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Pharmacist prescribing labelled ‘unreasonable and unsafe’


Morgan Liotta


18/04/2023 4:03:36 PM

The RACGP has responded to open consultation on new pharmacist prescribing standards by highlighting key concerns with the move.

Pharmacist holding medications
In its submission, the college highlights the importance of appropriate settings where diagnosing and prescribing skills are practised.

The RACGP has highlighted its concern about the conflation of diagnosing and prescribing skills in a new submission to the Australian Pharmacy Council (APC).
 
Made as part of an open consultation process associated with the development of accreditation standards for pharmacist prescriber education and training, the college has warned that the role of diagnosis in prescribing is being diminished, putting patient safety at risk.
 
According to the RACGP, algorithms and checklists that will likely be relied on by pharmacists have ‘limited utility’, because they are unable to assimilate and convey all the relevant information about a patient, including baseline assessment on temperature, heart rate, respiratory rate and blood pressure.
 
‘It is unreasonable and unsafe to expect pharmacists to take on this level of risk and it is unsafe for patients who may have alternative diagnoses missed in addition to the elevated risk of an incorrect diagnosis, or a delayed diagnosis of a significant medical or surgical condition,’ the submission states.
 
This concern is shared by other medical colleges, including the Urological Society of Australia and New Zealand and the Royal Australasian College of Surgeons, which made a joint submission to a separate inquiry looking into pharmacist prescribing for uncomplicated UTI.
 
The RACGP is also concerned that the work of developing standards is being undertaken when the cost-effectiveness of a pharmacy model has not been demonstrated compared with general practice care, and that retail pharmacy pilots are already being rolled out across the country before these standards have been developed. 
 
The college is calling for a safer pilot looking at pharmacists prescribing in a team-based setting where diagnosis can be undertaken by medical practitioners, and pharmacists have access to a broader multidisciplinary team, comprehensive patient records and medical practitioner support.
 
Pharmacists practising their expanded skills in prescribing should continue working within medically supported multidisciplinary teams, the RACGP says, as these settings also allow for the separation of prescribing and dispensing.
 
The submission recommends minimum postgraduate qualifications, pre-requisite entry requirements and duration of supervised practice under the supervision of a prescriber.
 
It also states that pharmacists should have a minimum of two years’ experience after general registration in patient-facing pharmacy or a clinical environment relevant to the area of practice as a prerequisite for tertiary postgraduate level training, followed by a six-month full-time supervised training placement in general practice or similar setting.
 
Australian GPs complete more than a decade of medical training where ‘differential diagnosis is interwoven throughout before prescribing’, the college highlights, and while it takes approximately 12 years to become a qualified GP, it takes five years to become a pharmacist.
 
‘Pharmacists are not trained in diagnosis and non-medication management,’ RACGP Vice President and Chair of RACGP Queensland, Dr Bruce Willett, recently told newsGP.
 
‘And a course for 120 hours really doesn’t make you a fully trained doctor; it’s not the same as 12 years of medical training. If pharmacists work completely independently of general practices that’s going to fragment care.’
 
The submission also highlights the need for appropriate consultation settings and workforce capacity to ensure care is culturally safe, comprehensive and coordinated to enable high-quality diagnosis and prescribing, and reduce risk of medical errors.
 
‘The settings in which diagnosing and prescribing skills are practised is important,’ the college states. 
 
‘A busy retail pharmacy setting does not provide the optimal environment for critical thinking and complex diagnostic reasoning when the pharmacist has multiple distractions switching between tasks such as dispensing, recommending over-the-counter medicines for symptom management and selling retail products.’
 
Additionally, the submissions points to evidence that community pharmacies can lack cultural safety and appropriateness, and may be unaware that Aboriginal and Torres Strait Islander people often feel uncomfortable entering their pharmacies.
 
The college also feels it is unwise to develop accreditation standards that would increase demands on a health workforce that is already experiencing burnout and shortages.
 
In a 3 March press release accompanying its submission to the SA Select Committee on access to UTI treatment, Professionals Australia (PA) also flagged workforce shortages and doubts over the capacity of existing employee pharmacist to absorb further demands, particularly in regional and rural areas.
 
The trade union stated that any additional work demands on pharmacists will increase their already high workloads, further adding to work-related stress and risks to workplace health and safety in community settings.
 
The APC will undertake three rounds of consultation to develop the standards, and the RACGP has indicated it will keep members updated on when the APC provides a summary of the first round of consultation and when the next round of public consultation opens.   
 
The RACGP has also noted that the APC is developing separate standards for pharmacists working in aged care. It is unclear if there will be any overlap in the standards.
 
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