SINCE the final decision to put dispensing separation on hold, a decision made by the Ministry of Health in May 2016, the Malaysian Pharmaceutical Society (MPS) seems to be defying the decision by pressuring the ministry with public statements.
In December 2015, Pemandu from the Economic Planning Unit of the Prime Minister’s Department organised a week-long stakeholders meet in Port Dickson, where more than 100 stakeholders of the medical profession, including doctors, pharmacists, consumer groups and NGOs met to deliberate issues in the Pharmacy Bill, which includes dispensing separation. We all stayed in Port Dickson for one week.
The Malaysian Pharmaceutical Society and its president, Amrahi Buang, was present at that stakeholder meet to present their concerns as well.
After much deliberation by various stakeholders, the concerns were presented by Pemandu to the MOH and it was decided that a hybrid system of dispensing (which we practise currently) was the best suited in the interim, while waiting for the other building blocks of health reforms to be in place before any changes are made.
The government felt that the best time to implement dispensing separation – where the sick visit the doctor and collect their medicines at the pharmacy – is with the introduction of the Health Financing Scheme.
However, almost immediately after the decision was made, the MPS started harping on the issue, despite being party to the discussions and deliberations.
At the meet, doctors also urged pharmacists to work together in the primary healthcare GP clinics.
Doctors want a clause in the Pharmacy bill, which bars pharmacists working together with doctors in the GP clinic removed. The removal of this clause will allow doctors and pharmacist to work together in GP clinics and not in silos, should dispensing separation come in future.
As such, currently there is no law barring doctors from being employed by pharmacists, so we are of the opinion that pharmacists should not be barred from working in GP clinics as such preserving the GP clinic as a one stop centre for the convenience of the sick.
A decision was also made that a general practitioner has to provide a prescription to his patient upon request, if the patient intends to buy his medication at the pharmacy, also nothing new – something which the doctors have been doing for a very long time.
This decision was made after the work flow in the GP clinic was explained to all present in Port Dickson and it was acknowledged that it was unnecessary to issue a prescription to all patients who attend the GP clinic as the person in charge of the clinic and person in charge of the pharmacy is the same person.
Hence it was decided that a hard copy of the prescription will only be issued if the patient requests and intends to get his medication at a pharmacy.
Dispensing separation is only possible when the following are in place
1. A national health financing scheme so that universal health coverage can be attained. With dispensing separation, the sick and the poor must still be guaranteed accessibility and affordability of healthcare.
2. Remove doctors’ professional fees from the Private Healthcare Facilities and Services Act
3. Integrate the system, remove the clause in the draft Pharmacy Bill barring doctors and pharmacists/assistant pharmacists from working in the same facility.
4. Encourage pharmacists to open pharmacies close to GP clinics/within GP clinics so that the one stop facility can be preserved and convenience and compliance to/of the sick can be met.
5. Enforcement following dispensing separation must be strict. Private pharmacies must have an enforcement agency like the Private Medical Practice Safety Unit and Private Medical Practice Control Unit to enforce regulations on private pharmacies and to ensure uniformity.
I think if doctors and pharmacists can work together on these points, the Pharmacy Bill and dispensing separation will be passed sooner than later.
Dr Raj Kumar Maharajah
Medical Practitioners Coalition Association of Malaysia