Expanded scope would waste health resources: RACGP


man holding 'no' sign

The RACGP doesn’t support a Pharmacy Council in Queensland and says the ownership rules are “out-dated”

In its submission to Queensland’s Parliamentary Inquiry into the pharmacy sector, the doctor group slams the concept of pharmacist prescribing and says it “advocates against multiple health professionals offering the same services”.

The Parliamentary Inquiry, underway in Queensland, is not only examining the scope of pharmacists’ practice, but also the ownership rules and the establishment of a Pharmacy Council.

In its submission, the RACGP says that “Pharmacists do not have the appropriate diagnostic skills to identify all potential health issues that arise from a consultation – attending to ‘minor ailments’ or issuing repeat prescriptions is not always as straightforward as it may initially appear, and could be an indication of deeper health issues”.

“Pharmacy-based preventative care programs will lead to duplication of services, fragmentation of care and an increased risk of adverse events,” it says.

“Fragmentation of care invariably causes wasted, valuable, health resources, and results in poorer health outcomes for patients.

“Access to primary healthcare, including preventative health interventions, should be provided within the general practice setting to avoid fragmentation of care.”

Pharmacists add value when providing services related to the safe, effective and efficient use of medicines, the RACGP says, but proposals for an expanded scope of practice put patients at risk of poorly coordinated care and wastes health resources.

It says that for many patients, “interactions with community pharmacy are episodic and ad hoc” and that a pharmacist does not have a comprehensive patient history or appropriate training to prescribe.

“The more prescribers, the more risks for errors. Medication misadventure is one of the leading causes of hospital admission. Multiple prescribers and the involvement of less qualified prescribers will inevitably risk patient safety and increase mortality and morbidity.

“A particular concern is the prospect that these pharmacy prescriptions would be provided to the most vulnerable patients in our society, and those with chronic diseases.”

The RACGP singles out low-dose codeine, upscheduled to Prescription Only on 1 February 2018.

“If it has been determined that it is not safe to dispense such medications over the counter, it raises the question of how can it be considered safe for pharmacists to prescribe a variety of other medications that can also be dangerous when inappropriately prescribed (e.g. for patients with certain medical conditions that put them at higher risk).”

RACGP Queensland Chair Dr Bruce Willett told newsGP reporter Doug Hendrie that “We must avoid making the system less safe, to profit a few pharmacists looking to increase their script numbers”.

He did not have an issue with pharmacists dispensing all repeats at once, however.

“Convenience could be better improved by allowing pharmacists to dispense all the repeats at once, as is done in other countries, rather than one month at a time.”

In its submission, the RACGP also said that the pharmacy ownership rules “restrict patient choice and inflate costs for consumers”.

“The RACGP believes that existing rules are also stifling competition and limiting potential improvements to the pharmacy model,” it says. “The rules are an out-dated method of promoting access and it is unclear why these regulations apply exclusively to pharmacy.”

As for a Pharmacy Council in Queensland, the RACGP does not support the establishment of such a body.

“It is unclear what the problem is this proposal is trying to solve. There are better alternatives than establishing another governance body.

“It is inappropriate for a Pharmacy Council to set standards about pharmacists’ and pharmacy assistants’ roles and scope of practice.

“Should a Pharmacy Council nevertheless be established, despite recommendations to the contrary, representation from consumers and doctors’ groups is essential to avoid further fragmentation of care, duplication of services, and confusion for consumers.”

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