Andy Gray
A recent report of the brief given by President Mbeki to his new Cabinet indicates that Ministers will be expected to have more focus, be results-driven and master the ability to operate smartly. Naturally, as organised pharmacy, we have certain expectations of the new Minister of Health Dr Manto Tshabalala-Msimang as well. One of those will be to sort out the incredible tangle in which legislation pertaining to pharmacy now finds itself. As a taster of the problems which lie ahead, let us examine just one aspect of medicines supply – the provision of psychiatric medication at district level. Section 31 of the SAMMDRA Act has been referred to repeatedly as a "dog’s breakfast". In one of its more well meaning but perhaps unenforceable sub-sections, it imposes new restrictions on prescriptions for schedule 5 medications with anxiolytic, hypnotic or antidepressant actions. If use of the agent is required for more than 6 months, then the prescription needs to be counter-signed by a psychiatrist. If a psychiatrist initiated the prescription, then a second psychiatrist has to counter-sign the prescription. Most psychiatric medication at district level is prescribed, if not initiated, and then dispensed by psychiatric nurses. In sparsely populated and remote parts of the country, notably the Northern Cape, visits by psychiatrists from the cities are infrequent. How should a regional or district pharmacist in a remote area like the Kalahari now manage psychiatric medication? The schedules have not been published, the EDL does not list prescriber categories, and the scope of practice of psychiatric nurses remains vague. Regulations explaining what the psychiatrist’s counter-signature really entails have not been published. Truly a time for greater focus, a results-driven approach, and smart operating. But above all, for an open, participative attitude as we all try to untangle the web.
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