Use of the government's primary health care pharmacies

In recent years we have seen a gradual increase both in the number of patients eligible to receive free medicines as well as in the range of medicines available from primary health care pharmacies.

Just to give some idea, in 2000 these pharmacies served 321,834 patient visits, while in 2005 these same pharmacies served 42 per cent more or 456,931 patients.

These increases have continued at an accelerating pace and this year we are witnessing congestion and even crowding of patients in some of the pharmacies' waiting areas, especially those with the larger catchment areas at Paola, Mosta and Gzira. This is not surprising as again comparing the first seven months of 2006 with those of 2005, the number of patients has increased by a further 15 per cent and the number of items dispensed by another 17 per cent.

Apart from these huge increases, other reasons for this crowding, apart from staff shortages, is the fact that most such pharmacies are small, usually converted side-rooms in health centres. They are not purpose-built pharmacies with proper waiting areas. When the workload was much smaller these pharmacies served their purpose but, now that the figures have increased dramatically, their limitations are beginning to show.

The government has introduced a number of measures in an attempt to reduce this inconvenience and minimise patient queues and waiting times for medicines.

Opening times for patients to collect their medicines have been extended. The Qormi, Gzira and Cospicua pharmacies are now open from 1.30 to 3 pm every Tuesday and Thursday, while the Paola, Floriana and Mosta pharmacies are now open from 1.30 to 3 p.m. every Monday, Tuesday and Thursday.

Some minor structural works have been commissioned such as the opening of a fourth dispensing window at the Mosta pharmacy counter. A similar expansion is planned for the Gzira pharmacy and should be ready soon.

A number of new internal procedures have also been introduced to help reduce the waiting times at the busiest pharmacies.

The preparation of time-consuming extemporaneous medicines like specifically compounded creams, syrups and powders has been transferred from the busy Paola pharmacy to the less frequented Cospicua pharmacy.

Similarly patients collecting bulky gluten-free products have been asked to collect their medicines from Birkirkara pharmacy instead of Mosta.

Certain homes and institutions whose residents take quite a number of medicines have also been shifted from Mosta to Birkirkara pharmacy.

New standard operating procedures have been introduced for all pharmacies so that patients who would have been asked to return to collect an "out of stock" item need no longer queue again but instead are served immediately.

Another new procedure provides that any one person may only collect medicines for a maximum of three persons, so that the queue does not get stuck behind someone with 10 or 15 prescriptions, as was happening before.

Measures to improve queue management have also been introduced. A security officer is now present at all times during pharmacy opening hours in all the pharmacies for better queue control especially regarding special access card holders, kartanzjan holders and patients calling to collect items that were out of stock.

Electronic ticketing machines are being installed and should be in place in all of the pharmacy waiting rooms shortly for better queue management.

Further ways to reduce the queues are being explored.

Administrative arrangements are under way for three-month supplies of medications to be dispensed for patients having chronic conditions, instead of a two-month supply as at present. There are, however, some logistic problems which have to be overcome. This will mean that these patients will only need to go to the doctor twice a year for prescriptions as they will be given two prescriptions lasting three months each.

We have had preliminary talks with the private sector on how it can help with dispensing pre-packed medicines to chronic patients, saving them the hassle of queuing up for them.

Procedures for the recruitment of new pharmacists into the service to replace those who have retired, resigned or are out on long family leave have also been started. This should increase the number of dispensing staff and reduce the waiting times for dispensing.

It is important to note that, in a scenario where the population is getting older, more health conscious and better informed about its rights to free medication, the demand for free medicines is likely to gradually increase over the next few years. This means that even when working at optimum levels of efficiency, there will likely always be some waiting time for free medicines. The department will continue to strive to keep this waiting time to the barest minimum possible.

Dr Amato-Gauci is acting director of the Primary Health Care Department.