Proposals by the Department of Health to curb the dispensing of medicines by doctors will create all kinds of other problems, reports Rehana Rossouw
SOME three million patients across South Africa receive medication from their doctors every month. By the end of September, the Department of Health will have changed this.
Dispensing doctors have united to slam proposals by the department to curb their right to dispense medicines. They say it will drive up the cost of health care for the poorest sector of society.
The National Convention of Dispensing Doctors (NCDD), which represents 7 200 of South Africa’s 8 000 dispensing doctors, says most of their patients live in disadvantaged areas where there are no pharmacies or where facilities close after working hours.
“Our typical patient cannot afford to take time off work to see the doctor, so he visits the surgery after working hours, long after the day hospitals accept their last patients for treatment,” said NCDD representative Dr Theodore Rai.
“By the time he leaves the surgery, if there is a pharmacy in the area, which is often unlikely, it will be closed. It is too dangerous for him to take public transport to another area to find a pharmacy, so he relies on his GP to dispense medicine.
“What the department is doing is removing the GP’s tools to treat the patients. Many people who see doctors in disadvantaged areas don’t just want to hear that they have gastroenteritis or bronchitis, they expect the doctor to help them cure it as well.”
Not true, said the department’s chief director of registration, regulation and procurement, Bader Pharasi, who is steering the draft regulations to withdraw doctors’ rights to dispense medicines. The department wanted to ensure patients receive medication from the people best trained to do so — – practising pharmacists.
Pharasi said the department had found shocking examples of unsafe and unhygienic premises in visits to 1 103 dispensing doctors. Medicines were not properly labelled with names and usage instructions, syringes were re-used, premises were dirty and medicines were stored at room temperature instead of in refrigerators.
He said the amendments to the Medicines Control Act, which will require doctors to receive additional training and certification before they are allowed to dispense, was aimed at providing patients with the best service. Doctors were not trained in pharmacology, and dispensing doctors’ premises were not inspected regularly.
“Traditionally, throughout the world, diagnostic and dispensing services are separated. The department has been investigating this issue since 1994 and we are not advocating a total ban on dispensing doctors, we just want to ensure they are properly trained to do the job properly.”
He admitted pharmacies were not widely available in disadvantaged areas, and said the department would examine introducing regulations to make it incumbent on existing pharmacies to open after hours.
Rai said he doubted the department’s “survey” of 1 103 dispensing doctors had been scientific. There were existing channels to censure dispensing doctors who practised in unhygienic conditions or prescribed the wrong medication. The Interim Medical and Dental Council could take action against these doctors.
“I find it strange that the department is sitting on these examples of bad practices among dispensing doctors and using them as a tool to justify their actions. It claims to have shocking evidence, but it has not referred these doctors to the council for disciplinary action. It is completely derelict in its duty to the public.”
Doctors and other interested parties have been given until the end of August to comment on the proposals. The NCDD has sent a memorandum to the department objecting to the proposals and has asked patients to write to Minister of Health Nkosazana Zuma, expressing their opposition.
They are also concerned that the changes will push up the prices of medication. “We see indigent patients who pay between R30 and R60 for consultations and get their medication free. This makes up about 30% of our members’ patients,” said Rai. “These people will have to go to state hospitals — we estimate they would total about 600 000 patients each month. State facilities are already overburdened, and it is unlikely that these people would receive better care than we provide.
`We also have contractual agreements with trade union sick funds to provide their members’ medicines at cost price. I doubt whether pharmacies will provide medicines at cost. The only patients from whom we make a profit are those who belong to medical aid schemes, and believe me, those bills are scrutinised, so there is little chance of profiteering.”
Pharasi said doctors who provided medication for sick fund members would be “treated on their own merits”. If it was in the patients’ interest for them to continue dispensing, the department would have to ensure those doctors were competent to do so.
The NCDD is outraged by the department’s failure to consult it before publishing the amendments in the Government Gazette in April.
“The department only met us in April, after we requested a meeting and paid for a venue. We asked for a follow-up meeting to present our case, and were allowed one delegate in a meeting of 30 people,” said Rai.
Pharasi admitted the department had only consulted two organisations, representing dispensing doctors in Gauteng and KwaZulu-Natal, before publishing the regulations. But the department held workshops on the issue last year and had used the media to publicise its new policy.