Parliamentary Speech for the Second Reading of the Pharmacists Registration Bill 2007

20 Sep 2007

By Mr Khaw Boon Wan

Venue: Parliament

Mr Speaker, Sir, I beg to move that the Bill be now read a second time.

2.                 The      Pharmacists Registration Bill seeks to repeal the Pharmacists Registration Act (Chapter 230 of the 1985 Revised Edition) and to re-enact it with amendments.

3.                 The Bill aims to achieve two main objectives.  First, it is to help raise the practice standards of pharmacists.  Second, it is to ensure that our laws remain relevant to the practice of pharmacy today. In so doing, the Bill will establish a new statutory body, the Singapore Pharmacy Council, and enhance its powers to enable it to perform its regulatory functions more effectively.

Background

4.                 There are almost 1,500 registered pharmacists in Singapore. After nurses and doctors, pharmacists form the third largest healthcare professional group. The demand for pharmacists will continue to increase to meet the rising healthcare needs of Singaporeans and to support the growth in the biomedical sciences and pharmaceutical research sectors.  We will step up local training of pharmacists but we will also need to augment it by recruiting trained pharmacists from abroad. The Bill will make provisions to facilitate such foreign recruitment.

5.                 Pharmacists work in a wide range of jobs in both the public and private sectors. Traditionally, pharmacists’ role as custodians of drugs is to ensure the passage of safe and good quality drugs to our patients through proper distribution and dispensing, protecting the patients from counterfeit and substandard drugs.

6.                 Over the years, the profession has progressed from a mere drug focus to a patient focus. While they still provide the check and balance in the drug dispensing process, pharmacists today also tailor drug therapy according to the patients’ needs, for example, the titration of antibiotic dosages for individual patients. Pharmacists must therefore update their knowledge and skills through continuing education in order to provide pharmaceutical care of the highest standard. This Bill seeks to mandate continuing professional education for all pharmacists.

7.                 The pharmacy profession has undergone many changes. With continuing discovery of new drugs and novel drug delivery systems, there will be new demands on pharmacists.  They will play an increasingly important role as domain experts in drug evaluation, drug use and surveillance.

8.                 Patients today have access to better and more potent medicines. But these medicines are not without side effects or risks. Patient medication management has therefore become more complex due to a wider range of drugs and treatment regimes. Poly-pharmacy amongst the elderly and patients with multiple illnesses are situations in which the expertise of pharmacists can be called on. We need better trained pharmacists with postgraduate training and specialised knowledge, skills and experience to manage these complex drug therapies. Through this Bill, we seek to establish a ‘Register of Specialists’ for specialist pharmacists who are capable of providing advanced medication management.

9.                 The current Pharmacists Registration Act was enacted in 1981, more than 25 years ago. There is a need to bring it up to date with the modern practice of pharmacy.  We also seek to enhance the regulatory role of the current Pharmacy Board for it to function more effectively. Our proposal is to establish a new statutory body, the Singapore Pharmacy Council, with enhanced regulatory powers to help maintain good professional conduct of pharmacists and raise the standard of pharmacy practice.

10.            The Bill will repeal the existing Pharmacists Registration Act but most of the current provisions which remain relevant will be re-enacted.  But several key amendments are proposed, which I will now elaborate.

First: Compulsory Continuing Professional Education 

11.            Like doctors and dentists, pharmacists need to keep up with the latest developments in the field of pharmacy in order to provide up-to-date, high quality and cost-effective pharmaceutical care. Many countries, including the UK and Canada, have therefore introduced compulsory continuing professional education for their pharmacists.  We should do the same.   

12.            Clause 74 of the Bill will enable the new Pharmacy Council to prescribe conditions for the grant and renewal of practising certificates. One of these conditions will be mandatory participation in continuing professional education. Only pharmacists who accumulate the requisite number of points specified by the Council will be issued with practising certificates, or have their certificates renewed. 

Second: Conditional and Temporary Registration

13.            The growth in the healthcare and biomedical sciences sectors will push up the demand for more pharmacists. We will continue to ramp up our supply. The National University of Singapore (NUS) has increased its Pharmacy student intake over the years, from 41 in 1996 to 115 in 2006.  This is a tripling in number over 10 years. But we need to do more.  Current projection suggests a need for 200 additional pharmacists each year for the next 10 years.  While NUS will consider expanding the intake, we will also have to recruit from abroad to augment our local supply.  

14.            The Bill will make provisions to facilitate foreign recruitment.  Clauses 17 and 19 will allow, in addition to full registration, the conditional and temporary registration of pharmacists. The Bill will enable the Pharmacy Council to conditionally register a pharmacist who holds a prescribed qualification in pharmacy conferred by a tertiary institution outside Singapore, or any other relevant qualification which in the Council’s opinion is not lower in standing than the prescribed qualifications.  These pharmacists will work under the supervision of a fully registered pharmacist for a certain period of time. On successfully completing the period of supervision, the pharmacist may apply to the Council to be fully registered.   

15.            Temporary registration will be granted to pharmacy experts or pharmacists whose qualifications are deemed adequate by the Council, and who are temporarily in Singapore for the purpose of teaching, research or postgraduate study in pharmacy.

16.            This scheme, comprising full, conditional and temporary registration, is modelled against that of the medical and dental professions.

Third: Register of Specialists

17.            Clauses 15 and 18 of the Bill provide for the setting up of a separate register for specialist pharmacists and the registration of such specialists. Clauses 36 and 37 establish a Specialist Accreditation Board to define specialities and to determine the requirements for specialist registration.

18.            Pharmacists with specialised expertise are increasingly required, particularly in areas such as oncology, cardiology, critical care and geriatrics, to ensure safe, evidence-based and cost-effective use of medicines for better patient outcomes. Such specialist pharmacists will enable cost-effective drug prescribing, optimal dosing of drugs, reduction in medication errors and fewer drug-therapy related complications. 

19.            With the advent of molecular medicine, there will also be a need for targeted therapy, to deliver the right dose of the right drug to the right patient at the right time. Specialist pharmacists in pharmacogenomics and nanotechnology will support such advancements in disease management from research to pharmaceutical manufacturing and clinical service.

20.            Responding to this sophisticated demand, we observe a growing number of pharmacists with such specialist qualifications. They are mostly American Board-certified specialist pharmacists and they are providing an excellent level of pharmaceutical care to our patients. But we need more.

21.            The establishment of a Register of Specialists will encourage more pharmacists to pursue postgraduate education in their chosen field.  Besides enhancing patient care, this will also make the professional environment here more attractive to well trained foreign pharmacists and encourage their inflow into Singapore. 

Fourth: Singapore Pharmacy Council

22.            The Bill will establish a new statutory board, the Singapore Pharmacy Council. Currently, the profession is regulated by the Pharmacy Board which is a department of the Ministry of Health.  Our proposal is to convert the Pharmacy Board into a statutory board and to enhance its regulatory powers. 

23.            The Council will comprise 11 members, 9 of whom will be appointed by the Minister, with the Chief Pharmacist and the Head of the NUS Pharmacy Department (or designate) as ex-officio members. This is provided for in clauses 3 and 4. The Chief Pharmacist will function as the Registrar.

24.            Clause 5 of the Bill will strengthen the Council’s ability to regulate standards of pharmacy practice and direct the development of the pharmacy profession. The Council will now be able to make recommendations for the undergraduate courses of instruction, pre-registration training and compulsory continuing professional education for pharmacists.

Fifth: Enhanced Disciplinary and Health Inquiry Framework

25.            Currently, complaints made against pharmacists are dealt with by the Singapore Pharmacy Board. The Board is empowered to discipline a pharmacist, after conducting an inquiry or after giving the pharmacist concerned an opportunity to explain himself. The pharmacist may be issued a warning. In more serious cases, he may be struck off the register.

26.            Part VI of the Bill establishes a more robust disciplinary and health inquiry framework for pharmacists, modelled after the medical and dental professions. Under this system, complaints that the Singapore Pharmacy Council receives will be referred to the Complaints Panel. From this Panel, a Complaints Committee will be instituted to inquire into the complaint. After doing so, the Complaints Committee may either dismiss the complaint or refer the matter for a full hearing before a Disciplinary Committee. For less serious cases, the Complaints Committee may issue the pharmacist with a letter of advice or a formal warning.

27.            Clause 42 of the Bill sets out the composition of the Disciplinary Committee. It will comprise 3 pharmacists of at least 10 years’ standing, of whom at least 2 are Council members. There will also be one observer who is a lay person. The Disciplinary Committee is empowered to take a variety of disciplinary actions against errant pharmacists. For instance, under clause 46, it may strike him off the register or suspend him for up to 3 years. It may impose conditions to restrict his practice, or impose a penalty of up to $50,000. In addition, the Committee may censure the pharmacist, issue him with a warning or a letter of advice, or obtain an undertaking that he will not repeat the conduct complained of. The pharmacist or the complainant aggrieved by the decision of the Committee may appeal to the High Court.

28.            Clause 50 of the Bill establishes a Health Committee. Its role is to inquire into the physical or mental fitness of a pharmacist to practice pharmacy, when concerns about the health of pharmacists are received by the Council. The Health Committee will be empowered under clause 51 to suspend a pharmacist, restrict his practice, or, in cases of serious impairment, removal from the register.

Sixth: Interim Orders Committee          

29.            Inquiries into disciplinary and health matters may take some time to complete and presently, a pharmacist who is under investigation is still able to practise. This may not be entirely satisfactory in some situations as there may be compelling reasons to suspend such a pharmacist from practising, even before the outcome of his inquiry, either for the protection of the public, or in the interests of the pharmacist.. 

30.            Clause 53 allows the Council to appoint an Interim Orders Committee with the power to suspend or restrict the practice of a registered pharmacist for these reasons, pending the completion of disciplinary proceedings against him. To safeguard the interests of the pharmacist, measures have been put in place in the Bill. For instance:

(a)  Interim orders cannot be made unless the pharmacist has had an opportunity to be heard;

(b)  Interim orders cannot exceed 18 months. If the Interim Orders Committee wishes to extend this, it will have to obtain a High Court order;

(c)  Interim orders have to be reviewed after 6 months, and thereafter every 3 months; and

(d)  The affected pharmacist may apply to the High Court to vary or revoke the interim order made against him.

31.            These enhancements to the disciplinary processes are modelled on the Medical Registration Act and the Dental Registration Act.

Finally: Composition of Offences

32.            Clause 69 allows the Council, with the approval of the Minister, to prescribe offences which may be compounded and, where appropriate, to compound such offences.

Conclusion

33.            Mr Speaker, Sir, our pharmaceutical services have seen many improvements over the years. But as medical science will continue to develop, the pharmacy profession must be given the support and backing of this House to enable it to keep pace with the rest of the healthcare professions.    

34.            Mr Speaker, Sir, I beg to move.