14 Sep 1996


14 September 1996


There is still considerable concern and much public confusion about
the implications of the Department of Health`s proposed new regulations
on the dispensing of medicines by private medical practitioners. This Bulletin
seeks to clarify the issue.

The Background

The Department of Health has announced plans to change the way that
medicines are dispensed to patients by private doctors. These changes will
only come into effect once the 1974 Medical, Dental and Supplementary Health
Service Professions Act is amended, which will allow an open process of
consultation on the issue. Currently, more than 8,000 private doctors are
registered to dispense medicines.

This practice came about to improve health care in underprivileged townships
and rural areas that were neglected by the health service under the National
Party Government.

Doctors have therefore been providing a valuable dual service, with
diagnosis on the one hand, and dispensing the medicines they prescribe
on the other.

The Proposals

The Department of Health has proposed to rationalise the dispensing
of medicines by doctors to improve safety and control. The proposals are

  • all doctors and dentists will have to apply for a licence to dispense
  • licences will be granted in areas where there are no pharmacies available
  • all doctors and dentists applying for a licence will have to complete
    an additional course in dispensing medicines, approved by the Interim Medical
    and Dental Council of South Africa and the South African Pharmacy Council
  • all doctors and dentists granted a licence will have to dispense the
    medicines personally or have qualified staff trained in dispensing to perform
    this task
  • all doctors and dentists wishing to dispense medicines will have to
    ensure they have the proper environment needed to dispense medicines safely
  • licences will be renewed annually and a licence can be withdrawn if
    practitioners fail to comply with the conditions of the licence.

Questions and Answers

Q Isn`t the Department of Health just trying to stop doctors from
dispensing medicines?

A No. Doctors will still be able to dispense medicines where
there are no pharmacies. The Department of Health continues to recognise
the important service that dispensing doctors are providing to disadvantaged
communities in South Africa.

Q Won`t it be more difficult for patients - especially in disadvantaged
and remote communities - to get medicines under the proposed regulations?

A No. Patients will still be able to get medicines from dispensing
doctors, if they are licensed, or from pharmacies. The Department of Health
is committed to ensuring an adequate and reliable supply of safe, cost-effective
quality drugs to all citizens of South Africa.

Q What is unhygienic about the way doctors currently dispense medicines?
Are pharmacies any better?

A The majority of dispensing doctors already meet very high standards.
But some do not. According to the results of inspections of medical practices
by MCC inspectors and of pharmacies by Regional Pharmacy Council Inspectors:

  • more than half of medical practices allowed staff who were not properly
    trained to dispense medicines - in some cases receptionists - and one in
    three medical practices counted out tablets by hand, which could
    lead to contamination. But in 98 per cent of pharmacies, dispensing was
    done under the supervision of a properly-trained pharmacist
  • almost four out of ten medical practices did not store medicines which
    should be kept cool at the proper temperatures, making the medicines potentially
    ineffective or dangerous. But in 93 per cent of pharmacies, such medicines
    were correctly stored in fridges
  • more than a quarter of practices did not put labels, information or
    expiry dates on medicine containers. But in 97 per cent of pharmacies,
    all medicines were clearly labelled and expiry dates were regularly monitored
  • almost two out of three medical practices did not have adequate containers
    to store medicines safely.

Q What is the evidence for the claim that doctors may be prescribing
medicines unnecessarily?

A A study by the South African Pharmacy Council found that dispensing
doctors charged more than three times more than pharmacists for medicines
to treat patients with similar conditions. Another study of medical claims
of more than seven million medical aid members found that dispensing doctors
wrote out an average of 3.71 scripts, compared with 2.01 scripts for prescribing
(non-dispensing) doctors.

Thanks to the ANC Health Study Group for its
assistance in preparing this Bulletin