Dear Colleagues

As medical practitioners we have an ethical and moral responsibility to always ensure the safety and best interests of our patients. We must, therefore, carefully look at the proposed amendments to the Pharmacy Act of 1973 – Pharmacist-Initiated Management of Antiretroviral Therapy Services in South Africa and the rules relating to good Pharmacy Practice.

Changes to the Act could, in effect, compromise the health management and subsequent quality of care a HIV patient receives. If pharmacists are permitted to provide HIV medication without a prescription, this basically implies that the HIV patient does not receive the clinical, or even psychological, support associated with treating and managing HIV.

In effect it also implies the broadening of the pharmacist’s scope of practice to include therapeutic guidance associated with HIV patients, including contraception, pregnancy, abortion services, and even sexual and gender-based violence. Pharmacists are not clinically trained in diagnosing and treating patients suffering from complex diseases. The Act may also expose pharmacists to potentially dangerous consequences by increasing their scope of practice to include the provision of sexual and reproductive health services to the public.

My concern is that HIV medications are classified as Schedule 4 drugs and the proposed amendments can pave the way for pharmacists to ultimately prescribe other Schedule 4 drugs. This will, inevitably, degrade the careful control mechanisms put into place around the prescription of these dangerous or scheduled substances.

SAMA will be consulting with other stakeholders and respond to the amendments which have been made.

Another contentious issue, The Certificate of Need, also comes to mind. We have not received any feedback yet subsequent to making our submissions to the Department of Health on this issue.

In that submission reference was made to the survey SAMA conducted in which doctors rated regulation as the worst avenue to achieve a rational allocation and distribution of facilities, resources, and services in healthcare. The most preferred method indicated by respondents was multi-sector, multi-partner decision making.

SAMA takes the position that the CoN Act has not been extensively and satisfactorily debated, and that it ignores the serious disapproval by the health and medical industry. SAMA will continue to engage with stakeholder groups on this matter and keep our members informed.

I would value your input in these matters.

Be safe.

Yours in Solidarity

Dr Angelique Coetzee
SAMA: Chairperson

Broadened scope of pharmacists unlawful, unfair and not in patients’ best interests – SAMA

Proposed changes to the Pharmacy Guidelines, which will broaden the scope of practice of pharmacists, are unlawful, will compromise patient care. It present a clear conflict of interest in terms of diagnosis and treating patients, and the issuing of medicines and health products. The South African Medical Association (SAMA) has opposed the proposed amendments in a written submission to the South African Pharmacy Council (SAPC) in which it underscores its deep dismay at what it deems an over-reach of pharmacists’ roles in broadening their scope.

The proposed changes 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.

In its submission SAMA notes that the rules broadening the scope of pharmacists contravenes the Health Professions Act which makes it an offence to conduct acts described under any of the professions within its ambit whilst not being registered in that specific profession.

Whilst the financial pressure pharmacies have been under since the regulation of medicines prices and their dispensing fees are understood, this reduction in income cannot be address by venturing in the scope of practice of other healthcare professionals.

In addition, the SAMA submission refers to the skills – or lack thereof – of pharmacists in performing a broadened scope of practice, which includes aspects of mental health (counselling in cases of for example gender-based violence), complex medical- and social fields such as infertility, amongst others.

“There is no way a pharmacist, by means of some ‘accredited course’ or CPD event, will 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” says Dr Angelique Coetzee, Chairperson of SAMA.

Also of concern to SAMA are the rights of patients who have an expectation to be treated by persons who are adequately qualified and experienced. Medical practitioners spend years in hands-on care for patients, from their third year in medical school, two years of formal internships, and gain additional experience during community service.

“It is also unclear how matters of medical negligence will be handled – are providers of pharmacist malpractice aware of this broadened scope of their clients and the implications thereof? And, what happens in cases of misdiagnosis, or the provision of incorrect treatment, care or non-referral?” asks Dr Coetzee.

Apart from these concerns, SAMA has also raised the issue of conflict of interest. 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. It is for these reasons that medical practitioners are prohibited from owning any direct or indirect stake in any pharmacy.

“The broadening of the scope of pharmacists includes the use of any product which can have a direct benefit to a pharmacy. In our view this creates a clear incentive to over-supply, over-service or inappropriately service patients and is a massive conflict of interest. As medical professionals with patient care as our main priority, we cannot abide by such a suggestion,” notes Dr Coetzee.

Part of SAMA’s submission also focuses on the issue of unfair competition.

“Put bluntly: 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,” says Dr Coetzee.

SAMA says it will pursue meetings with all relevant stakeholders – including the SA Pharmacy Council and the National Department of Health, in order to protect the public.

Third wave of Covid-19 infections showing signs of a downward trend - experts

Covid-19 infections have been showing signs of a sustained downward trend, health experts said on Wednesday.

According to a statement by the National Institute for Communicable Diseases (NICD), 7 338 new Covid-19 cases were identified in South Africa on Wednesday, bringing the total number of laboratory-confirmed cases to 2 836 773.

More than 1,300 healthcare workers in South Africa have died of Covid-19

In August 2020, Maverick Citizen reported that 181 healthcare workers (HCWs) had died because of Covid-19. We called on society to recognise their sacrifice and emulate their values. By last week, according to the Department of Health Deputy Director-General, Anban Pillay, that number had risen to 1,297. Further tragic losses were recorded over the weekend.

Why fewer men in South Africa are getting vaccinated against Covid-19 than women

Men in South Africa are not taking up Covid-19 vaccination at the same rate as women.

Only 40% of those who had been vaccinated by 13 August 2021 were men, according to a Health Department report.

Net widens for suggested mandatory Covid-19 vaccinations

DURBAN – The South African Committee of Medical Deans (Sacomd) and the South African Committee of Dental Deans (Saccod) announced on Tuesday that they would be recommending compulsory vaccination for health students and the general health-care workforce.

Cancer patients: Relief as oncology unit opens in Mbombela

Travelling long distances for treatment is a thing of the past for Mpumalanga cancer patients, who can now receive treatment at the newly-opened oncology unit at Rob Ferreira Hospital in Mbombela.

COVID-19 vaccine deemed safe for people living with HIV

The COVID-19 vaccine does not interfere with antiretroviral medication or cause adverse side effects people living with HIV, provided a person’s immune system is intact, meaning that they are not suffering from any other ailments or infections.

The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa
Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181, South Africa www.samedical.org

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