AMA ‘missed the fundamental question: why?’


The AMA has called for the relaxation of pharmacy ownership laws, saying this would improve access to medications

On Monday the AMA released its updated Position Statement on the Ethical Guidelines on Ownership of Pharmacy and Dispensing by Doctors 2019, which it says replaces a 2015 statement on the matter.

The updated position statement, to which the AMA says changes are minor, notes that the AMA believes that patient “access and convenience” in obtaining necessary medications could be improved if medical practitioners were allowed to own pharmacies – as long as such ownership was managed ethically, addressed conflicts of interest and maintained the “clear distinction” between prescribing and dispensing.

“Relaxing pharmacy ownership laws would improve patient access to medications,” said AMA national president Dr Tony Bartone.

“The AMA guidelines have been updated to assist doctors who have a direct financial interest in a pharmacy to manage potential conflicts of interest, to maintain their patients’ trust, and to preserve public confidence in the wider medical profession.

“The guidelines will support the AMA’s advocacy regarding new dispensing models, including doctor ownership of pharmacies and pharmacists dispensing from general practice, which will offer patients enhanced convenience, safety, and quality care in their access to medications.

“We recognise that real and perceived conflicts of interest may develop if a doctor owns a pharmacy.

“All potential conflicts of interest should be addressed appropriately in order to maintain public confidence that the profession will continue to fulfil its primary duty to put patients’ interests first and protect the integrity of the doctor-patient relationship,” Dr Bartone said.

The position statement highlights that doctors’ duty of care to patients takes primacy above all else and advocates the importance of maintaining patients’ trust through open and honest disclosure of the doctor’s financial and commercial arrangements that may affect, or be perceived to affect, patient care, including that any pharmacy ownership must not influence prescribing or other treatment decisions.

It also promotes the importance of doctors and pharmacists maintaining professional autonomy where a doctor owns a pharmacy, the AMA says.

Anthony Tassone, Victorian branch president of the Pharmacy Guild of Australia, responded by saying that “things must be very quiet in AMA land”.

“So many AMA words and resources devoted to pharmacy ownership by doctors, but they missed the fundamental question: why?” he told the AJP.

“We categorically reject Dr Bartone’s assertion that ‘relaxing pharmacy ownership laws would improve patient access to medications’.

“Australian patients trust their local pharmacist and there is widespread documented support for the requirement that only a pharmacist can own a pharmacy.

“It is also bizarre that the AMA would create guidance ‘to assist doctors who have a direct financial interest in a pharmacy’ when any such interest is currently legally impossible in all Australian jurisdictions.

“Does the AMA want to ‘support’ its members not complying with the law now?

“Rather than producing material to ‘help’ doctors in something they can’t legally do, or something patients aren’t asking for—the AMA should worry more about patient access to GPs in primary care.”

The AMA’s updated position statement can be viewed here.

According to a statement issued by the organisations, in terms of doctors owning pharmacies, the guidelines:

  • highlight doctors’ duty of care to patients that takes a primacy above all else;
  • advocate the importance of maintaining patients’ trust through open and honest disclosure of the doctor’s financial and commercial arrangements that may affect, or be perceived to affect, patient care. The doctor’s financial and/or commercial interests in pharmacy ownership must not influence their prescribing decisions or other treatment recommendations;
  • promote the importance of patient choice of pharmacy; and
  • advocate the importance of doctors and pharmacists maintaining professional autonomy where the doctor owns a pharmacy. This includes maintaining a clear separation between prescribing and dispensing where pharmacists retain the professional and legal responsibility for dispensing medicines, independent of the doctor and ensuring that pharmacists are under no incentive or obligation to refer patients to the doctor/the doctor’s practice and vice versa.

In terms of dispensing by doctors, it says the guidelines:

  • now highlight that the separation of prescribing and dispensing is an important safety mechanism as it ensures the independent review of a prescription;
  • clarify that dispensing involves more than just handing out medications but also identification, preparation, packaging, labelling, record keeping and supply of the correct medicine; and
  • revise the conditions under which it is appropriate for a doctor to dispense, from suggesting that dispensing only occur if there is ‘no reasonable alternative’ to suggesting that dispensing being reasonable where ‘the benefits to the patient outweigh potential safety concerns and the dispensing is based on clinical need and not undertaken for the purpose of material gain’.

 

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2 Comments

  1. Nicholas Logan
    17/12/2019

    The obsession with pharmacy is bizarre. Providing support for members currently owning a pharmacy and breaking the law? Time for their leadership to stop slandering pharmacists and come up with an original, progressive idea. AMA members are embarrassed to be hamstrung by the leadership politics.

  2. PeterC
    18/12/2019

    All professional groups would do well to stick to their knitting and support their members in their core functions/ core business.

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