The United Kingdom is far from being alone in having dispensing doctors, despite what the pharmacists may have people believe.    Mostly they are under threat.

From time to time country doctor will publish items from other countries.  Right now our South Africa colleagues are having a bit of a problem, as shown below.

12 June 2003

Dispensing: Doctors fight on 12/06/2003 21:27 - (SA)

Pretoria - A bid by dispensing doctors to stop new legislation - that radically changes their rights - from coming into force partly failed in the Pretoria High Court on Thursday.

Judge Eberhardt Bertelsmann refused to grant an order declaring null and void the proclamations which bring into operation sections of the Medicines and Related Substances Control Act and the Medical, Dental and Supplementary Health Professions Act.

He said the National Convention on Dispensing Doctors and the Affordable Medicines Trust - representing over 11 000 dispensing doctors - had not yet persuaded the court that dispensing doctors would not be able to qualify by May 2, 2004, when the new legislation comes into effect.

The application was, however, not dismissed outright, but postponed to October 21, when the applicants will again be able to ask the court for an order, should their worst fears about the legislation prove true.

Radical changes

The judge said the legislation introduced radical changes in the existing order and was of grave concern to dispensing doctors, the pharmaceutical industry, health services in general and the public.

It was in the public interest that the issue be kept alive. The applicants argued that the implementation of the legislation before the necessary infrastructure to regulate the process was in place was so irrational that it lacked legality.

They said chaos and uncertainty would arise for all concerned if the issue were only debated shortly before May 2 next year, by when (it was argued) it would become clear that insufficient time would have been allowed to dispensing doctors applying for licences.

The new legislation replaces the present system, where the Health Professions Council register doctors as dispensing doctors. The new system will require doctors to complete a prescribed course and apply to the Health Department for a licence.

Protect patients

Health authorities were adamant that the new licensing requirements would protect patients and ensure they were prescribed appropriate drugs. Dispensing doctors fear the legislation would favour pharmacy industry interests and that a dispensing licence would not be based solely on competence, but would also take into account the availability of pharmacy services in the area.

The applicants on Thursday argued that the appropriate regulatory infrastructure would not be in place in time and that doctors would not be able to obtain licenses before May 2 next year, affecting not only their rights but also the rights of patients.

However, health authorities said everything would be in place by the end of September, generous rebates would be available, prior learning would be taken into account and no one would be prejudiced.

Judge Bertelsmann said he shared a measure the applicants' concern that the future may show that the cart was put before the horse in bringing the legislation into place in the absence of provisions for the necessary structures.

But, he added, it was possible the minister and director-general of health could be ahead of planning and might be able to accommodate all dispensing doctors before May 2, 2004.

Cape Times     March 15, 2004

[Ed:  Mind you, the UK DDA Ltd, in cahoots with pharmaceutical bodies, gives up dispensing rights without a fight]

--------------------------

Dispensing docs' row simmers
20/04/2004 21:57  - (SA)  

Johannesburg - Concern is mounting about what will become of thousands of sick people - especially the elderly and people with HIV/Aids - once it becomes illegal for their doctors to give them medicine without a dispensing licence.

Under the Medicines and Related Substances Act, by May 2 dispensing doctors, nurses and dentists must obtain a dispensing licence from the department of health or they will be breaking the law.

However, even although the law came into effect last May, only 10% of the approximately 11 000 dispensing doctors have applied for the licence that will allow them to continue.

More than 5 000 medics are still completing the distance-learning course that has to be done for the licence to be issued.

'Patients are going to suffer'

Although permission has been granted for doctors without a licence to dispense emergency medication, the low compliance is a worry for people in remote communities.

"Whether the doctors are wrong or not (in not applying or applying late), patients are going to suffer," said Jonathan Berger, a lawyer with the Treatment Action Campaign.

Berger said the principle of separating prescribing from dispensing was necessary and would address a range of abuses such as prescribing medication which was cheaper, but less effective.

"The danger is, if you don't allow doctors to dispense, there is no access to medication," said Berger.

He said some people with HIV/Aids preferred to get their medication from their doctor to retain confidentiality.

It would also affect people paying for medication out of their own pockets as they would now have to budget for medicine from a chemist on top of the doctor's consultation fee.

Sibani Mngadi of the health department said the regulations formed part of efforts to get quality, affordable medication for everyone, and affected the whole industry, from wholesalers to distributors through a combination of laws.

Outstsanding work 'appreciated'

"Many doctors receive discounted drugs and this influences dispensing choices, which are not based purely on the health of the patient," he said.

"In an ideal situation, people will see a doctor and then go to a chemist for their prescription," Mngadi said.

"But, in South Africa, where there is a shortage of chemists, dispensing doctors have closed the gap and the government appreciates the outstanding work they have done."

However, Norman Mabasa, spokesman for the National Convention on Dispensing, (NCD) said doctors found the process unnecessary, bureaucratic and expensive.

He believed that a better system would be to check if dispensing doctors complied with the criteria, and to introduce dispensing into the curriculum at medical schools.

The NCD is putting the finishing touches to an application for an interdict to have the May 2 deadline set aside until the Constitutional Court can hear their case.

Edited by Iaine Harper

-------------------------------------------

 

U-turn on licences for dispensing doctors Health department about-turn spells further grief for the pharmacy sector Science and Health Editor CAPE TOWN In a potentially embarrassing policy U-turn, a senior health department official says that, contrary to expectations, doctors who apply for licences to dispense medicines are almost certain to have their applications approved. The department's apparent about-turn spells further grief for the pharmacy sector, already reeling under disputed new pricing regulations limiting the mark-ups on medicines. "It is not our intention to reduce the number of practitioners dispensing medicines," health department deputy director-general for human resources Dr Percy Mahlati said yesterday. Regulations to the Medicines and Related Substances Act prohibit doctors from dispensing all but emergency medicines to patients, unless they have licensed by the health department. These regulations were meant to come into effect last Sunday, but Health Minister Manto Tshabalala-Msimang has put them on hold pending a high court challenge from the National Convention on Dispensing (NCD) and other health professionals . Mahlati said 120 licences had been issued to date, out of a pool of more than 1500 applicants. No applicants had been rejected, he said, and this was likely to occur only if the department was made aware of "gross ethical misconduct" by a practitioner. The department has previously said that dispensing was to be curtailed in areas where there were alternative pharmacy services, such as retail pharmacists or government clinics. The about-turn is a blow to the pharmacy sector. During talks with the health department over pricing regulations, the pharmacy industry was led to believe their reduced margins on drugs would be compensated to some extent by increased volumes, said Ivan Kotze, executive director of the Pharmaceutical Society of SA. The plan was for dispensing to be reduced in doctors' rooms, increasing the number of patients buying prescrip-tion medicines from retail pharmacists. The pricing regulations limit pharmacists' mark-ups to 26%, capped at R26, for prescription medicines. For schedule 1 and 2 medicines sold without a prescription, the professional fee is limited to 16%. Pharmacists, who say their businesses are not sustainable on such thin margins, are to meet state health officials tomorrow. Kotze said that contrary to the health department's own policy, it had awarded dispensing licences to doctors in close proximity to pharmacies. "We are very concerned, and are consulting lawyers," he said. Mahlati denied the health department had changed its stance on dispensing doctors, and said there had been "a lot of misinterpretation". NCD spokesman Dr Lex Visser said: "We pointed out to them (health department) that licensing would reduce accessibility to the cost-effective medicines they espouse, and now they act as if this was entirely their idea."

10/5/04