The UAE health sector is an increasingly important part of the UAE economy and its national wellbeing. Whilst servicing a growing population (both foreign and national) the UAE is also becoming a hub for companies’ regional operations as well as a centre for medical tourism.
With the sector being predominantly privatised (underpinned in large part by private medical insurance) a key concern is to regulate the behaviour and service delivery of professionals within the industry. How to balance the business need to operate profitably with the public interest of patient welfare is an issue at the forefront of the Ministry of Health’s strategic vision and regulatory rules. This article is one in a series examining how the Ministry of Health seeks to regulate various professionals whose activities fall within its remit.
The UAE Ministry of Health’s professional code of conduct for the pharmacy profession (the Code) outlines the standard of behaviour expected of licenced pharmacists, and associated staff, in the UAE.
Although the Code is directed towards managing the conduct of pharmacists in the UAE, it indirectly imposes obligations on employers and operations. In addition, a pharmacist’s failure to comply with the standards outlined in the Code may not only directly affect the individual pharmacist but may also have implications for the pharmacist’s employer and/or the operation the pharmacist represents.
Code – Key value principles
The Code focuses on three core value principles: competence, respect and integrity. Interestingly, it states that it is not exhaustive and professionals should therefore be alive to their obligations generally.
This principle requires pharmacists to act competently, providing the best level of care possible in a scientific and compassionate way. Under this principle, a competent pharmacist is committed to maintaining his/her competence through lifelong learning and ensuring that he/she receives adequate in-service training for services the relevant pharmacist is required to perform. Pharmacists must be members of a national or internationally recognised pharmaceutical organisation.
Pharmacists also have a duty to review, maintain and improve their knowledge and abilities with the advancement of medical technology and availability of new medicines.
In addition, pharmacists are required to take responsibility for the competency of staff that they directly supervise and competent pharmacists must also have knowledge of first aid.
This principle provides that a pharmacist’s primary concern must be for his/her patient and other members of the wider community. According to this value principle, pharmacists are required to respect the patient’s culture, race, class or gender, the patient’s right to receive safe medicine, fellow professionals and the pharmacy profession. For example, pharmacists should not supply medicine if there is doubt as to the quality, safety or effectiveness of a medicine.
Pharmacists are also required to have respect for the environment when disposing of unwanted medicine, chemicals and other materials. Given that failure to dispose of such materials in accordance with the prescribed regulatory standards may result in a penalty being imposed on employers, training on the safe and lawful disposal of potentially harmful substances should be provided to pharmacists (and all employees responsible for the disposal of such substances).
Finally, pharmacists must be honest and fair in all dealings, including not taking advantage of their position for personal gain. While the Labour Law governs the employment relationship onshore in the UAE and in Dubai Healthcare City, the law does not impose fiduciary duties on employees. In order to bring the pharmacy profession in line with internationally recognised health care standards and ethics, the Code incorporates a number of obligations on pharmacists to act in good faith and to avoid conflicts of interest in the performance of his/her profession.
Interestingly, the Code goes further by expressly stating that pharmacists must live according to reasonably expected standards of behaviour both within and outside of their professional practice. Notwithstanding this, employers should take care if electing to implement disciplinary action on the basis of a pharmacist’s conduct outside of work as an employer must have a “valid reason” to terminate an unlimited employment contract under the Labour Law, and a “valid reason” is generally accepted as a performance or misconduct-related reason connected with work.
Under the Code, pharmacists must carry out all responsibilities and duties in a fair and honest manner at all times, ensuring transparency in all financial and contractual matters. This includes not allowing personal benefit to interfere with their professional judgment. Employers should incorporate provisions in pharmacists’ company employment contracts requiring them to disclose any potential conflicts of interest upon commencement of employment and throughout employment. In addition, employers and operations should have clear policies in place documenting how potential conflicts of interest are to be disclosed and handled within the organisation.
Additionally, pharmacists must uphold the confidentiality of patient medical records; subject to the prescribed exceptions (which includes where the patient’s life is at risk, where a court or officer with authority under law demands disclosure, and where the patient or their legal guardian demands disclosure). Pharmacists should be made aware that unlawful disclosure of medical records may constitute a criminal offence under the UAE Penal Code (as it is a criminal offence to infringe an individual’s privacy, as well as to publish/disclose personal or sensitive personal data to third parties). Given the importance of maintaining confidentiality of patient records, this should be reflected in the pharmacists’ employment contract.
Sale of Drugs
Pharmacists and medical professionals (nurses, doctors and other practitioners) also need to be alive to their duties with regard to the sale and prescription of drugs. A common practice within the industry is for sales staff to be incentivised by the volume of deals closed and there is therefore a personal interest in persuading pharmacists and associated staff to purchase and prescribe particular drugs. Article 17 of the UAE Federal Law No 4 of 1983 concerning the pharmaceutical profession and institutions (as amended) prohibits pharmacists from encouraging patients to buy medicines through secret deals with others.
Offering an incentive to a pharmacist or associated staff to prescribe drugs or promote certain drugs is unlikely to be ethical and it should be noted that bribing (which can be widely defined) a public official or individual carrying out a public function can amount to a criminal offence under the UAE Penal Code. For organisations operating internationally such acts could also fall foul of laws with wide scale application, for example the UK Bribery Act.
Organisations employing or engaging pharmacists and associated staff should ensure that they are doing the following:
- Providing a training programme to ensure the pharmacist is up to date with industry knowledge;
- Ensure that employment contracts are properly drafted to include fiduciary duties and contractual obligations to comply with the Code;
- Ensure that job descriptions and employment contracts adequately define the supervisory role of the pharmacist; and
- Ensure that codes of conduct and clinical governance procedures are in place, and regularly reviewed and notified to staff.