The AMA has released new minimum standards for prescribing – aimed at cutting out prescribing rights for pharmacists
The AMA’s new 10 Minimum Standards for Prescribing are “consistent with medical ethics and frameworks for the quality use of medicines,” the Australian Medical Association says.
National president Dr Tony Bartone said the standards are concerned with putting patient interests first – as well as “providing governments with strong evidence to reject attempts by unauthorised or inappropriately skilled practitioners who may seek prescribing rights outside of their scope of practice”.
He said the guidelines were developed to make clear the minimum standards required of all prescribers authorised to prescribe S4 and S8 medications.
“Currently, a range of health professionals can prescribe S4 and S8 medications. The primary prescribers are doctors, but dentists, optometrists, midwives, and nurse practitioners also have authorised prescribing rights within regulated limitations and in very specific circumstances,” Dr Bartone said.
“There is a push from the Pharmacy Guild of Australia for pharmacists to have prescribing rights, but the AMA totally rejects this proposal.
“It is inappropriate, and unsafe for patients. Instead, the AMA wants to see pharmacists working in general practices within the scope of their practice.
“Working collaboratively with the Pharmaceutical Society of Australia, which represents individual pharmacists, the AMA developed a proposal for integrating pharmacists within general practice to assist GPs and their patients with medication management.
“Working closely with GPs in a general practice provides the ideal setting for pharmacists to use their complementary skills to ensure the quality use of medicines and the reduction of adverse drug events in patients.
“The Pharmacy Guild, on the other hand, would like to see is pharmacists paid to prescribe as well as paid to dispense. This would create a significant conflict of interest.
“The AMA has long held that separation of prescribing and dispensing is an important safety measure. It also contributes to the trust relationship between the doctor and the patient.”
Dr Bartone said the AMA Prescribing Standards will provide guidance to all prescribers in understanding their role within a patient’s GP-led multidisciplinary health team.
“It is vital that health professionals operate within their scope of practice,” Dr Bartone said.
“Doctors are the only health professionals trained to provide comprehensive medical care.
“Doctors are the only health professionals trained to fully assess a person, initiate further investigations, make a diagnosis, and understand the full range of clinically appropriate treatments for a given condition, including when to prescribe and, importantly, when not to prescribe medicines.
“GPs train for 10-14 years, some even longer. This training enables them to holistically assess, examine, investigate, and diagnose a patient presenting with undifferentiated symptoms.
“The AMA urges all governments to ensure that patient care is not fragmented, misdirected, or delayed by prescribing models that do not align with the AMA’s Standards,” Dr Bartone said.
A Pharmacy Guild spokesperson was unfazed by the release of the new standards.
“The last time we looked, the AMA wasn’t a regulatory authority so their minimum standards have no standing in relation to pharmacists,” they said.
The spokesperson cited a column written earlier this year by Guild national president George Tambassis in which he said that the outcry from “medical alarmists” about pharmacist prescribing was “predictable”.
“Patients want and deserve to benefit from pharmacists operating at their full scope. And our health system – creaking under so many demands and pressures – demands that all health professionals should be making the best possible contribution to patient care,” Mr Tambassis said at the time.
PSA noted the AMA’s Standards for Prescribing, saying it agrees that there should no pecuniary or non-pecuniary benefit to the prescriber related to the choice of medicines prescribed or the dispensing of those prescribed medicines, according to Associate Professor Chris Freeman.
“This is why we have clearly stated that doctors should not own pharmacies that are dispensing the prescriptions of those very same doctors who own the practice,” A/Prof Freeman told AJP.
“Equally we have stated that when an independent decision is made to initiate a Schedule 4 or Schedule 8 medicine by a pharmacist (in the future) that this needs to be separated from the act of dispensing.
“As part of the development of the 2016 National Competency Standards for Pharmacists development process, the competencies required for prescribing have already been mapped to those of the NPS Competencies Required to Prescribe medicines and there is very good alignment.
“When we have surveyed PSA members, autonomous prescribing is not as high on the priority list as some might expect. Our members tell us that that expansion of continued dispensing arrangement for chronic diseases should be progressed as a matter of priority and having flexibility to adapt prescriptions for medicines shortages would go a long way to addressing challenges at the coal face,” he said.
“We would like to see collaborative prescribing arrangements for aged care, hospitals, general practice and community pharmacy developed as a matter of priority.”
The AMA’s 10 Minimum Standards for Prescribing are:
Standard 1: Prescribing by non-medical health practitioners should only occur within a medically led and delegated team environment in the interests of patient safety and quality of care.
Standard 2: There must be no pecuniary or non-pecuniary benefit to the prescriber related to the choice of medicines prescribed or the dispensing of those prescribed medicines.
Standard 3: Before prescribing establish a therapeutic relationship with the patient and perform a comprehensive medicines assessment to identify what other medicines, including complementary medicines, the patient is taking and consider any implications to the patient’s treatment plan.
Standard 4: Prescribers ensure they:
- a) consider the necessity and appropriateness of medications in managing the patient’s health care needs,
- b) choose the most suitable and cost-effective medicines when medicines are considered appropriate, taking into account the efficacy, potential for self-harm and the ability of the patient to adhere to the dosage regimen,
- c) advise patients are aware of the relevant side effects of prescribed medications as well as relevant interactions between medications, and
- d) report any adverse reactions to the TGA.
Standard 5: Prescribers must maintain clinical independence.
Standard 6: Prescribers must operate only within their scope of practice and comply with state, territory and legislative requirements including restrictions under the Pharmaceutical Benefits Scheme.
Standard 7: Prescribers work in partnership with the patient to set therapeutic goals and with other health professionals as appropriate to select medicines and to tailor and implement a treatment plan.
Standard 8: Prescribers provide clear instructions to delegated prescribers within the health care team and to other health professionals who dispense, supply, or administer the prescribed medicines.
Standard 9: Prescribers with the patient consent communicate with other health professionals within the patients’ health care team about the patient’s medicines and treatment plan.
Standard 10: Prescribers monitor and review the patient’s response to treatment and adjust the treatment plan as appropriate.