RACGP strongly opposes push for pharmacist prescribing

Doug Hendrie

15/04/2019 3:59:02 PM

The RACGP is against a proposal to introduce pharmacist prescribing for restricted medications, suggesting it is a solution in search of a problem.

Restricted medications
Pharmacists currently cannot prescribe restricted Schedule 8 medications.

The Pharmacy Board of Australia – which is responsible for regulating the country’s pharmacists – released a discussion paper in January suggesting that ‘non-medical prescribing may contribute to the delivery of sustainable, responsive and affordable access to medicines’.
The paper suggested pharmacist prescribing of Schedule 4 and Schedule 8 medicines could also help tackle issues regarding doctor shortages.
The paper backs three models of pharmacist prescribing, first outlined in the 2013 Health Professionals Prescribing Pathway:

  • Prescribing under a structured prescribing arrangement
  • Prescribing under supervision
  • Autonomous prescribing
In a submission to the Pharmacy Board, the RACGP ‘strongly opposes’ all three models for pharmacist prescribing, concluding they ‘must not be applied in the primary care setting’.
‘It appears that the consultation is considering “how” pharmacists should prescribe, without appropriately considering whether pharmacy prescribing is appropriate at all,’ the submission states.
‘We know that many medical professions, and even pharmacists themselves, consider it inappropriate that pharmacists expand their role into prescribing.
‘The provision of medical services by health professionals lacking the necessary medical training or registration is an inappropriate and unsustainable solution to address the health needs of Australians.’
RACGP President Dr Harry Nespolon told newsGP that pharmacist prescribing is beyond the profession’s scope of practice.
‘This has very little to do with good patient care. It’s more likely about supporting their business model,’ he said.
‘You can cut it and splice it as many ways as you like, but no one has answered the question about why we need to do this.
‘Until they can make a case for it, we’re not going to change our minds.’

Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health Systems Reform (REC–FHSR), was involved in developing the submission.
‘The RACGP would not support expansion of the role of pharmacists beyond their core function – providing medicine advice and dispensing,’ he told newsGP.

RACGP President Dr Harry Nespolon believes pharmacist prescribing is beyond the profession’s scope of practice.
Dr Wright said pharmacist prescribing would fragment care and lead to more medication errors.
‘Almost 90% of the population see their GP every year, but only 70% require a prescription and need to see a pharmacist. So I’m not sure how it would improve access,’ he said.
‘Most importantly, what is the purpose? I can’t see how this can benefit patients. Creating new silos of care isn’t going to improve health outcomes.
‘I know there are lots of other providers who would like to expand their role in the healthcare system, and we see providers working to the top of their practice as a goal for all healthcare providers.
‘But GPs are ideally placed to manage patients because we have comprehensive long-term care and oversight of the whole condition, instead of single episodes.’
Efforts to expand the role of pharmacists beyond their scope of practice have multiplied recently.
Dr Mark Morgan, Chair RACGP Expert Committee – Quality Care (REC–QC), recently questioned a move by the Federal Government to down-schedule medications by directing the Therapeutic Goods Administration to create a new group of medications between Schedule 3 and 4, able to be dispensed by pharmacists. The RACGP last year criticised efforts by the Pharmacy Guild to lobby for pharmacist prescribing in Queensland.
Pharmacists can currently supply Schedule 2 and Schedule 3 medications, and can authorise emergency supplies of Schedule 4 medication in certain situations, but cannot prescribe Schedule 8 drugs such as oxycodone and morphine.
‘It is unclear what issue the proposed models intend to solve,’ the RACGP’s submission states. ‘While the discussion paper notes that the models could improve medication management, it is not clear how pharmacist prescribing would achieve this.
‘There are many other models and mechanisms that can be explored to improve medication management that would not require pharmacist prescribing.’
The submission restates the RACGP’s long-held position that pharmacist prescribing will expose patients to unnecessary risks, and that pharmacists are not equipped to provide preventive care and chronic disease management.
‘No amount of training, other than the completion of a medical degree and specialist training, would be sufficient to support autonomous pharmacist prescribing,’ it 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 RACGP recently released two additional position statements on pharmacist prescribing:
  • Retail pharmacy position statement states that while the RACGP recognises the important role that pharmacists have in supporting patient healthcare through procuring, advising and dispensing medicines to patients, it has significant concerns with the retail pharmacy model and sees it an inappropriate environment for the provision of medical care
  • General practice-based pharmacists position statement states that the RACGP would support the inclusion of general practice-based pharmacists roles in a team-based model as a way for practices to increase their capacity to offer medication management and education services – but sees a need for research on this model in the Australian context

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Dr George Al-Horani   16/04/2019 8:45:54 AM

We are fully supportive for our college and Dr Nespolon , this should not happen not now and not ever to allow pharmacists to prescribe nor to allow repeats without the doctor approval .
So many patients come to see doctors only for repeats , and when you examine their medical records you will find that they are not up to date with their follow up blood tests or have not had heart check .... which all related to their medical conditions .
We as doctors should ask for the right to dispense medications especially in rural areas or after hours if there is no pharmacy in the area .

Chris Newall   16/04/2019 9:58:10 AM

Pharmacists already can prescribe drugs. Drugs S1 - S3 drugs are currently able to be "prescribed" by chemists. These drugs in the most part relate to the treatment of non-serious and short term health problems. Pharmacists do not (currently) have the training or expertise to give advice regarding the more serious and long term health problems (despite the fact that I often hear them and their staff doing this when I visit a store). Consequently they should not be allowed to "prescribe" for these conditions. Not now, perhaps never unless their course training changes to include the contents of the medical syllabus.

JC   16/04/2019 9:58:15 AM

Question is why isn't th RACGP doing anything for GP's and pushing for doctors to sell medications. Happens in other countries.

Ahad KHAN   16/04/2019 11:07:31 AM

A Prescription should only be a Sequel to a DIAGNOSIS being established.
Pharmacists are not DIAGNOSTICIANS.

Without a MBBS Degree, a Proper Diagnosis cannot be made by a NON-MBBS.

When the FRACGP, insists that even with a MBBS Degree, Plus Hospital Internship, is INADEQUATE & UNSAFE for a Doctor to be let loose on his / her own & that a further GP Registrar Training is essential, before this MBBS is considered SAFE for the Populace

it is VERY VERY DANGEROUS for a Pharmacist to to take on the Role of a Prescriber.
The INNOCENT Populace must be protected.


Dr Syed Ali   16/04/2019 12:14:04 PM

Wish it was as easy as writing a script for a proposed duration, It’s a assessment @ a point in time- whether to continue, decrease, increase or withdraw.

Dr Manu Mittal   16/04/2019 7:47:48 PM

I really appreciate the stand which our President Dr. Nespolon has taken, in support of the GP's in Australia. I completely agree with my above colleagues's comments and opinion.
I moved from the UK to Australia 2 yrs ago. One of the reasons for the move for me and I am sure for other UK GPs too, was "a complicated system which UK NHS has adopted" leading to the GP's hating the system. In the UK, if I am allowed to compare, a sad system has been running where the respect & power from the GPs has been snatched away and handed over by the health politicians and pharmacy teams to other professionals e.g. physiotherapists, nurses, chemists etc. Highly trained & qualified GPs in the UK are nowadays feeling helpless.

I hope that the GP authorities in Australia do not follow the bad aspects of the UK General Practice e.g. telephone triage, pharmacy prescribing, nurse clinicians etc.
Please continue to SAVE US.

I don't want to be "JUST A GP"
I have no intention to disrespect. Thank you.

K. Grao   16/04/2019 9:45:50 PM

First of all not all medical conditions require diagnosis via blood tests, scans etc. Secondly pharmacists are fully trained not only on how medicines work but also for the conditions they treat. Of course we can't diagnose as we don't have at our disposal lab referrals etc but accurate history taking is not rocket science. The amount of ridiculous prescribing I see by GP's is a joke. As is the few weeks of drug/medicine training in these MBBS degrees that gives right to prescribe. There is a place for pharmacist prescribing. We also do years of Pharmacotherapeutics. This includes an overview of clinical presentation, pathophys., clinical course & management of disease. If only I could count on two hands the amount of times a patient is left lost & confused about their medical condition post GP appointment. Lucky they have their pharmacist. Maybe those with a MBBS degree should do another 4 years of uni before they can 'sell'...Kind regards, future pharmacist prescriber

Dr Joe   17/04/2019 7:10:39 AM

It appears Racgp can not take criticism. Hence my comment was censored.

keith Brewerton   17/04/2019 11:01:33 AM

I agree with the comment solution looking for a problem. Governments of both persuasion always look to make changes to save money spurred on by lobbyist who only have self interest at heart. You have to applaud the pharmacists guild for controlling and protecting their base by restricting the number of pharmacies, unfortunately for general practice and the RACGP we have not done this. Instead we continue trying to justify our position , competing with each other and bleating about rebates. I would like to see the health department show the savings they have made from prior changes before considering further changes. I doubt whether the rebate freeze saved money as the number of services just increased. I must admit I do not know the answer to providing for areas of need but giving city pharmacists prescribing rights is not one.

Ahad KHAN   17/04/2019 1:22:52 PM

K. Grao, you say : " Of course we can't diagnose as we don't have at our disposal lab referrals etc but accurate history taking is not rocket science. "
How deluded you are !

There is a Saying :
The One who knows not what he knows not - BEWARE of this Person.
The One who knows that he knows not - TEACH this Person
The One who knows that he knows - follow him.

It would not be 'Rocket Science ' to guess which one of the 3 you are.


Paul Borah   3/07/2019 5:39:22 AM

I am a retired pharmacist in the United States. Private insurance companies control medical care in the USA. The patient receives those meds the Insurance co will cover not what the physician prescribes. Dr Kahn feels pharmacist prescrbing is very dangerous. Of course with prescribing the pharmacist would have to be taught laboratory medicine and authorized to order lab tests to monitor the therapy.

If Dr Kahn believes pharmacist prescribing to be dangerous, Im curious how he views prescribing by insurance employees with no pharmacological training. Slowly
but surely the insurance companies are replacing doctors with nurse practitioners and physicians assistants. Not to benefit patient care, but to save money.

I have worked as a pharmacist with nurse NPs calling in prescriptions and there often was a problem. They have no knowledge of drug interactions. When I would call the NPs they would get quite upset. How does Dr Kahn feel about PA and NP prescribing?

moe   22/07/2019 2:30:28 PM

I am a pharmacist with 14 years experience, army, and hospital and I am more than qualified to prescribe the contraceptive pill and antibiotics.
I am not advocating the change but I find the article an insult to my studies and experience, the main issue I have is taking work from Doctors and in some instances such as rural locations, it may be warranted.

Poor sick person   30/08/2019 1:06:14 AM

I don't have the money to see a doctor or the time to find and wait for a bulk billing one. Nearest according to google is over 30 mins drive away. Nearest chemist is next door.

Pharmie   4/09/2019 6:35:57 PM

Maybe the docs should diagnose and pharmies should prescribe. My experience working in community pharmacy has told me docs need help prescribing. Pharmacists are very good at deprescribing too. Also they need help with their practice in general.. practice nurses should be mandatory in GP practices with govt funding. Nurse management of GP clinics would greatly reduce human error and organisation. It's ridiculous every little thing has to go through a GP with an itemised MBS funding. Do you think the govt is silly enough to continue paying hefty MBS fees for flu injections and simple consults.

Mohamed Ali   16/09/2019 12:29:42 PM

There are no single pharmacist has claimed that he/she is capable of diagnosis, it is not our job at all to diagnose, but after a physician done diagnosis, a pharmacist will be the only qualified healthcare professional to choose what chemical molecule, drug, dose and form to be given to the patient, so the question that need to be answered, what level of qualification a physician has to enable him to write a drug for a patient?, and based on what education ?, and how come a doctor prescribe a chemical component that he/she is not fully aware of its nature and never studied it in full? a pharmacist who study much more in depth about every single medicine and their metabolism, dynamics and kinetics, a knowledge that is unique only to pharmacist, I feel sorry for public and a system that allow this to happen