Questions persist around pharmacist prescribing education

The college has doubled down on its previous warnings that increasing pharmacist powers could be putting patient safety at risk.
 
Those fears come as the Australian Pharmacy Council (APC) launches its second round of consultation into its draft accreditation standards for pharmacist prescriber education programs.
 
In its response, the RACGP reiterated its long-held concerns around a conflation of diagnosis and prescribing skills, citing a lack of education on the behalf of pharmacists.
 
‘If pharmacists are diagnosing prior to prescribing, then pharmacists should complete the same level of training as a GP,’ the college’s latest submission said.
 
‘GPs complete over a decade of medical training where differential diagnosis is interwoven throughout before prescribing.’
 
RACGP’s Dr Tim Senior contributed to the submission and said GPs go through years of training to hone their diagnostic skills, unlike pharmacists.
 
‘Locally, I have really good relationships with our pharmacists who do a great service for our patients, but their role is in quality use of medicines, helping patients access their medicines, using them correctly, and that’s very different to prescribing medications,’ he told newsGP.
 
‘The whole process that we’ve had decades of training for, it’s about managing the uncertainty, about exploring patients concerns, about discussing side effects, about selecting the most appropriate medication, and having the knowledge and the systems in place to monitor the outcomes of that.’
 
The submission comes after a first round of consultation wound up in April 2023, in which the RACGP responded to an initial environmental scan and literature review.
 
The college’s overall stance on pharmacy prescribing remains unchanged, with the college opposed to independent or autonomous prescribing by pharmacists in a retail setting.
 
‘There isn’t a clear separation of pecuniary interests and there are perverse risks of financial incentives from prescribing,’ the submissions said.
 
‘The unique and siloed retail-health model of community pharmacy incentivises business needs over patient care and is a conflict of interest.’
 
In its expansion of its initial submission, released on Tuesday, the RACGP called for more clarity around the word ‘diagnosis’, with the framework instead using the phrases ‘information gathering’, ‘clinical reasoning’, and ‘assess the consumer’ to describe the practice.
 
It also called for further clarification on the role of supervisors and work-integrated learning, questioning whether pharmacies will be able to meet their performance outcomes.
 
Dr Senior said better systems and programs are needed for pharmacies to adopt to the prescribing changes.
 
‘They’re geared towards dispensing at the moment rather than documenting clinical decision making,’ he said.
 
‘One of the notable things in the draft accreditation standards are about pharmacies using My Health Record for sharing information with other practitioners, but My Health Record isn’t set up to do that at all.’
 
This second round of consultation comes as several controversial pharmacy trials continue to rollout and expand.
 
Last week, the Queensland Government announced it is extending its contentious scope of practice pilot, handing every pharmacist in the state autonomous prescribing powers, provided they complete an online training course.
 
Similar pilots have also been rolled out across the country for uncomplicated UTI treatments; however, this has already led to emergency department presentations for the infections surging.
 
‘We have to keep contributing and advocating so it’s as safe as possible,’ Dr Senior said.
 
‘You’ll see commentary on this that it’s a turf war, but actually that’s just not the case at all.
 
‘Pharmacists are expert health professionals and we’re really keen to work with them, they provide skills that we don’t have, but if they’re trying to provide the skills that we do have, the patient loses out.’
 
The RACGP has also questioned the reliance on the NPS Medicinewise Prescribing Competencies Framework as a foundational document, despite it ending operations in December.
 
The APC has confirmed there will be a total of three rounds of consultation for the standard’s development.
 
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accreditation standards expanded scope of practice pharmacy prescribing RACGP advocacy