Official Journal of the Society of Hospital Pharmacists of Australia

EDITORIAL

Separation of dispensing and prescribing in Malaysia:

will the time come?

In Malaysia, both prescribing and dispensing rights still

lie with private general practitioners (GPs) in private
clinics. Concerns have arisen with this model, due to
potential conicts of interest, as GPs prot from the prescribing and sale of prescription medicines. This may
well lead to unnecessary as well as over-prescribing. The
idea of dispensing separation is not new and has been
discussed for many years with strong objections from
various organisations, including the medical associations. More recently, there has been increasing discussions on this topic and many arguments still remain
around reduced convenience and increased costs to consumers and an insufcient pharmacist workforce.1 3

GP clinics in rural areas may be suitable options to consider in order to overcome issues with accessibility and
convenience.
Although an argument against dispensing separation
is that it may increase costs to the public due to the need
to visit two healthcare professionals, this may not necessarily be the case. A local study has highlighted that consumers may need to pay more in order to get the same
brands of medicines from GPs.5 Furthermore, the prots
gained by GPs from both the prescribing and dispensing
of medicines, mean there is a potential for overprescribing of medications and this is further highlighted by two
local studies in Malaysia.6,7

SAFETY

WORKFORCE

Currently at private clinics in Malaysia, no one checks

for the safety and appropriateness of the prescription
and any potential for medication-related problems. The
individual who dispenses the medications in these
clinics usually does not have any pharmacy knowledge
and sometimes may not have any health-related qualications. This is of major concern as patient safety
may be compromised as medication errors could easily
occur during prescribing and dispensing. Many of these
medication-related errors are likely preventable and their
consequences could lead to severe adverse events, hospitalisation and even death in serious cases. Is it not about
time that patient safety took top priority?

CONVENIENCE, ACCESSIBILITY AND COSTS

There are arguments that patients may not want to rst
visit the GP and then head to a pharmacy to have their
medications dispensed. However, this will not be a
major issue if pharmacies are co-located within the vicinity of clinics and would be a slight inconvenience (if any)
in return for patient safety. Furthermore, a recent local
survey among consumers had reported that the majority
of participants supported implementation of dispensing
separation.4 Alternative models to pharmacy services in
rural areas and whether incorporating a pharmacist into
2015 Society of Hospital Pharmacists of Australia.

A shortage of pharmacists in Malaysia is one of the commonly cited arguments by those against the separation
of dispensing and prescribing. Over the years, the profession has tried to overcome this by producing more
pharmacy graduates. Currently, Malaysia has about
19 pharmacy schools producing approximately 1200
pharmacy graduates annually. There are currently about
13 000 pharmacists in Malaysia and the argument on the
shortage of pharmacists should no longer be valid. On
the contrary, we now have a potential situation on our
hands with graduates unable to obtain employment
owing to the lack of demand for them in the absence
of dispensing separation.8 Anecdotally, some graduates
have indicated that they have yet to nd employment
and on average, it takes most at least 610 months post
graduation, to gain employment. With the shortage of
positions within the public sector, there is an increasing
number of pharmacists within the private sector and in
community pharmacies. We may face an issue with an
oversupply of pharmacists if the supply exceeds current
demand.
The debate has been ongoing for decades, and the
arguments against dispensing separation used today are
no different from those mentioned years ago despite evidence of advantages from the separation of these roles.
It is time for policy changes by the government and for
Journal of Pharmacy Practice and Research (2015) 45, 394395
doi: 10.1002/jppr.1162

Editorial

all key stakeholders to place patient safety as their top

priority. Its about time we see these reforms.
Vivienne Mak, BPharm(Hons), PhD
Senior Lecturer, School of Pharmacy, Monash University
Malaysia, Selangor, Malaysia
E-mail: vivienne.mak@monash.edu
Mohamed A. A. Hassali, BPharm(Hons),
MPharm(Clin Pharm), PhD
Deputy Dean (Student Affairs & Networking), School of
Pharmaceutical Sciences, Universiti Sains Malaysia,
Penang, Malaysia

REFERENCES
1 Shae AA, Hassali MA, Azhar S, Ooi GS. Separation of prescribing
and dispensing in Malaysia: a summary of arguments. Res Soc Adm
Pharm 2012; 8: 25862.
2 Msia ready for medicine dispensation; 2015 Mar 21. Available from
<www.dailyexpress.com.my/read.cfm?NewsID=1527>. Accessed
24 September 2015.

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3 Sivalingam J. PKR says separate dispensing has no benet to

patients; 2015 Mar 18. Available from <www.freemalaysiatoday.
com/category/nation/2015/03/18/pkr-says-dispensing-separationa-hindrance-to-patients>. Accessed 24 September 2015.
4 Hassali MA, Saleem F, Aljadhey H. Public perceptions
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5 Tan CS, Hassali MA, Alrasheedy AA, Saleem F.
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Antibiotic prescribing for childhood febrile illness by
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7 Alabid AH, Ibrahim MI, Hassali MA. Dispensing practices of general
practitioners and community pharmacists in Malaysia a pilot
study. J Pharm Pract Res 2013; 43: 1879.
8 Achariam T. No shortage of pharmacists! 2015 Feb 25. Available
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Journal of Pharmacy Practice and Research (2015) 45, 394395