Autonomous pharmacist prescribing off the table – but no barriers to restricted models

Doug Hendrie

17/10/2019 1:43:35 PM

The Pharmacy Board of Australia has found no obstacles to collaborative prescribing alongside medical professionals, and structured prescribing where pharmacists have limited authorisation.

Pharmacist and customer
Will pharmacist prescribing move forwards – or is it off the table for now?

After a four-year investigation, the Pharmacy Board of Australia (PBA) has released a new position statement on prescribing by pharmacists, clearing the way for two monitored models of prescribing.
The PBA found there are no obstacles to collaborative prescribing, undertaken alongside medical professionals, and structured prescribing, where pharmacists have limited authorisation under a guideline or standing order.
But changes in state and territory legislation governing medications would be required to permit these models.
Fully autonomous prescribing, by contrast, would require extra regulation through an ‘endorsement for scheduled medicines’ and would need to be signed off by state and federal governments.
The PBA has no current plans to apply for this endorsement, effectively ruling out this model.
RACGP President Dr Harry Nespolon told newsGP the outcome is not surprising.
‘It seems odd to ask pharmacists whether they should be prescribing – the not surprising answer was yes,’ he said.  
‘This is a solution looking for a problem. Is there any evidence that patients are missing out on medication? If so, removing the geographical location rules [on pharmacy ownership] would fix the problem.’ 
Autonomous pharmacist prescribing has been hotly contested by peak medical bodies such as the RACGP and Australian Medical Association (AMA), primarily over concerns regarding lack of medical training, antibiotic resistance and fragmentation of care.
But those same peak bodies also have concerns with more restricted models of prescribing.
The RACGP’s submission to the PBA on pharmacy prescribing is categorically against autonomous prescribing, and opposes the other two models in a primary care setting.
‘No amount of training, other than the completion of a medical degree and specialist training, would be sufficient to support autonomous pharmacist prescribing,’ the submission states.
‘It is not possible to substitute the years of study and clinical practice undertaken by a specialist GP, or other medical specialist, with a minimum level of clinical experience and a postgraduate qualification.’
The AMA recently released 10 minimum standards for prescribing.
‘Prescribing by non-medical health practitioners should occur within a medically led and delegated team environment in the interests of patient safety and quality of care,’ one of the standards states.
By contrast, the Pharmaceutical Society of Australia (PSA) welcomed the PBA position statement as a way ahead for pharmacists to ‘prescribe as part of a collaborative healthcare team’ and called for immediate action.
PSA president Associate Professor Chris Freeman said the statement means the two semi-autonomous models could now be ‘progressed immediately’.
‘It is incumbent now upon state and territory jurisdictions with their medicines and poisons legislation to review their legislation to remove any unnecessary barriers to pharmacists “prescribing via a structured prescribing arrangement” and “prescribing under supervision,”’ he said.
‘[W]e are committed to enabling pharmacists to practise to their full scope by advocating for expanded roles and new opportunities in prescribing, consistent with their recognised competency framework.’
Australia’s hospital pharmacists also claimed the PBA’s position statement is a vote of confidence in pharmacist expertise and represents the ‘next logical step’ towards improving medicine-prescribing practice.
Society of Hospital Pharmacists of Australia (SHPA) chief executive Kristin Michaels called the statement a ‘strong endorsement for the continuation of clinical pharmacy practices in Australian hospitals that already involve medication chart review and endorsement, and which are proven to improve patient care by optimising the efficacy of multidisciplinary teams’.

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Dr Rodney Paul Barkman   18/10/2019 6:57:15 AM

In my early days, pharmacists used to make up mixtures, lotions, pastes, etc. Now they pick up a packet, write a label and sell it to the patient. I think it would save an ill patient the effort of a trip to the pharmacy if the doctor handed over the packet at the time of consultation. This was quite common in more remote rural communities 50 years ago

Dr Richard Mark Smith   19/10/2019 10:49:56 PM

Is this a blatantly commercial push by the powerful Guild with it's hand in the taxpayer's pocket?
Is the RACGP's submission not relevant because the quality of GP-led care doesn't matter?
I ask you ... who benefits from this ?

Dr Simon Charles Madin   20/10/2019 6:19:55 PM

Rodney, doctors in remote practice in Australia still provide patients with their medications at the time of consultation and I have not seen any related problems. No pharmacist is involved (because remote locations typically don't have pharmacists) and it's quicker, easier and cheaper for the patients.