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RACGP opposes push to expand pharmacist scope in Queensland
The RACGP is firmly opposing efforts in Queensland to allow pharmacists to become prescribers, warning that the move risks public health.
Who can prescribe?
In its submission to the Queensland government’s inquiry into the pharmacy sector, the Pharmacy Guild of Australia has called for extending pharmacists’ scope to include independent prescribing, dispensing repeat prescriptions, treating minor ailments, National Immunisation Program vaccinations and point-of-care testing.
But the RACGP made its concerns around public health clear in its own submission.
‘Pharmacists add value when providing services related to the safe, effective and efficient use of medicines. The increasing push to expand the scope of pharmacy beyond this puts patients at risk of poorly coordinated care and wastes valuable health resources,’ the college submission states.
‘The more prescribers, the more risks for errors. Medication misadventure is one of the leading causes of hospital admission. Multiple prescribers and the involvement of less qualified prescribers will inevitably risk patient safety and increase mortality and morbidity. A particular concern is the prospect that these pharmacy prescriptions would be provided to the most vulnerable patients in our society, and those with chronic diseases.
‘For a large number of patients, interactions with community pharmacy are episodic and ad hoc. A pharmacist does not have comprehensive knowledge of a patient’s history or the appropriate medical training on which to draw in order to provide safe and high quality medical care, spanning triage, diagnosis and treatment.’
RACGP Queensland Chair Dr Bruce Willett told newsGP the college had no concerns with pharmacists working collaboratively in a GP practice or hospital, but that patient safety and trust must be the primary concern.
‘We must avoid making the system less safe, to profit a few pharmacists looking to increase their script numbers,’ Dr Willett said.
‘GPs, as specialists in patients’ medical histories, are uniquely placed to be able to deliver high quality care to Australians through a thorough understanding of their patients’ overall health.
‘While the RACGP welcomes and recognises the important contribution of other healthcare providers to patient care, international and Australian experience has repeatedly shown GPs are the most appropriate profession to be at the core of a patient’s healthcare experience.
However, he said he had no concern with allowing pharmacists to dispense all repeat prescriptions at once.
‘Convenience could be better improved by allowing pharmacists to dispense all the repeats at once, as is done in other countries, rather than one month at a time’, he said.
Dr Willett said a patient receiving health advice or screening in a retail pharmacy would miss out on important health services provided by a GP.
‘Limited repeats on medications such as oral contraceptives and cardiovascular disease medicines ensure patients can continue to be monitored by their GP while receiving treatments and medications, ensuring the right medication is prescribed at the right time,’ Dr Willett said.
‘For example, through prescribing contraceptives during an appointment, GPs are able to review if the right method is being used through a review of symptoms, ensuring side effects do not have dangerous consequences. Removing this opportunity for a GP-patient consultation also takes away from ensuring vital tests such as cervical screenings and STI [sexually transmitted infections] tests are completed and women have a full picture on the potential use of options such as long acting reversible contraceptives [LARCs],’ he said.
The RACGP submission states that pharmacists do not have the appropriate diagnostic skills to identify all potential health issues arising from a consultation, and that pharmacy-based preventive care programs will lead to service duplication, fragmented care and poorer health outcomes.
The Australian Medical Association Queensland submission mirrors many of these concerns, stating that the organisation ‘does not believe that there is a compelling, evidence based argument for increasing the scope of practice for pharmacists and pharmacy assistants … [we] cannot support any measures which would facilitate pharmacists becoming prescribers.’
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