Dispensing Separation

Dispensing Separation (DS) is a division of labour where a doctor will focus on the diagnosis of a patient’s sickness and prescribe an appropriate treatment, including a drug therapy for him, while a pharmacist will audit the prescription and dispense the drugs with adequate medication counseling. DS in health delivery system is a very successful and time proven system that is being used by all the advanced nations

In 1985 Malaysian Medical Association (representing the doctors) had officially agreed in a signed Memorandum Of Understanding (MOU) with Malaysian Pharmaceutical Society (representing the pharmacists) that “dispensing of medicines is a professional role of the pharmacists”.

For whatsoever reasons the private medical doctors are still dispensing drugs to their patients 20 years after the MOU. It is unbelievable that in an advanced developing country like Malaysia, where professional human resources are scarce, more than 2,000 qualified professional pharmacists have been marginalized in their profession and livelihood.

Malaysian government had planned to march towards “Health for All”. To achieve that objective, the primary health care approach will require the redefinition of the roles and functions of all categories of health personnel including those of physicians, nurses, dentists, pharmacists, and sanitary engineers, etc. The ideal Health Team should be “a group of persons who share a common health goal and common health objectives, determined by community needs, towards the achievement of which each member of the team contributes, in a coordinated manner, in accordance with his/her competence in skills, and respecting the functions of others.

It is in accordance with such achievable and noble national aspiration to build an ideal health team, encompassing all the skills of different healthcare disciplines and professionals, granting each healthcare group a national mandate to exercise their professional roles, with a common goal of providing quality, equitable, affordable, and accessible healthcare for all the people in Malaysia, that our Government must amend legislation immediately (by deleting Section 7 of Poisons Act 1952, and Regulation 3 of Poisons Regulations 1952) to bring into being Dispensing Separation.

If the Government does not amend the Pharmacy Legislation soon but continue to permit the private sector to diagnose and dispense the drugs, the pharmacists in Malaysia will encounter such great difficulty that they will be forced to mutate and to develop a practice that will be very independent and in direct competition with the doctors as well Chinese physicians. If such a trend takes deeper roots, the private doctors will forever be without the desirable complementary professional inputs from the pharmacists.

The private doctors will suffer because most of them will never be able to advance into real clinicians roles in diseases investigation, diagnosis, and finding a solution, due to their misplaced desire to dispense drugs to their patients. Keener competition from others, both within and outside their profession, will erode their earning capacity and standard of medical practice. Studies have also indicated that many more doctors will be brought to court for medical negligence and errors.

Many pharmacists have gone through the disillusion stage in the first few years of their careers because the actual pharmacy practice in Malaysia is too far away from what they have been trained in their Pharmacy Degree Courses. Many private sector pharmacists will sell whatever they can to survive because they have not been prepared, through their university pharmacy degree course, to encounter such a hostile working environment in their beloved country.

The patients will suffer the most because they are at the receiving end of a less than ideal health delivery system, where two very important healthcare professional groups cannot work together to bring them the optimal care. It is within the power of the Government to avert such a scenario.

Yes, there are enough community pharmacists to take on Dispensing Separation if our Government were to announce the Policy today. Since 2002, there was one pharmacist serving 7851 people in this country. This compares with one doctor serving 1727 people in the same year. More than 80% of qualified pharmacists worked in the private sector.

Since the Dispensing Separation will only affect the Private Sector, let us look at the statistics at this sector. (The statistics used here are official and gazetted. In this country, we are about 3 to 4 years behind time in gazetting statistics). In year 2002, there were 2,311 pharmacists and 6,600 doctors working in the private sector. This gives a ratio of one private pharmacist to 3 private doctors. This ratio has improved even more in the pharmacist’s favour because there were about 400 new pharmacists and 850 new doctors entering the working force in the last few years. There is no doubt that Malaysia has sufficient number of private sector pharmacists to dispense for all the prescriptions to be written by the private sector doctors.

Nobody knows the exact time. Only the Government can make the final decision on this matter. Leaders in the pharmacy profession have worked very hard to get the Government to include DS in the Ninth Malaysian Plan. The time appears to point to 2007 when the Government plans to launch the National Healthcare Financing Scheme/Authority.

All the private sector practicing community pharmacists and those who plan to enter this sector should be fully aware of the intention of the Pharmacy Professional Societies/Associations to implement radical changes to the pharmacy practice, that include the following areas:

The Government is serious in implementing the DS and the pharmacy practitioners should be proactive in our preparation to meet this new challenge. Indeed, whenever possible, we should begin to introduce the new standards, whether it is the practice procedures or facilities, into our community pharmacies over the next 1 to 2 years.

If you will be renovating your pharmacy premise, do refer to the Benchmark for Pharmacy Premise. Similarly, do consult Association’s secretariat if you are planning to computerize the pharmacy operations.

In order to bring the Dispensing Separation into reality, many pharmacists are currently involved in developing different aspects of the whole challenge. You are strongly advised to participate in at least one of these committees. If you wish to contribute financially, say 10K, 50K or 100K, please send the cheque to the secretariat (refer to Contact Us). The committees hereby proposed are:

. . Pharmacy Practice Benchmark.
. Pharmacy Premise Benchmark.
. Pharmacy Zoning (Mapping of pharmacies and clinics).
. ICT Matters.
. Drugs Pricing.
. Quality Drugs and Rational Uses.
. CPD.
. Public Opinion & Pharmacist’s Image.

Everyone works for a living. Pharmacists’ professional service in dispensing the medicines and providing pharmaceutical care must be appropriate paid. How much is the appropriate Dispensing Fee for a dispensed drug? Germen paid Euro$5.00 to $10.00, Australian paid A$4.81, and British paid 6.30 Sterling Pounds. Is it reasonable for Malaysian pharmacists to charge Rm3.00 per dispensed drug to their patients’ prescriptions? Should it also include the costs of containers, labels and leaflets? How do we calculate the medicines’ charge? Cost prices or a 15% mark up prices? Who shall regulate the medicines’ prices? Who shall determine the generic or brand drugs and subsequent payment?

The following section is for you to participate in the discussion on any matter related to Dispensing Separation. You may forward all your suggestions here.