RACGP declines participation in pharmacy prescribing stakeholder group

The RACGP has declined to participate in the Australian Pharmacy Council’s (APC) Stakeholder Reference Group (SRG) for the development of pharmacy prescribing accreditation standards.
 
The college received an invitation in December from the independent accrediting authority for pharmacy education and training, following a request from the Pharmacy Board of Australia (PharmBA) to develop accreditation standards for courses that will support the initiative of pharmacist prescribing.
 
RACGP Vice President and Chair of RACGP Queensland, Dr Bruce Willett, told newsGP the college was reluctant to join the group due to the requirement to sign a confidentiality agreement.
 
‘We feel that this should be an open process and open to community and patient scrutiny,’ he said.
 
The prospect of independent pharmacy prescribing is a contentious issue.
 
Various state governments, including in New South Wales, Queensland and Victoria, have proposed the expansion of pharmacists’ scope of practice to prescribing, with a pilot trial set to go ahead in North Queensland.
 
The decision follows extensive lobbying by the Pharmacy Guild and will see participating pharmacists prescribe S4 medications in North Queensland. The concerns, however, are numerous, with patient safety and the risk of adding to the growing issue of antimicrobial resistance at the fore.
 
The role of the SRG will be to inform the development of accreditation standards for pharmacist prescriber training programs, and where consensus on an issue has not been agreed, to provide expert commentary.
 
With this project, the APC, together with PharmBA, are aiming to contribute to the potential endorsement of pharmacists in Australia as prescribers.
 
However, Dr Willett said the RACGP has a very firm position on this.
 
‘Pharmacists should not be diagnosing,’ he said.
 
‘They’re not trained to diagnose – but we’re very supportive of pharmacists working in a clinical pharmacist capacity within a general practice.’
 
Currently in Australia, it takes approximately 12 years to become a qualified GP compared to five years to become a pharmacist.
 
This, Dr Willett says, is an important distinction and indicates the complexities involved in diagnosing patients and making decisions around treatment.
 
‘It’s roughly double the time to become a GP over being a pharmacist – that’s obviously important,’ he said.
 
‘Pharmacist prescribing uses algorithms and checklists which are not fail-safe and may not suit all patient situations. GPs undertake specialised training – just like surgeons and pilots – drawing on this expertise in the face of uncertainty and unpredictability.’
 
If pharmacy prescribing were to go ahead, Dr Willett says Australia only need look to the House of Commons report into general practice in the UK for an example of what is to come.
 
‘They have actually said they’ve concentrated far too much on accessibility rather than continuity of care – and that’s been to the detriment of the whole health system, including the hospital system,’ he said.
 
‘And now, they’re trying to wind back exactly this sort of initiative and focus on improving general practice team-based care, preferably with teams housed within the same building.’
 
With Medicare reform now in the spotlight, and the primary care sector already stretched, one of the recommendations of the Strengthening Medicare report, released last month, is to have a greater range of health professionals working to their full scope of practice.
 
While Dr Willett supports the proposal, he notes that ‘full scope of practice’ does not mean ‘exceeding that full scope’.
 
‘Pharmacists are not trained in diagnosis and non-medication management,’ he said.
 
‘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. What that means for patients is that there’s confusion; they would have to self-triage which health professional they need to see, a possible doubling up and interaction of medications, but also waste.
 
‘Things get done twice, which already happens, but this will certainly aggravate that, and we really should be moving the other way to a more efficient and coordinated health system rather than worsening the waste problems we already have.’
 
Instead of participating in the SRG, the RACGP has said it will contribute to the open consultation and submission process.
 
The APC’s project is expected to be completed by December 2023.
 
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