The National Convention on Dispensing (NCD) expressed concern on Monday that medical aids could refuse to cover claims for medication prescribed by doctors who will not have licences to dispense medicine by the May 2 deadline.

As the deadline looms, the Department of Health issued a statement saying that whether they had a licence or not, all doctors would still be able to dispense emergency medication to patients.

Under the Medicines and Related Substances Act, by May 2 dispensing doctors, nurses and dentists must obtain a licence from the Department of Health or they will be breaking the law.

However, according to NCD spokesman Norman Mabasa, an affidavit filed by the Department of Health last week said that out of the 11,078 dispensing doctors, only 13 have been granted licences.

"We think we have good grounds for an interdict (to set the deadline aside). The fact is that on May 2 there will be great confusion as about 10,000 doctors won't be allowed to dispense," Mabasa said.

"Medical aids won't pay and there may be many stand-offs between doctors and the department (of health) by May 2. They (the doctors) can't buy drugs from drug companies and it will be anarchy," he said.

The NCD has decided to take the matter to the Constitutional Court and already has two challenges against the Department of Health filed in lower courts. They said that at last week's hearing to settle a costs dispute before they proceed further, Pretoria High Court Judge William de Villiers said that he was concerned that patients could be deprived of medicines and that doctors could be made into criminals.

He said that in his view, the deadline should be extended for a year, or at least until the outcome of the Constitutional Court challenge.

Although the doctors have had a year to comply with the Act, many objected to reapplying when they had been dispensing for many years already, and found the process bureaucratic, time consuming, and expensive, Mabasa said.

"We have said they must apply if they can, but many are reluctant."

They questioned why they had to include details of other pharmacies, health care professionals and disease patterns in their areas as part of their application. They were concerned that it violated competition regulations, might jeopardise investments in dispensing facilities and were reluctant to complete a dispensing course which was required by law.

According to Mabasa, the process costs about R5000 each.

He estimated that up to 200,000 patients per week could be disadvantaged as many doctors include medication in the cost of consultations.

They believed it would be better to ascertain whether doctors already comply with regulations.

However, the Department of Health said the health care professionals have known about the regulations for some time and that 5,500 health care professionals had already registered for the distance learning course.

Noting that only a fraction would have completed the course by the deadline, a department statement issued on Sunday said: "If doctors had taken the matter seriously they could comfortably have met the deadline."

On Monday the department said that so far 1200 applications had been received and over 450 processed. It would also scale up its processing capacity as the deadline nears.

"We know that there are many areas that are still under-serviced in term of provision of health care in the country. We consider these factors when we evaluate applications. Wherever there is a genuine need and applicants have completed the course and otherwise complied with the requirements of the law, we will issue dispensing licences," a statement attributed to Health Minister Manto Tshabalala-Msimang said.

Gary Taylor, director of Medscheme, which administers up to seven million medical aid claims a month, said they would not refuse to pay for medications prescribed by a doctor who has a practice number. This entitles a doctor to dispense medication and it was not up to Medscheme to judge the doctor's conduct, he said.

However, they would be watching to see how the Health Professionals Council of South Africa (HPCSA), which registers doctors, and the Board of Healthcare Funders (BHF), which issue the practice numbers, reacted on May 2.

"We are just administrators, we don't get involved in policy issues," he said. "If the doctor has a practice number, we will pay."

However, HPCSA spokesman Phephela Makgoke said complications could arise if doctors broke the law.

"If the doctors pay their annual fees and comply with our regulations we can't strike them off," Makgoke said.

However, the director-general of the Department of Health could lodge a complaint if a doctor did not comply and the HPCSA would be obliged to investigate. A formal investigation would be launched, giving the doctor the right to reply and a decision would be taken by a committee. Censure ranges from a fine for minor infractions, to suspension and removal from the register.

BHF spokeswoman Heidi Kruger said although there would not be a mass removal of practice numbers on May 2 for doctors who did not comply, the BHF is finalising a circular reminding medical aids of the new regulations which state that it is illegal to dispense without a certificate.

They are also devising a new practice number system which will reflect whether a doctor has a dispensing certificate or not, she said.

"We are hoping the Department of Health will put interim measures in place as we won't say that it is okay to pay if a doctor is flouting the law. Nobody really knows what to do," she said - Sapa.