Presented by Vincent Tlala Manager: Pharmacy Practice

1. Services rendered by Pharmacists Presented byVincent TlalaManager: Pharmacy Practice

2. SECTION 35A OF PHARMACY ACT Entitles Council to make rules relating to: • a code of conduct for pharmacists and other persons registered in terms of this Act; • what constitutes good pharmacy practice; • the services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees.

3. SECTION 35A OF PHARMACY ACT Progress Report with regard to publication of these Rules • Code of Conduct – submitted to the Office of the Minister together with Ethical Rules • Good Pharmacy Practice Standards – published in December 2004 and additional standards added in December 2005 • Services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees- published on 23 February 2007

4. SECTION 35A OF PHARMACY ACT Regulations relating to practice of Pharmacy in SA Rules relating to services for which a pharmacist May levy fee or fees Scope of Practice Good pharmacy practice manual Pharmacist

5. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) • On 18/19 September 2003 resolved that draft rules in this regard be published for public comment as a board notice • The proposed rules were published for comment in October 2003 in the Government Gazette (Gazette No. 25492) as Board Notice No 94 of 2003 • On 15 October 2004 Council published the Rules relating to services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees. • As a result of implementation problems Council on 25 October 2004withdrew the set of published Rules. • On 24/25 February 2005Council accepted and approved a revised set of rules relating to services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees.

6. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) • Council resolved further that the office of the registrar embark on a consultation process with various stake holders before publication of the Rules i.e. • Other statutory councils, • Office of the Minister and DG • Health portfolio committee • Competition Commission, etc • Council at its meeting of 29/30 June 2005, resolved that pharmacists must participate in National Health Reference Price List (NHRPL) • Council also noted that the present fees structure as proposed in Rules document, did not necessarily bear any relationship to the actual cost experienced in the practice environment

7. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) • On 12/13 October 2005 Council resolved a research be conducted to determine: • the units for the procedures as contained in the South African Pharmacy Council’s Rules document. • the tariff of fees payable to a pharmacist in respect of professional services rendered by him/her using formula contained in Circular No 8 2005 from Council for Medical Schemes. • staffing ratios for all categories of pharmaceutical personnel in both institutional and community pharmacy by examination of selected best-practice sites. • On 12/13 October 2005Council resolved that the Schools of pharmacies be approached to assist in the study of the above. • Council at its meeting on 12/13 October 2005further resolved that the office the registrar must submit an input to the pricing committee on the dispensing services.

8. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) • At the meeting of all stake holders (Council, Department of Health, pharmacy schools and other interested parties) held on 25 October 2005 it was resolved that a pilot project be conducted in order to present a report to the pricing committee with regard to the determination of units on dispensing services. • A pilot research project was undertaken at the end of 2005 as a collaborative effort between the SAPC and pharmacy schools and the results of the study were presented to the Pricing Committee • It was identified that a more comprehensive study encompassing all the professional services which can be provided by a pharmacist was needed • The follow up study should also include the activities involved in the dispensing process and be conducted in both the public and the private sector

9. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) 27 November 2006 : R & D Task Team met • Proposed research project should be conducted in two phases namely: • Phase 1: baseline survey consisting of an empirical investigation to determine which services are currently provided in community and institutional pharmacies situated in the public and the private sector recorded with the South African Pharmacy Council. • Phase 2: is a study to determine units based on the activity time for procedures (services) for which a pharmacist may levy a fee, the tariff of fees as well as staffing norms for all categories of pharmaceutical personnel in both sectors

10. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) • The outcome of Phase 1 will assist in determining the sample size, i.e. number of pharmacies that will be used in Phase 2 of the research project. • This approach was chosen to ensure that the sample chosen is representative of the services that are provided in all pharmacies throughout the country • On 1 December 2006 the Minister published Regulations relating to the obtainance of information and the processes of determination and publication of reference price lists. • The information may be submitted by any person, professional association representing a discipline concerned or statutory body established to regulate the relevant profession

11. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE History (2003 – to date) • On 24 October 2006 Council sent a letter to the Minister informing her of Council’s intention to publish the Rules • On 13 February 2007 Council received approval from Minister to publish the Rules • On 23 February 2007 Council published the Rules relating to the services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees • The Rules were published without the units and fees attached

12. SERVICES FOR WHICH A PHARMACIST MAY LEVY A FEE Why were Rules published without units and fees? • In terms of Section 49(1)(a) of the Pharmacy Act the Minister in consultation with Council make regulations relating to tariffs of fees payable to a pharmacist in respect of professional services rendered by him/her • Council and NDoH agreed not to publish the Rules with units and fees attached • To afford Council to conduct research re the above • To avoid confusion in the market place

13. RESEARCH Research Objectives • To determine the units for the procedures as contained in the South African Pharmacy Council document Rules relating to the services for which a pharmacist may levy a fee and guidelines for levying such a fee or fees. The units are based on the activity times for each procedure. • To determine the tariff of fees payable to a pharmacist in respect of professional services rendered by him/her using formula contained in Circular No 8 2005 by Council for Medical Schemes. • To determine staffing norms for all categories of pharmaceutical personnel in both institutional and community pharmacy.

14. RESEARCH Research Objectives • The research project should be conducted in two phases • Phase 1 : baseline survey consisting of an empirical investigation to determine which services are currently provided in community and institutional pharmacies situated in the public and the private sector recorded with the South African Pharmacy Council. • Phase 2 : is a study to determine the activity time for procedures (services) for which a pharmacist may levy a fee, the cost of providing a pharmaceutical service based on return on investment and operating expenses as well as staffing norms for all categories of pharmaceutical personnel in both sectors

15. RESEARCH OBJECTIVE OF BASELINE SURVEY The specific objective of phase one of the research project was to determine which of the services for which a pharmacist may levy a fee are provided currently in community and institutional pharmacies in both the public and the private sector.

16. RESEARCHMETHODOLOGY • Target population - all communityand institutional pharmacies (public and private sector) • Research instrument - The Data Collection Instrument(DCI) • Three structured questionnaires for all pharmacies i.e. : • Community • Private Health Facilities • Public Health Facilities • DCI was applied by means of a telephonic interview for communityand institutional pharmacies in private sector • DCI was sent to all public hospital pharmacies to be completed by the responsible pharmacist at the respective hospitals in the various provinces

17. Private institutional and community pharmacies in the different provinces

18. Public institutional pharmacies in the different provinces

19. RESULTS • The results are discussed in the following three sections: • Community pharmacies =1690 respondents. • Private institutional pharmacies =158 respondents. • Public institutional pharmacies =352 respondents • The results indicate that dispensing, compounding and providing information are the major activities provided by community pharmacy

20. Overall Results of the different categories of pharmacies in the different provinces

21. Overall Results of services in the different categories of pharmacies

22. Overall Results of services in the different categories of pharmacies

23. Overall Results of services in the different categories of pharmacies

24. Overall Results of services in the different categories of pharmacies

25. Phase 2 • Way forward following baseline survey • Determine sample size that is statistically representative • The following factors were considered when determining the total number of services that should be evaluated per pharmacy: • prevalence of the service in the baseline response group • available time for the field worker • availability of human resources • results of the dispensing pilot project • the geographical distribution of the pharmacies

26. SAMPLING METHOD FOR PHASE 2 • The population used for the sample is based all pharmacies (community, public and private institutional pharmacies) responded during the Phase 1 (baseline survey). • A stratified random sampling method was used to select a sample of pharmacies in each province and from each category of pharmacies • For each individual pharmacy category a stratified random sample were taken on provincial level • All pharmacies in a specific category in a province that provided services with a prevalence less than 15% were included in the sample • From the rest of the pharmacies in that category in a province a sample of 20% were taken • This method insure that pharmacies that provide services with a low prevalence (< 15%) are included in the sample

27. SAMPLING METHOD FOR PHASE 2

28. Budget Implications – Phase 2

29. IMPORTANCE OF THERESEARCH PROJECT • Council and NDoH • Uniformity • Viability • Transparency • Affordability • Accessibility • To give guidance to the profession • To give guidance to the public • Provide with accurate staffing norms for both public and private sector

30. IMPORTANCE OF THERESEARCHPROJECT (Cont) Medical Schemes (Funders) • To give guidance to medical schemes re services • A fee that is fair and just and scientifically determined • Assist in budgetary processes for medical aids • Input to NRPL Profession • Confirm and validate the professional activities of pharmacists, based on best-practice requirements • The proposed fee structure will be based on the actual cost experienced in the practice environment. • It will assist the pharmacist to modify his/her own practice to increase efficiency or to reduce costs • Assist both the institutional and the community pharmacy sector to determine staffing norms, which will be important in determining human resource requirements in these sectors

31. IMPORTANCE OF THERESEARCHPROJECT (Cont) • Pharmacy Schools • Human resource requirements will, in turn, influence students intake by educational institutions. • Provides an opportunity for schools to collaborate in research relating to pharmacy practice. • To ensure that best practices are adhered to in conducting the research and provide us with expertise • Experience obtained from research will assist teaching by universities on practice related matters

32. WHAT FEES SHOULD BE LEVIEDIN THE INTERIM • Aim is not to supplement dispensing fee • As an ethical profession, Council expects pharmacists to not charge excessive fees • Benchmark against fees already in the market (NHRPL) • Negotiation between service providers and medical schemes/funders

33. Conclusion The starting point for improvement is to recognise the need “People who dream the most do the most” Unknown