A couple of weeks ago, timesofmalta.com published an article on the fact that pharmacists were becoming stricter and reluctant to dispense prescription-only medicines (POM) without a prescription from a medical doctor.
This stems from the fact that without a prescription the pharmacist becomes directly liable to any undesired effects that may result from the use of medicines without the authorisation of a medical doctor who is generally liable when signing a prescription.
This reluctance by pharmacists to issue drugs without a prescription is justifiable. Such a restriction is part and parcel of the pharmacist’s role as a gatekeeper to the use of controlled drugs and POMs.
In the majority of instances, this deters abuse and may also reduce potential resistance to specific drugs, antibiotics being a classical case. Moreover, in case of any legal implications, pharmacists would not be covered by the now mandatory indemnity insurance if it were found that they issued POMs without following the correct procedures.
People may argue that such a strict requirement to visit a GP each time you require a prescription is a form of tax or an additional cost to the taxpayer. In reality, I argue to the contrary. In any advanced healthcare system, such tight control measures and strict rules come only second to nature. After all, that is why such drugs are labelled as prescription-only and sold from licensed pharmacists only.
The pinnacle of all this is not what makes us closer to these advanced health systems but rather what repeatedly keeps us years away from these countries – that is, who we define as a prescriber. This is the real cost of a prescription to the everyday patient.
Conveniently listing only three professions as prescribers satisfies a small monopoly of healthcare professionals while blatantly discriminating and disregarding others who are equally trained and competent to advance in their field of practice and maximise their skills and service to their patients by prescribing safely and efficiently.
In fact, in these most advanced health systems, the connotations defining a prescriber is strikingly broad and in contrast to Maltese law, which lists only medical doctors, dentists and veterinarians as prescribers.
Classical examples of professions conveniently left out from this ‘privileged’ list in Malta include podiatrists, physiotherapists and, to an extent, also pharmacists.
Some of these professionals diagnose and treat in their specific field of specialised practice and, like dentists, did not go to medical school. In advanced healthcare systems, these professionals are regarded as competent enough to issue prescriptions. Strangely enough, in Malta this is not the case, even though training is somewhat always better than that of foreign counterparts.
Let’s have laws that facilitate not limit the skills of our healthcare workforce
In Malta, we choose to ignore the rapidly developing field of healthcare outside the comfort zone of specific decision-makers at the cost of delayed care, further cost to the taxpayer and longer patient care pathways. This is the consequence of an outdated law. In the UK, when the law defining prescribers changed to include appropriately qualified and accredited healthcare professionals, apart from the traditional prescribers, this move was justified on the premise that patients requiring a prescription may obtain it faster and without additional cost.
Such law change also recognised the skills of different health professionals who, together with medical doctors and dentists, complement an invaluable service to their patients. In return, this measure yielded a reduction in healthcare costs, hospital admissions, incorrect or overlapping of different medical treatments and a maximisation of skills of all professionals while empowering the primary and community healthcare system we boast so much about.
This approach was so successful in the UK that it continued expanding to include other professions.
Let’s accept and endorse further regulations and enforcements on the control of access and use of drugs. However, we should be equally conscious and aware of the fact that the day and age has come to amend outdated and obsolete laws that blatantly discriminate advanced professions from prescribing.
Let’s create the opportunities and have laws that facilitate, not limit, the skills of our healthcare workforce at a time when the invaluable resource of our healthcare professions needs to be maximised, not kept stagnant or, worse, diminished.
The author is president of the Association of Podiatrists of Malta.