A question of continuity: Keeping prescriptions in general practice

Bruce Willett

24/05/2018 2:36:27 PM

RACGP Queensland Chair Dr Bruce Willett examines the issue of whether pharmacists should have the power to prescribe medications.

Repeat prescriptions in general practice allow patients to be monitored by their GP while receiving treatments and medications.
Repeat prescriptions in general practice allow patients to be monitored by their GP while receiving treatments and medications.

Pharmacists undoubtedly play a key role in Australian healthcare, but should their role include dispensing prescriptions for so-called ‘low-risk’ medications?
In short, no.
The proposal by the Queensland Pharmacy Guild to allow prescriptions to be written within pharmacies will only serve to fragment patient care and place people’s health at risk.
As GPs, we are not only specialists in primary healthcare, but also in our patients’ medical histories. This means we are able to deliver care tailored to the individual sitting in front of us, rather than to the customer who comes to the counter, as I fear people seeking detailed medical advice may be treated in a pharmacy.
Such a situation means patients would likely miss out on important preventive healthcare services, which could result in a delayed diagnosis and, in turn, delayed care.
Patients seeking oral contraceptives present a good example. Limited repeats allow patients to be monitored by their GP while receiving treatments and medications.
Prescribing contraceptives during a consultation allows GPs to ensure the correct contraceptive is being used and has no dangerous side effects. This means the right medication is prescribed at the right time.
Removing this opportunity takes away from ensuring vital tests, such as cervical screenings and STI checks, are completed so women have a full picture of the potential use of all options.
This is really the key to the issue of whether pharmacists should expand their powers and be allowed to write prescriptions: ensuring patients remain healthy by prescribing the correct medication at the appropriate time is a core role of all specialist GPs.
Allowing anyone other than a patient’s regular GP to write those prescriptions fragments continuity of care and puts people at risk.
Prescriptions must stay where they belong, in general practice.

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Cathy Lee   25/05/2018 9:39:46 AM

Completely agree, Bruce.
Contraceptives are a classic example. A yearly "repeat script" visit with the GP is essential for the reasons you've mentioned and more. Have LARC options been discussed? A gentle chat about fertility for those approaching 30 perhaps? Check of the BP and BMI and any contraindications. Migraine with aura or smoking over the age of 35 being common ones.
Blood Pressure "just a quick repeat script" appointments present the opportunity for a cardiovascular risk assessment and appropriate red book preventative activities for the patient who might not otherwise come in to their GP.
The short sightedness of such a proposal shows a lack of understanding of the value in General Practice and we all need to advocate on behalf of our role and our patients' best care.

Dr Peter Strickland   25/05/2018 10:31:49 AM

I'll point out one recent problem --a pharmacist advising an elderly women with polymyalgia rheumatica and pain from a fall that it was safe to take ibuprofen whilst on prednisolone. Fortunately, I was able to advise otherwise, as I did not want an episode of GIT bleeding adding to her problems.

Richard Smith   25/05/2018 2:30:52 PM

Pharmacists should be replaced by automatic dispensing machines linked to the GP desktop