GPs call for relaxation of prescribing regulations

Anastasia Tsirtsakis

26/03/2020 3:41:38 PM

A change to legislation would give GPs an interim solution amid the coronavirus crisis, with most consultations likely to become telehealth-based.

GPs are calling for a change to legislation for electronic transfer prescriptions to meet legal requirements in line with telehealth expansion.

‘It is unnecessary, it defeats the principles of social distancing. Our priority now is to stop the spread of the coronavirus and reduce unnecessary exposure and demand on healthcare services.’
Dr Nathan Pinskier, GP and member of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), is referring to the current legislation that requires a paper prescription with a GP’s wet-ink signature as authorisation for pharmacists to dispense medication to patients and claim through the Pharmaceutical Benefits Scheme (PBS).  
Despite a number of GPs working remotely, and the majority expected to transition a significant percentage of consultations to a telehealth format as of next week, as the law stands, patients or carers would still be required to visit a clinic in person to pick up the prescription.
Alternatively, for patients who are in self-isolation or quarantine, doctors would need to eventually send the prescription via post and pharmacists would have to chase them up – time that GPs argue would be better spent responding to needs of patients during the current crisis. 
As an interim solution, the RACGP is calling for the current law to be amended so that use of the electronic transfer of prescriptions (eTP) through a prescription exchange service (PES) meets legal requirements, allowing pharmacies to dispense medicines without sighting a physical paper prescription.
Between 90–95% of general practices already have the ability to send eTPs with a barcode through a PES directly to pharmacists, which can be scanned to download the script.
‘If they’ve already got the barcode and it’s been dispensed electronically, it should be acceptable for the purposes of meeting the legislative requirements and for the purposes of Medicare paying the pharmacists through the PBS,’ Dr Pinskier told newsGP.
Meanwhile, provision of the barcode alone protects patient privacy as there is no identifying prescription information.

The RACGP has long been advocating for a transition to electronic prescriptions. As part of its 2018–19 Commonwealth Budget, the Government responded, partnering with the Australian Digital Health Agency to develop a new system called Electronic Prescribing (EPP).
The system is designed to generate a token – or QR code – that patients will receive on their phone or that can be forwarded to the pharmacist directly, without the need for a physical copy of the prescription.  
The original plan to unroll the EPP over the next 12 months has since been sped up in response to the coronavirus pandemic. But Dr Pinskier believes the reality of rolling out a new, untested software in the next eight weeks in the middle of a crisis is risky, problematic and largely unnecessary given an electronic prescribing system already exists.
‘What we’re saying is, while EPP is the long-term game … given that we’ve now moved to essentially a telehealth environment from Monday where it’s probable that most consultations will happen over the phone or over the internet, we need a solution whereby doctors are not sitting in practices with empty waiting rooms having to print scripts for patients seen by telehealth and then have to ask the patient or the carer to come down to the clinic,’ Dr Pinskier said, ‘when the prescription’s already in the PES.’
If the call is heeded and legislation is amended, it would allow doctors to print the prescription with the barcode as per normal, place it in front of the webcam for the patient to take a screenshot or alternatively can be emailed direct from the GP to the pharmacist.
‘Any way that gets the barcode in the pharmacy without having the patient needing to leave the home will be a big step forward,’ Dr Pinskier said.
‘You can’t have doctors working with telehealth and not having the tools to support the delivery of services.’
The RACGP has written to Federal Health Minister Greg Hunt, outlining the college’s recommendations to be considered by the national cabinet and implemented immediately as an interim solution.

The RACGP has more information on coronavirus available on its website.
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Dr Henry Arthur Berenson   27/03/2020 10:02:07 AM

Anyone considered the authority scripts for controlled medications. Handwrite the script then add an electronic signature???

Dr Catherine Emma Linda Sloan   27/03/2020 2:31:29 PM

Why should we handwrite scripts for opiates etc? Surely there are more mistakes possible than if done on computer, and we still have to record on computer that we've prescribed it. Better to be computer-generated, & sent straight to pharmacist (I wouldn't want to give QR code to patient here)