Private pharmacy issue: a storm in a teacup!

According to their letter (The Sunday Times, December 28) the representatives of the Chamber of Pharmacists were supposed to clarify once and for all why they are against the liberalisation of pharmacies. However, letters and articles continue to appear and these also merit a reply.

When there is a sensitive and delicate issue of public concern, such as the pharmacy licences, pharmacy owners and their union representatives would serve their colleagues better by trying to avoid unnecessary public alarm. The worst thing is to issue press releases and address a news conference!

I am not saying that these people do not have the right to speak in public. However, when you have an issue that directly affects the consumer, it would have been much better if discussions and opinions were to be addressed solely to the minister concerned (in this case, the Health Minister), because after all it is from him that they urgently need a positive reply.

Was it worth telling everyone that they clashed with the Government? These people are making a fuss for a difference of just 266 inhabitants because after all, the minister, Dr Louis Deguara (unlike Dr Louis Galea, who was health minister in 1996) does not intend to liberalise this sector. The government drafted a proposal for a ratio of 1,600 inhabitants per pharmacy and these people admitted that presently there is an average of one pharmacy for every 1,866 inhabitants.

If you look at the Medicines Act 2003 which concerns the restrictions on the granting of licences (Government Gazette, November 21), one will note in the introduction that the Health Minister allowed any person four weeks to make representations to the Director General and ask for a revision of the draft. Now, if the government was prudent enough to give ample time for any person to forward suggestions on this draft, was there any need to threaten with industrial action for the government to discuss this issue with the unions concerned?

See what happened now: every week (or day!) we read about this subject which is attracting greater public interest. A correspondent in The Times (January 7), for example, is telling us that pharmacies that have not yet started charging clinic fees, will probably do so once pharmacies are liberalised.

In a letter to The Malta Independent on Sunday (January 11), I wrote: "The doctor uses the (pharmacy) clinic without paying a penny in rent. In the clinic there is a comfortable chair, desk, couch, telephone, air-condition and water heater... The owner starts getting angry, especially if the doctor does not prescribe any medicines. So he turns towards the pharmacist and unethically asks him to charge the poor patients 25c for using the waiting room!" In view of this, whom do you think should pay the clinic fee?

I still have a copy of the circular to all pharmacists issued by the chamber, dated May 22, 1996 regarding clinic fees. I rarely agree with the chamber, but sometimes they do it right... although they still spoiled it at the end! This is what they said: "The Chamber has come to know that some pharmacies are charging patients a fee for the use of a waiting room. While we recognise the expenses incurred and the investments made in providing, besides professional services, a comfortable environment for patients visiting their doctor, it is the opinion of the Chamber that the method being used is not considered to be ideal and portrays the profession in a negative commercialised manner. Other methods should be chosen which do not directly involve the patient."

The chamber secretary however, concluded by reminding pharmacists (even if they are just employees) that they are responsible for all activities in the pharmacies under their management. Was the chamber ready to safeguard the employment of any employee (pharmacist) who may have been fired because he refused to obey the owner (who is usually not a pharmacist) who forced him to charge a clinic fee for each patient visiting the doctor?

In the light of the present situation, when it is working hand in hand with a business association, the GRTU, for the common interests of pharmacy owners, will the chamber issue a similar circular and perhaps address it this time to the owners even though many of them are not pharmacists?

In an article (The Times, January 8) the president of the pharmacy owners' section of the GRTU wrote that the Consumers' Association has suddenly declared itself an interested party. If, as already stated in the Government Gazette, the health minister invited everyone to state their views, what's wrong in the Consumers' Association deciding to do so?

The same person refers to a GRTU survey which according to him proved that consumers are satisfied with the services provided by the present number of pharmacies. I have not seen this survey, but past experience tells me that a survey conducted by an interested party is usually biased. I would recommend The Sunday Times Opinion Survey to be credible.

The GRTU representative mentions Denmark in his arguments. Are the rates of students graduating in pharmacy from various universities in Denmark comparable with ours? And what are the other job opportunities for pharmacists in Denmark? Is the pharmaceutical industry there comparable to that of Malta?

Who can compete with supermarkets or the Monti hawkers? But I have still seen, to a certain degree, discounts and special offers in some pharmacies, even though such practices are not officially acceptable to the authorities concerned, as they are thought to lower the professional standards of a pharmacy.

The correspondent questions whether there are any unemployed pharmacists registering for work. However, I know many who are realising that they made the mistake of their lives and are opting for completely different careers such as teaching.

He also states that young pharmacists are refusing to work in the community. Who knows why? I question the conditions of work and remuneration rates being offered to pharmacists...

How many times does a pharmacist have to stay beyond normal working hours with no overtime rights, because the doctor/specialist has a lot of patients? What hassle has the pharmacist got to go through to take a day or afternoon off? He has to phone a countless number of other pharmacists to find someone to relieve him.

These are just two conditions which annoy most pharmacists, besides the remuneration packet which not always reflects their great responsibilities including also the use of the cash register and cashing the doctor/specialist's fees as well, which may amount to quite a big sum!

The correspondent, although an active GRTU representative, is only officially recognised to speak on behalf of the pharmacy owners' section. The GRTU membership figures he gave cannot be denied. However, I cannot understand how he has the cheek to put all business outlet owners, be it ironmongers, butchers, hair salons etc., in the same pharmacy saga.

Whenever I speak with such non-pharmacy related owners, they tell me "what's so special about you pharmacists?" These people too have problems, pay taxes and bills, and have to earn a living.

I admit that their respective sectors are completely liberalised, including prices, i.e. they are not impeded from officially offering sales and discounts (as pharmacy owners are) but I am sure they never charge their clients a fee for waiting!

I think every business outlet owner fears competition, but such is life! In fact, I am sure that these 7,000 GRTU members think the same as pharmacy owners i.e. they are against liberalisation of their respective sectors. But bearing in mind that for these people the GRTU never (as far as I know) officially said there should be any limit on the number of such outlets to be established, and there is no legislation to protect their interests (in fact their sectors are liberalised), it would be interesting to question in a proper survey how these people feel when they are put in the same pharmacy dilemma.

One last suggestion for the proposed survey: it would be interesting to see whether it is justified that if the pharmacy sector is not liberalised at all costs, these people still continue to sell products that are completely unrelated to health!

Finally, I turn my attention to a letter by Mr J.J. Saliba (The Sunday Times, January 18), who is trying to imply that I do not know what is happening and that I wish to see pharmacies, especially small pharmacies that do not enjoy the clientele seen in more established ones, to close down.

First of all, I am not "oiling the health minister's propaganda machine". On the contrary, in my letter of December 21, I criticised the minister as follows : "How can we speak of a more modern and liberal society in the light of Malta's accession to the EU and still the Health Minister is proposing a figure of one pharmacy per 1,600 inhabitants! Although this is a great improvement over the 1984 figure of 1:3,000, it still does not tally with the fact that University doors are wide open to students wishing to graduate in pharmacy."

Mr Saliba seems baffled because I compared pharmacy with both business and professional entities. I think I was incorrect when I said that "Maltese pharmacy is a double-edged sword": on one side business and the other side professional (The Times, December 31). Pharmacy is a breed of its own! It is so special!

To show I am not "one-sided", I will quote from various letters published in the past. The parts that show that I also feel for the pharmacy owners' present situation will be in italics for the sake of clarity.

"I said it many times that, with all due respect to the owners, competition is healthy" (The Times, December 31, 2003).

"The Government would respect the Chamber's opinion if they tell us the truth, namely that pharmacy owners have families and opening a pharmacy near an already established one would lower the income of that particular pharmacy. I would reason the same if I ever owned a pharmacy, but competition cannot be suppressed." (The Sunday Times, January 19, 2003).

"Pharmacists have a Dr Jekyll and Mr Hyde behaviour. When we are still employees, we think of having higher salaries and better conditions of work, then when we own our own pharmacies and we become employers, we think the opposite for obvious reasons." (The Sunday Times, August 18, 2002).

Even at the beginning of this article, if one reads between the lines, I am advising owners that the less they speak in public the better for them. What else can I tell them?

Mr Sammut said that "There is not one graduate pharmacist who was not offered a job in the existing 209 pharmacies before he/she even graduated". On the other hand, as stated earlier in this article, the president of the GRTU pharmacy section said that they all refused to work in the community and he continued to stress this fact by saying that "not one of them did. It is a perennial problem for pharmacy owners to find pharmacists for employment..."

Is it because the University is not producing enough pharmacists to meet the demand, as they are trying to tell us? Definitely not. So why would they refuse to work in private pharmacies? This is simple logic. It seems that the young generation are wiser than previous ones, and they are not easily fooled by offering them just Lm50 or more than the Government is presently offering its employees.

Why do we often see adverts for pharmacists through employment agencies? If an owner boasts that he offers a salary of Lm600 a month, why shouldn't he disclose the name of his pharmacy?

If we pharmacists make a professional mistake and the Pharmacy Board is informed, we risk ending up without a warrant. Even part-timers have to shoulder great responsibilities. What is Lm3 an hour (or even less) nowadays for a pharmacy graduate? Is this rate comparable with Lm5 for just a couple of minutes for every patient demanding free medicines?

Are the remuneration rates of several European countries comparable to those offered to Maltese pharmacists? If the local rates are described by your correspondent as "excellent salaries" because according to him there is a shortage of pharmacists, I wonder what rate he will offer when he finally realises that there is a surplus of them!

I would like to end on a positive note. I have no personal axe to grind. Till now I do not intend to open a pharmacy. Nor do I have anything against a particular owner. On the contrary, I thank all owners whom I have worked for during the past 12 years for the invaluable pharmacy experience I gained; indeed, if it were not for these people, which university would ever teach me the skills of the trade?

I sympathise with these people because I can imagine how it feels to be in such a situation especially when they read my articles. I therefore, respect the opinion of everyone but I do not tolerate mere excuses and lies such as, that liberalisation leads to the downfall of our profession, and so on... Honesty is the best policy!