Another YEAR has come. Some received it with gladness and expectation. Some 'dropped into' it with worries and trepidation. Whatever state you may be in, time does not wait for you to get ready; we have to manage it. If you had not done well last year, then you need to "PLAN for 2016" to ensure greater success. Nobody owes you a meal; you have to work for it. We can only wish you success this year.If you are practising Community Pharmacy in Malaysia, we invite you to join us propmptly as a member (click Member's Section) and you will reap the Member's benefits and pharmacy networking that is required in a professional practice. Malaysian Community Pharmacy Guild (MCPG) (Persatuan Farmasi Komuniti Malaysia) is a national Community Pharmacy organization that will focus on all Industrial Matters pertaining to community pharmacy practice. As on Sept 2015, about one-third of more than 13,147 registered pharmacists in Malaysia participate in community pharmacy practice. MCPG seeks to promote and protect the interests of pharmacy practitioners while desiring that all the consumers and patients receive quality pharmacy-care and related health services. The Motto "Towards Community Pharmacy Excellence" shall guide members to serve patients and consumers well. MCPG was legally established on 7th October 2005 under the (Malaysian) Society Act 1966, and Society Regulations 1984 under the name PERSATUAN
FARMASIS KOMUNITI MALAYSIA (Malaysian Community Pharmacists Association)--
MCPA. It was officially approved for change to MCPG on 8th April 2013.
PART (I): WHO ARE REGISTERED PHARMACISTS? All Registered Pharmacists are University graduates who study a 4 to 6 years Pharmacy Degree Course that specializes in Medicines (Drugs) properties, mechanisms of action, formulation, manufacturing, correct uses and doses, drugs toxicities, drugs interactions and incompatibilities, compounding and dispensing of medicines, proper storage, transportation, handling and disposal of drugs. Malaysia has more than thirteen thousand fully qualified pharmacists who are
registered under the Registration of Pharmacists Act 1951 before they can practise pharmacy. Pharmacy profession is strictly controlled by Pharmacy
Legislations.
Only Registered Pharmacists are Formally trained in University to Dispensing
Drugs (Medicines). Medical doctors specialize in diagnosis and treatment of
diseases; they are not formally trained in Dispensing Medicines. This is the reason
why Malaysia needs Dispensing Separation in the private sector. We had waited for
63 years for Government to implement a legal provision enacted in 1952. Can
Someone in authority be merciful to us??
PART (II): PATIENTS' RIGHT TO PRESCRIPTIONS
Most Malaysians do not know that it is their Legal Right to have a Prescription Issued
to them after their medical doctors have examined them and had decided to
prescribe some medicines for them. This patients' right is clearly stated in
Poisons Regulations 1952, Regulation (23).
Poisons Regulations 1952 stipulates, under above Regulation (23), that:
"The Poison shall only be supplied by, or on and in accordance with a
prescription of, a registered medical practitioner for the purposes of medical
treatment, or a registered dentist for the purposes of dental treatment, or a
veterinary surgeon for the purposes of animal treatment."
The next time, when you go to a medical clinic, PLEASE remember to exercise your
Legal Patient's Right to get a PRESCRIPTION from your doctor. The next door
Community Pharmacists are formally trined to dispense your prescriptions. A
Community Pharmacy carries 1,500% more medicines than a typical medical clinic.
Go for quality services and obtain superior selection because you pay for it.
REMEMBER: "MyHealth.MyRights.MyPrescription"
A PRESCRIPTION shall (legally) contain the following information:
#1--Name and Address of the patient, (and age of patient for Psychotropic
Substance);
#2--Name (strengthen and pharmaceutical form) of medicine;
#3--The dose and total amount of medicine to be supplied;
#4--Specify the number of times (not exceeding three) the medicines to be
dispensed, and if dispensed more than once, at what intervals;
#5--Name and Address of prescriber, (with telephone number for Psychotropic
Substance); and
#6--Be in writing signed and dated by the prescriber.
A Prescription is a Legal Document that has legal power/ authority as well as
accountability. It is illegal to write a Prescription wholly or partly in code or in such
manner that it is not readily decipherable and capable of being dispensed by any
pharmacist.
PART (III): FREQUENTLY ASKED QUESTIONS IN DS
This FAQ Section has been added to meet the needs of our Readers on a
hotly debated Topic called DS.
1) What is DS?
>DS stands for medicine Dispensing Separation.
>DS refers to a Separation of Professional Roles of Medical Doctors and
Pharmacists. Pharmacists will audit and dispense all the prescriptions written by
Doctors according to their University training and studies. Pharmacists will contact
doctors if there is deficiency, incompatibility or drug interactions in any prescription.
This is done in 100 other nations to improve patient medication safety.
>DS is absolutely necessary because only pharmacists are Formally Trained
in university to dispense medicines. It is a fact that all medical doctors self-
taught themselves in dispensing on the day when they set up their private clinics.
Doctorsnever learn to dispense any medicine while undergoing 3 years of
compulsoryservices in Government hospitals or clinics.
>Professional Roles of doctors are to diagnose the diseases and then write a
suitable Prescription to treat the condition. They are trained as Clinicians.
>Pharmacists are trained to manufacture, formulate, dispense and counsel
patients on all medicines as they study in university every aspects of drugs
molecules and their mechanisms of action.
>DS implementation is meant to bring Greater Benefit to all the patients
as Malaysia has suffient number of doctors and pharmacists.
>The CORE-VALUES in DS are Teamwork and Professionalism. These are
universal values recognized and actively promoted by World Health Organization.
Every Malaysians deserves this DS Service.
2) Why do Private Doctors in Malaysia Resist DS?
>It is normal of anybody, including doctors, to Resist change. This is more
pronounced when a large percentage of them are Elderly Doctors who do not want
to adopt any changes.
>But the fact is these doctors only constitute a minority 14% of all the doctors
and they operate small independent medical clinics. The majority 86% of doctors
are already practising under DS-System. It is fair to expect minority to follow the
majority in any professional practice.
>Most of these Private Doctors make-good-money from selling medicines in
addition to their Consultation Fees. A few medical clinics even become ILLEGAL
wholesalers as their purcahse quantities revealed clearly. So many clinics Resist To
DS because of money, and not because of factors like lack of 24-hours pharmacy
and inconvenience-to-patients.
3) Are there Sufficient number of Pharmacists in Malaysia?
>There are more than 12,000 pharmacists in Malaysia. This compared well with
47,000 doctors. Malaysian Pharmacists-To-Doctors Ratio is better than many Asian
developing nations that had implemented DS 10 years ago.
>There are sufficient pharmacists to dispense doctors' prescriptions in any place
(towns or rural districts) as long as there are private medical clinics there.
>All the Registered Pharmacists hold either Bachelor Pharmacy Degrees, or
Master Degrees, or Doctor of Pharmacy Degrees from more than 70 universities in
16 nations, ranging from Australia, Arab Saudi, America, Britain, Egypt, India,
Indonesia, Japan, New Zealand and United Kingdom. In Malaysia, there are 6 Public
Universities and 13 Private Universities that offer recognized Pharmacy Degrees.
>There are 1,000 to 1,200 NEW Pharmacy Degree Graduates produced each year.
>Pharmacists will face unemployment unless Government implement DS in near
future. Alternatively, Government should close down 50% of all medical and
pharmacy universities to avoid over-production of graduates.
4) Can 24-Hours Community Pharmacies be established?
>24-Hours Community Pharmacies will be established when Government FIX
The Date to implement DS. This is long over due.
>"Demand-and-Supply" ecomony-rule will ensure that community pharmacies will
be everywhere to cater to the needs of patients and consumers. Pharmacy Guild and
Society use geo-mapping to assure even distribution of pharmacies.
5) Will it be CHEAPER to obtain Dispensed Medicines from Community Pharmacies?
>A straight answer is a Definite YES.
>You can get cheaper medicines from most community pharmacies. Local university
researchers had confirmed it. There are very keen Price and Service Competition
among all the pharmacies.
>Pharmacy Guild and Society will, after DS is implemented in private sector, try to
work out a Better Price and Value for All the Dispensed Medicines. That is possible
due to economy-of-scale.
6) Why did Doctors SAID that it would be inconvenient for patients to obtain
Dispensed Medicines from Community Pharmacies?
>"Inconvenience-To-Patients" is one of 3 excuses that private doctors USED To
Protect Their Own INTERESTS. Is it really true or is it just their imagination?
>Let us examine the actual situation on the ground. Let us examine the Federal
Pensioners (who are Elderly Aged above 60 YEARS Old and they are SICK) who have
experienced Community Pharmacists Dispensing under DS System. When Pensioners
could not obtain their medicines from a Government Out-Patient-Pharmacy, they
would bring their Doctors' Prescriptions to a near-by community-pharmacy
(numbering 720 under this e-MASS Project) to get Dispensed Medicines.
>This e-MASS Project had been carried out for more than 2 years now.
>There are No Complaint Of Inconvenience by any Government Pensioners. They
are more than 300,000 Federal Pensioners under this Project.
>E-MASS Project had Proven-Beyond-Doubt that DS-System will NOT bring
Inconvenience-To-Patients. And 2,000 Community Pharmacies are ready to
dispense all prescriptions to be issued by 6,600 private doctors.
7) Why should all patients obtain medicines from Community Pharmacies?
There are many reasons for private and public patients to obtain their Dispensed
Medicines from Community Pharmacies. 8 Reasons are given below:
#1--TRAINING: Only Pharmacists are Formally Trained and qualified from university
education to dispense medicines, but doctors are Not.
#2--CLINICIAN: All Medical Doctors are trained as Clinicians to diagnose and give
treatment. They only self-taught themselves medicine-dispensing on the day they set
up their private clinics. There are Higher Risks in self-taught practitioners.
#3--RISKS: Modern medicines are potent chemicals that can either cure or kill
depending on users ability. We need qualified pharmacists to handle these medicines
in order to give patients better protection.
#4--SUPERIOR CHOICE: Most Private medical clinics keep about 120 drugs as compared
to most pharmacies that keep 2,000 drugs. Obviously many Private Patients have
often been deprived off superior medicines as they are not available from clinics and
doctors refuse to write prescriptions for patients to get elasewhere although it is
patients' right to Best medication.
#5--EDUCATION: Pharmacists study pharmacokinetic and pharmacedynamic properties
of each drug in university. Such knowledge is required in medicine dispensing and
counselling that will lead to enhanced therapy outcome and improved patient's
comfort.
#6--ECONOMY: Government should take note that patients faster recovery from
illnesses (by using superior drugs) means Higher National Productivity and enhanced
National Income. DS will help Malaysia to achieve a High Income Nation Status.
#7--TRANSPARENCY: Patients (and employers) want itemized billing for their
medicines. Most Private Medical Clinics refuse to follow what the patients and
employers want. DS will resolve this administrative and transparency problem.
#8--COST CONTAINMENT: Patients do not want to pay more than necessary.
Government wants to ensure that national medicine bill is not out-of-control. DS
Implementation will address this issue especially when Government introduces the
Universal-Health-Coverage to take Overall Control in Medicines Cost and Selling
Prices, and health-care providers services charges.
8) Some Private Doctors had complained that community pharmacies did not
keep the medicines they had prescribed. Why is that so? Is that serious?
>It is a known fact that most private medical clinics stock about 120 drugs as
compared to about 2,000 drugs stock in most community pharmacies. Patients will
get much better choice of good drugs when pharmacists are dispensing under the
proposed Dispensing-Separation System. It is absolutely for Patients' benefits.
>Since most Community Pharmacies keep 1666% more medicine items than
clinics, why are some prescribed drugs not available from pharmacy? The most
likely reason is because this doctor had prescribed a drug that is seldom used, or
is used only by certain groups of specialists like dermatologists, or the drugs are
restricted by Government to hospital setting only.
Having said that, it should be pointed out that there will be sometimes when
some drugs are temporarily unavailable from importers or wholesalers. Such a
temporary shortage of some drugs had also happened in America, Australia or
United Kingdom, or in our Government hospitals.
9)Have the Private Doctors been given adequate Notice to DS Implementation
in Malaysia?
>Private medical doctors and pharmacists had debated on DS in the past 30
years! In 1985, Malaysian Medical Association had signed a Memorandum of
Understanding with Malaysian Pharmaceutical Society that stated clearly that
"Medicine Dispensing is the Professional Role of Pharmacists".
>Then in 2004-2005, another round of public debate appeared in all mass-media.
Doctors asked for more time to quit dispensing. Pharmacists gave them 10 years!
>Alas, after a total of 30 years, Private Doctors still claim to be Not-Ready to
give up Dispensing. Now they cunningly pull the patients in to shield them!
>No More Extra Time this time around. Enough is enough.
>Patients medications in the private sector must be handled by most qualified
and formally trained pharmacists. DS is now, Year 2015.
10) Is DS a Bad Practice for Malaysia? Where can I see it practised?
>Almost all Malaysians have benefited from DS-System that are being used by
86% (40,400 doctors) who are working in Government hospitals, Private hospitals
and almost 2,000 Klinik Kesihatan nationwide.
>It is because of these 86% doctors that make Malaysian health-care system
an efficient and affordable one. The minority 14% caused Malaysian Overall ranking
under WHO to fall to #49 position due to non-compliance in reporting and related
works. Many diseases' root-causes are never investigated or identified.
>It is right to say that almost all Malaysians are familiar with DS-System. It is
a better health-care system as compared to that used in the private sector.
11) Who Will BENEFIT the Most from Dispensing Separation?
>Consumers and patients are the main BENEFICIARIES under DS-System.
>Teamwork: Pharmacists and Doctors will focus on "what they are trained in".
>DS-System is a Winning-Formula for consumers and providers.
>DS-System will ensure Affordable and Efficient Health-care System for
everybody. It is the fundamental right of everybody to health-care.
12) Why "Say NO To Clinics' Dispensing"?
>Because most medical clinics used untrained and unqualified staff to dispense
medicines without "Immediate Personal Supervision" by doctors, as required by
Pharmacy Legislation.
>The physical set-up of almost all the medical clinics make "Immediate Personal
Supervision" by doctors impossible to carry out.
>Pharmacy Guild and Society will not object IF THE DOCTOR himself dispenses
the medicines to patients in according to POISONS ACT 1952, POISONS REGULATION
1952, POISONS (PSYCHOTROPIC SUBSTANCE) REGULATIONS 1989, and DANGEROUS
DRUGS ACT 1952.
13) Malaysia have enjoyed the benefit of Financial Auditing and yet we do not
consider our Health as Equally Important. WHY, Health Minister?
>Yes, Malaysian Government made it a mandatory requirement under Company
Act 1965 for all the private limited company (Sdn Bhd and Berhad) to have their
annual account Audited by a qualified auditor. Why is our health not as important
as money? Nobody can revive or resurrect you once you are gone due to a
wrong drug or incorrect dose... Let us fight together for MALAYSIA to have HEALTHIER CITIZENS for years to come. Most of OUR CHILDREN will be RECEIVERS rather than Providers of Health-Care. PLEASE put the Welfare of Our-Children and Grand-Children ABOVE any monetary gain. ASK your Doctors for PRESCRIPTIONS. You have the Patients' Right to obtain medicines from clinic or pharmacy of Your Choice. A Pharmacy has 15 times more drugs (medicines) than A Medical Clinic.
PART IV: WHY ARE PRP (PROVISIONALLY REGISTERED
PHARMACISTS) FACING TRAINING PROBLEMS?
There are many reasons why the PRPs are facing problems to find the training
placement this year. Worldwide economic slow-down had affected the Government's
ability to create more training posts. More than 500 last-year PRPs have not
completed their 12-months training and hence are still occupying the previously
available PRP posts in the Public sector. These existing PRPs will complete their
twelve months Internship in batches over next few months, and afterwhich more
Training places will be available. We are aware of this problem and had informed the authority on the urgent need to limit the total number of new Pharmacy Graduates Malaysia should produce. This country has too many universities (6 public universities and 14 private universities) that produce about 1,200 new Pharmacy Graduates every year. Malaysia will probably be the first developing nation that has unemployed pharmacists in near future unless Government make a major policy shift in health-care system.
Higher Education Ministry issues License to any university that produce new
Pharmacy Graduates. Health Ministry does not seem to have a control on the
issuance of such licenses to universities. Here lies a potential explosive situation
where even more licenses may be issued to produce even more pharmacists. There is no easy solution to this problem! Public sector used to be able to give Training Placement to all the PRPs since the
Registration of Pharmacists Act 2003 stipulated the compulsory National Pharmacy
Services. The complusory National Pharmacy Services were reduced from the original (1+3)
years to the current (1+1) years. Financial consideration probably play a role in the reduction.
Private sector can also provide PRP-Training. Credit should be given to the
Pharmaceutical Service Division of Health Ministry for "liberalizing the PRP Training
to the private sector" since 2013. Less than 200 private community pharmacies,
pharmaceutical manufacturers, and private hospitals are recognized premises where PRPs can receive their training. Private sector Community Pharmacies can provide, currently, up to 300
places to PRPs when private doctors are willing to issue the patients
precriptions for the Preceptors (namely Senior Supervising Pharmacists) to
teach and train these new Pharmacy Graduates into competent registered
pharmacists. IT IS IMPOSSIBLE TO TEACH THESE PRPs without the real
doctors prescriptions. Government had been informed of such a situation.
Under POISONS REGULATIONS 1952, Regulation (23), private doctors must
write a PRESCRIPTION (Not a Patient's Note) whenever Controlled Medicines
are supplied to patients. This is a LEGAL requirement that MOST independent
medical clinics did not comply with. There is no reason why this legal provision
should not be enforced; 63 years of grace-period is beyond understanding.
POISONS (PSYCHOTROPIC SUBSTANCES) REGULATION 1989, Regulation (17)
is another legal provision that should have been enforced 26 years ago! Abuses
in psychotropic medicines should be reduced immediately. Take action now.
Above two legal provisions should be implemented immediately in order to
enable the private Community Pharmacies to partner with Government to
provide professional training-teaching to new Pharmacy Graduates. Only Prime
Minister, Health Minister, and Director General of Health can provide real help
to resolve this matter.
