Closing Speech for Pharmacists Registration Bill

20 Sep 2007

By Mr Khaw Boon Wan

Venue: Parliament

Mr Speaker, Sir, I thank the members who have spoken in support of the Pharmacists Registration Bill. 

Specialist Register

As noted by Members, pharmacists play an important role in Singapore’s healthcare system.  As Dr Fatimah Lateef put it, pharmacists are the experts in drug use, development, prescription and monitoring.  Their nimbleness, adaptability and commitment have enabled them to keep pace with new developments in healthcare.  They are no longer mere dispensers of medications but have taken on many specialists roles.  Dr Lam Pin Min commented that specialist pharmacists are especially needed to support Singapore’s vision to be a medical and biomedical sciences hub.  It is therefore timely to set up a Specialist Register for pharmacists.

In so doing, Dr Lam suggested that we set up Specialist Training Committees to look into the type of specialists that would be needed to cater to the diverse needs of the industry and the research community.  We will act on this suggestion.  

Mdm Halimah Yacob suggested that we publish the Specialist Register and make it accessible to the public.  I agree.  The Singapore Pharmacy Council will publish in its website the list of specialist pharmacists and their area of specialty. 

Continuing Professional Education (CPE)

Members also supported the need for Continuing Professional Education.  Dr Fatimah asked about the CPE requirements for pharmacists who were on overseas attachments or postings and the non-practising pharmacists who wished to return to active practice.  The new Pharmacists Registration Regulations will spell out the CPE requirements.  Briefly, pharmacists who have been away from Singapore for more than 90 consecutive days would have their CPE requirements prorated.  Non-practising pharmacists can keep their names on the Register of Pharmacists for up to 5 years without a practising certificate.  When they wish to return to active practice, they would have to meet at least half of the required number of CPE points during the preceding 12 months in order to qualify for a practising certificate.  It is certainly advisable for such pharmacists to undergo a period of clinical supervision to ensure competency.  Our institutions will provide the necessary support for such pharmacists. 

Dr Lam asked if specialist pharmacists would require special CPE requirements through participating in CPE activities that would be relevant to their specialty.  The answer is yes. 

Pharmacy Technicians

Dr Fatimah asked if we plan to regulate pharmacy technicians.  Yes. We currently have about 450 pharmacy technicians in our healthcare institutions.  They are either Diploma holders in pharmaceutical science and technology or have successfully completed the Certified Pharmacy Technician Course.  Pharmacy technicians play a supporting role and are under the direct supervision of pharmacists.  As the pharmacists take full responsibility for the action of the pharmacy technicians, the unregulated arrangement is satisfactory and my Ministry has no plan to regulate the pharmacy technicians for now.   

Dr Fatimah suggested that the clinic assistants working in the private medical clinics without pharmacists should have proper skills training, followed by certification.  The Singapore Medical Association currently runs such a certification programme in partnership with the Institute of Technical Education.  The GPs should encourage their clinic assistants to attend such a programme so as to upgrade their skills.  As clinic assistants come under the direct supervision of the doctors who are ultimately responsible for their work, it is in the interest of the doctors that their clinic assistants are properly trained.  

Mr Seah Kian Peng asked if trained Pharmacy Technicians could work in retail pharmacies.  The answer is yes, but they must be supervised by pharmacists who will be responsible for their action.  Mr Seah also enquired if pharmacy technicians could be allowed to dispense non-prescription drugs such as POM (pharmacy-only-medicines) in a retail pharmacy under the supervision of an off-site cluster pharmacist.  This is permissible if there are approved provisions such as video or tele-pharmacy facilities in the retail outlet to enable the cluster pharmacist to exercise adequate supervision, even though remote.  Some pharmacies have been approved for such a purpose. 

Singapore Pharmacy Council

Mr Seah suggested that the Singapore Pharmacy Council should include wide representation, including at least a representative from the retail trade.  We will bear in mind this recommendation when forming the Council. 

Members have all supported the strengthening of the Pharmacy Council so as to maintain high professional conduct and standard.  As black sheep cannot be completely eliminated, some disciplinary actions will have to be exercised as needed.  Dr Fatimah suggested that the Singapore Pharmacy Council appoint legal and clinical advisers to help the Council in some of its proceedings.  I think this is a sound suggestion for the Council to consider. 

Retail Business

Dr Fatimah also made some suggestions for the regulation of pharmacy business.  The Medicines Act and its Regulations cover all matters pertaining to the regulation of pharmacy business.  These are currently being reviewed and my Ministry will study her suggestions.

Manpower Needs

Dr Lam noted the shortage in pharmacists and supported the need to train more locally.  I understand that the NUS Pharmacy Department has plans to raise its student intake. We will also recruit from abroad to augment local training.  But in so doing, I agree with Dr Lam that we must not compromise on quality.  Foreign trained pharmacists will have to meet the same minimum criteria as our local trained pharmacists.  They will need to work under a supervisory framework before they can apply to be fully registered.  Dr Lam suggested that we list the pharmacy degrees that we recognise for the benefit of students who plan to study overseas.  We will do so. 

Mr Seah asked if we can allow pharmacists from countries like the Philippines or India to work in retail pharmacies under conditional registration.  This can potentially be allowed but the Council will have to assess their pharmacy qualifications to ensure that they are of sufficiently high standard. 

Prescribing and Dispensing

On drug cost for the poor, this is a continuing concern for me, and we review drug prices regularly and composition of drugs on the Standard Drug List.  We do a review once a year for this purpose, and there is an expert committee helping me, to ensure cost effectiveness and cost benefit, and to make recommendations to the ministry. We periodically add to the list to ensure drugs remain affordable to our people. Singapore is among the lowest in the developed countries in terms of the percentage of drug expenditure as a percentage of healthcare expenditure.

Finally, Mdm Halimah Yacob asked if my Ministry would re-think the current policy of allowing doctors to both prescribe and dispense medicine. As noted by her, in many countries, the two functions are kept separate, with doctors not allowed to dispense medicine, thus granting the pharmacists the sole dispensing right.   Mdm Halimah felt that such a system might be safer from patient’s point of view as there will then be proper checks and balances.  She noted that this is already the case in public institutions but not yet in the private sector. 

While a case could be made to grant pharmacists the monopoly in dispensing medicine, our current system is not without its benefits.  First, as noted by Mdm Halimah, patients have the convenience of consulting a doctor and getting their prescriptions filled in one place, without having to visit two places.  Second, the system of separating the two functions may end up more costly for the patients. When you restrict supply and prevent doctors from dispensing, I doubt it will enhance consumer interest. The key is whether the providers are competent in dispensing. I have no doubt that doctors are as competent. My natural instinct is to expand supply rather than restrict supply of providers.

My preference is not to replace our current system but work to enhance it.  The key is to give our patients the choice to fill their prescriptions at wherever they wish: at the doctor’s clinic or at a private pharmacy or even across the Causeway.  To achieve such an outcome, doctors should provide each patient with a clearly written, preferably computer-printed prescription.  This is already the case in public hospitals and polyclinics. 

The doctors in the private sector should do the same.  Given the high cost of medications prescribed by the specialists, the private medical specialists, in particular, should set the example and pave the way for this change in practice.  They should automatically issue prescriptions to all their patients, without the patients having to ask for them.  If the patients decide to buy the prescriptions from the medical specialists, then the cost of the medicine should be clearly printed on the clinic bill as a separate item from the doctor’s consultation fee.  We should expect such a level of transparency of all doctors in Singapore.  Our patients should demand such a standard of transparency.  Public sector has demonstrated that it can be done and I hope the private sector will follow suit, beginning with the medical specialists. There is one suggestion that I received from a creative pharmacist to address the current issue of errant prescribing of addictive drugs, for example, Subutex and Dormicum, by doctors. The pharmacist suggested separating the function of prescribing and dispensing for such addictive drugs. But there is no guarantee that the same black sheep we find in some doctors will not appear in the pharmacy profession. Perhaps the SMC can consider restricting doctors found guilty of errant dispensing of addictive drugs from dispensing such drugs.

Conclusion

Mr Speaker, Sir, I believe I have addressed all the comments raised by the Members and I would like to thank them once again for supporting the Bill.