The Independent Practitioners Association Foundation (IPAF) and the SA Medical Association (SAMA) have both submitted comprehensive written objections to the SA Pharmacy Council (SAPC) on the proposed Pharmacy Act amendments to broaden the scope of pharmacy practice which they state will compromise the quality of patient care.
Also copied into the IPAF submission has been the Minister of Health, the Director-General of Health and the Health Professions Council of SA.
The amendments in question are the Board Notice 17 of 2021 – Pharmacists who provide Pharmacist-Initiated Management of Antiretroviral Therapy (PIMART) services in South Africa (Board Notice 17); and Board Notice 71 of 2021 – Rules Relating to Good Pharmacy Practice (Board Notice 71).
“We submit (as general practitioners),” IPAF notes, “that the proposed approach in terms of the notices shall undoubtedly compromise the quality of care that patients are entitled to receive. Further, the comments demonstrate the inappropriateness and potentially dangerous consequences of increasing a pharmacist’s scope of practice to provide sexual and reproductive health services to the public.
“We strongly disagree that pharmacists are well placed to provide therapeutic guidance to women of all ages on matters of contraception, fertility, pregnancy, menopause, abortion services and sexual and gender-based violence.
“It is our view that should the above proposed amendments be passed,” IPAF warns, “the morbidity and mortality rates of patients will inevitably increase due to substandard medical care and we submit further that an even greater burden shall be created by secondary complications from the diseases themselves as well as from the inadequate treatment likely to follow.”
In a concurrent media statement released on its submission to the Pharmacy Council, SAMA reiterates the concern that the proposed changes would allow pharmacists to provide therapeutic guidance, and give diagnoses, and prescribe medication to patients: “Pharmacists are not educated, trained or experienced in treating patients, and their focus is on medicines only. Diagnosis and treatment choices are within the domain of healthcare professionals registered as such.
“Whilst the financial pressure pharmacies have been under since the regulation of medicines prices and their dispensing fees are understood,” the statement continues, “this reduction in income cannot be addressed by venturing in the scope of practice of other healthcare professionals.”
Adding her comments, SAMA chair Dr Angelique Coetzee said that there was “no way” a pharmacist, by means of some ‘accredited course’ or CPD event, would be able to acquire the skills needed for diagnosis and treatment in the fields of reproductive and sexual health listed by the notice: What is being proposed, quite simply, falls far outside the scope of pharmacy and squarely within the scope of general and certain specialist medical practices”.
This, in effect, has also raised the issue of conflict of interest. As SAMA points out, a key principle of the relationship between prescribers (doctors) and dispensers (pharmacists) is that there should be no incentive to prescribe or dispense any product.
“Put bluntly,” Coetzee concludes, “allowing pharmacists to compete with general practitioners and others, whilst not having the necessary qualifications, experience and registration – presumably at much lower rates – can only be described as unfair competition.”
SOURCES: IPAF chair, Dr Unben Pillay
SAMA Media Release