors and dentists wishing to dispense medicines will have to ensure they have the proper environment needed to dispense medicines safely
• licences will be renewed annually and a licence can be withdrawn if practitioners fail to comply with the conditions of the licence.

Questions and Answers

Q Isn't the Department of Health just trying to stop doctors from dispensing medicines?

A No. Doctors will still be able to dispense medicines where there are no pharmacies. The Department of Health continues to recognise the important service that dispensing doctors are providing to disadvantaged communities in South Africa.

Q Won't it be more difficult for patients - especially in disadvantaged and remote communities - to get medicines under the proposed regulations?

A No. Patients will still be able to get medicines from dispensing doctors, if they are licensed, or from pharmacies. The Department of Health is committed to ensuring an adequate and reliable supply of safe, cost-effective quality drugs to all citizens of South Africa.

Q What is unhygienic about the way doctors currently dispense medicines? Are pharmacies any better?

A The majority of dispensing doctors already meet very high standards. But some do not. According to the results of inspections of medical practices by MCC inspectors and of pharmacies by Regional Pharmacy Council Inspectors:

• more than half of medical practices allowed staff who were not properly trained to dispense medicines - in some cases receptionists - and one in three medical practices counted out tablets by hand, which could lead to contamination. But in 98 per cent of pharmacies, dispensing was done under the supervision of a properly-trained pharmacist
• almost four out of ten medical practices did not store medicines which should be kept cool at the proper temperatures, making the medicines potentially ineffective or dangerous. But in 93 per cent of pharmacies, such medicines were correctly stored in fridges
• more than a quarter of practices did not put labels, information or expiry dates on medicine containers. But in 97 per cent of pharmacies, all medicines were clearly labelled and expiry dates were regularly monitored
• almost two out of three medical practices did not have adequate containers to store medicines safely.

Q What is the evidence for the claim that doctors may be prescribing medicines unnecessarily?

A A study by the South African Pharmacy Council found that dispensing doctors charged more than three times more than pharmacists for medicines to treat patients with similar conditions. Another study of medical claims of more than seven million medical aid members found that dispensing doctors wrote out an average of 3.71 scripts, compared with 2.01 scripts for prescribing (non-dispensing) doctors.