SA parties differ on pharmacy prescribing

South Australia’s Shadow Health Minister says her party opposes the state’s expansion of pharmacy’s scope of practice, saying the Liberal Party focus is ‘making sure people can access a GP’.
 
Just weeks out from a state election, Liberal health spokesperson Heidi Girolamo told an audience of GPs at an Australian Medical Association South Australian (AMA SA) branch event last week that the Labor Government-backed pharmacy expansion program is ‘not a policy of ours at this stage’.
 
‘It is something that we are working through, and we’ve obviously got a number of weeks in the lead-up to the election, but our focus is on the GP,’ she said.
 
‘Pharmacies are very important. But at this stage, our main focus is on making sure we can have access to GPs across the state.’
 
The RACGP has called on the SA Government to match the state opposition’s position, with RACGP SA Chair Dr Siân Goodson saying there is ‘no serious evidence base supporting pharmacy prescribing trials’.
 
‘Most pharmacy trials conducted to date have not met accepted clinical trial standards, which understandably raises questions about their safety, validity, and the reliability of their findings,’ she said.
 
With an upcoming state election on 21 March, last week the AMA SA brought together SA Health Minister Chris Picton and Ms Girolamo, for ‘The Health Debate’, to face off for an evening of health policy questions from AMA members.
 
Among them was a question to the Minister on whether adequate pharmacist training could be guaranteed, as well as ensuring patient follow-up and safety, and governance ‘when things go wrong’.
 
In response, Minister Picton said although ‘this is probably not the room where this is going to be most popular’, the Government’s policy position was to have ‘every health professional in the system to be operating at the top of their scope of practice’.
 
He said this includes enabling GPs to be able to diagnose and treat ADHD ‘which isn’t universally popular with other specialists’.
 
He said pharmacists would be required to do a year-long postgraduate degree, followed by supervision.
 
‘This is a national model that’s being rolled out across the country, and we are absolutely supporters of it, because we think that it can improve access to people’s healthcare.’
 
Pharmacy prescribing continues to expand around the country. Last week, the RACGP called for safeguards to protect patient safety after the Western Australian Government announced a further 40 pharmacists will start training this month to diagnose and treat people in the state for a range of conditions as part of the Enhanced Access Community Pharmacy Pilot.
 
Under the pilot program, 50 WA pharmacists are already in training.
 
RACGP Vice President and WA Chair Dr Ramya Raman told newsGP that concerns such as those raised by the AMA SA debate attendee were not unique to South Australia, but ‘relating to many of the states around Australia’.
 
‘What hasn’t been clearly set out publicly is the clinical governance framework that would be expected for any of the expansion of prescribing, that ultimately accounts for who is clinically accountable if there was an adverse event,’ she said.
 
‘How are they going to be managed, and how are they going to be reported? This is what the RACGP is calling for, an evidence-based approach and a robust clinical governance and a transparent evaluation before any broader rollout.
 
‘There hasn’t been anything clearly set out for a clinical governance framework.’
 
Dr Raman said the models for the training and subsequent supervision of pharmacists also lacks detail.
 
‘The public materials don’t spell out the supervision model in detail; the frequency, the duration, or who would do the supervision,’ she said.
 
And while she agrees patients should have ‘access and convenience’, Dr Raman points to data from the Australian Bureau of Statistics and the RACGP’s Health of the Nation report, showing it already exists.
 
‘Two thirds of patients, 67%, could always see their preferred GP when they needed to, and our Health of the Nation report states that 99% of patients were able to see a GP when they needed to as well,’ she said.
 
‘In terms of access, from an RACGP point of view, we’re working with government to see how we can improve it, but not necessarily at the cost of fragmenting the care for our patients and the quality of care for our patients.’
 
Ms Girolamo said her party’s position is that it is ‘very important that a doctor is involved, to be able to have that continuity of care’.
 
‘We know that at the moment the health system is in crisis, and what we want to make sure is that people can see a GP when they need to, and then the pharmacy is obviously an important element.
 
‘At this stage, we’re not on the same page when it comes to what the Minister is proposing, but we are very focused when it comes to access to GPs as well.’
 
The Pharmacy Guild of Australia’s national Executive Director, Gerard Benedet, hit back at Ms Girolamo’s comments, calling them ‘shockingly misinformed and frankly backwards’.
 
‘The South Australian Liberals are not serious about increasing access to world class health services if they reject Community Pharmacists working to their full scope of practice,’ he said.
 
In August, the Guild unveiled its 10-year strategic plan, Towards 2035, in which it outlines its aim for pharmacy to be ‘the first port of call for primary healthcare services’ through the ‘adoption of full scope of practice’ across all jurisdictions.
 
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