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