‘Unsafe’: Medics push to end Thailand’s pharmacy healthcare experiment

Millions of Thais are holding their breath as the Medical Council battles with two other healthcare giants over universal healthcare scheme services at pharmacies.

“I am very worried and keeping my fingers crossed that the clash won’t end with these services being cancelled,” said one female pharmacy customer.

Speaking on condition of anonymity, she said it was convenient for her to get medicines from a nearby pharmacy and advice from the pharmacist, rather than waiting for hours to see a doctor.

What’s wrong with the services?

The Medical Council has filed a complaint with the Administrative Court against the National Health Security Office (NHSO) and the Pharmacy Council, accusing them of violating the Medical Professionals Act BE 2525 (1982) by allowing pharmacists to engage in medical practices. The NHSO manages the universal healthcare system, which covers the majority of Thais.

“How can pharmacists prescribe medicines to patients without getting a doctor’s diagnosis first?”, the Medical Council complained.

The NHSO and the Pharmacy Council added the “Primary Pharmacy” service to the universal healthcare scheme last year.

The service initially covered 16 types of minor ailments that could be treated with medicines from pharmacies rather than visiting a hospital. From August this year, the service expanded to cover 32 ailments.

The full list of ailments now treatable by pharmacies comprises dizziness, headache, joint/muscle pain, toothache, menstrual cramps, stomach ache, diarrhoea, constipation/haemorrhoids, dysuria, vaginal discharge, wound, rash, eye symptoms, ear symptoms, fever, cough, sore throat, COVID-19 infection, runny nose or nasal congestion, mouth ulcer, minor burns, itchy skin/scalp, parasitic infection, scabies/lice, abscess/ skin pus, numbness/tingling, insomnia, motion sickness, loss of appetite without underlying disease, nausea/vomiting, mild drug/food allergy/insect bites, illness from smoking, and gingivitis/bad breath.

The Medical Council launched legal action against the two healthcare giants last year, but its initial complaint was dismissed on a technicality. After an appeal, the Supreme Administrative Court has now agreed to hear the case.

Are public interests at stake?

NHSO secretary-general Dr Jadej Thammatacharee has assured that Primary Pharmacy services will remain in place unless the Supreme Administrative Court rules otherwise.

“We have not yet received a final court ruling. At this point, the Supreme Administrative Court has only decided to look into the complaint filed by the Medical Council,” he explained.

Fearing the dispute could harm the public, Thailand Consumer Council secretary-general Saree Aongsomwang has urged the Medical Council to withdraw its complaint.

“Primary Pharmacy services in the universal healthcare scheme have significantly enhanced people’s access to medicines and increased convenience. This means a lot to people living in remote areas or near overcrowded hospitals,” she said.

Saree also pointed out that hospital workloads reduce when universal healthcare patients opt to seek services from pharmacies.

“Providing Primary Pharmacy services also gives people a choice about how they access the healthcare system,” she added.

Public Health Minister Somsak Thepsuthin has invited doctors’ representatives for talks in a bid to settle the dispute. “I propose establishing a committee to review the scope of symptoms treatable by pharmacists,” he said.

Somsak added that the Medical Council and Pharmacy Council seemed to be relying on different laws, hence their unwavering stances.

“So, I think we should review the relevant laws together, with the committee comprising representatives from both sides.”

View of pharmacists

Kitti Pitaknitinun, a former president of the Pharmacy Council, said he couldn’t understand why the Medical Council was making a fuss over the inclusion of Primary Pharmacy services under the universal healthcare scheme.

“In reality, doctors are not legally allowed to dispense drugs, but when running their own clinics, they do it themselves without employing pharmacists,” Kitti said.

Despite this common practice, the Pharmacy Council has never taken legal action against doctors for dispensing medicine, he said, adding that health professionals have the duty to support one another in providing services to patients.

Kitti insisted that the Primary Pharmacy scheme did not mean pharmacists had taken over the duties of doctors.

“Pharmacists do not diagnose illnesses. They ask questions about the symptoms of patients to ensure their ailments match the medicines that are dispensed,” he said.

Kitti also emphasised that pharmacists were legally entitled to provide the Primary Pharmacy service under the Drug Act.

Earlier this month, the Pharmacy Council issued a statement defending the service, pointing out that it was introduced to the universal healthcare scheme only after a careful review involving several subcommittees. Doctors’ representatives also participated in the review process.

Views of doctors

The Medical Council recently released a counter-statement, complaining that it had made repeated efforts to voice its concerns about the planned launch of Primary Pharmacy but was unsuccessful.

Therefore, it resorted to legal action at the Administrative Court, with a focus on protecting patients from harm, it said.

“We are not against pharmacists dispensing medicines for minor symptoms,” said Dr Chanwalee Srisukho, in her capacity as a board member of the Medical Council. “The devil is in the details.”

She insisted that certain symptoms now treatable via pharmacies were potentially serious enough to merit direct attention from doctors.

“Treatment of vaginal discharge, for example, can be complicated when patients also have diabetes or a sexually transmitted disease,” she said.

Voice of consumers

Speaking on behalf of consumers, Saree said she understood the Medical Council’s concerns about protecting people from possible harm but said it should have considered an alternative solution to lodging a complaint with the Administrative Court.

“For example, guidelines for dispensing medicines could be tightened. And we could also raise public awareness on how to use medicines correctly,” she said.

The woman, whose dysuria – pain when peeing – disappeared after she consulted a pharmacist, said she tended to visit pharmacies for minor symptoms anyway. Hence, she would prefer to see Primary Pharmacy services continue as part of the universal healthcare scheme.

“I used to buy medicines from various pharmacies before the launch of Primary Pharmacy services. They paid far less attention to the description of my symptoms than pharmacies that are now providing services under the scheme,” she said.