Guild push for ‘full scope’ as 7CPA talks ramp up

GP shortages are leaving Aussies frustrated, says Guild in push for more vaccines, common ailments and prescribing, but AMA says pharmacists are trying to play doctor

After having to defend community pharmacy regulation in mainstream media over the past week, the Pharmacy Guild has shifted the conversation by releasing a new policy paper on Wednesday, calling for pharmacists to play a greater role in the healthcare system.

The paper, which comes as negotiations for the Seventh Community Pharmacy Agreement (7CPA) build momentum, pushes for expanded rights or what the Guild describes as “full scope of practice”, including treating common ailments, prescribing medicines and administering more vaccines.

This is a logical move to fill a gap left by GP waiting times, GP shortages and high-out-of-pocket costs that “are leaving many Australians are their families feeling frustrated”, reads the Guild policy paper.

The Guild wants to see community pharmacists recognised in the 7CPA as “professional, well-trained people that can offer solutions,” national president George Tambassis told the AJP.

“We want to make sure people understand that pharmacists aren’t practising at their full scope right now. You’ve got this underutilised community pharmacy network … it’s one of the solutions that the healthcare system has just forgotten about. Why don’t we make sure we utilise the asset that we’ve got – 5700 pharmacies not practising at their full scope.”

Mr Tambassis added that pharmacists should be able to administer the full range of vaccines, as well as treat common ailments and provide prescriptions for simple issues such as ear infections and UTIs to ease the load of a growing and ageing population on the healthcare system.

“We think that pharmacists are there to help fix some of the issues that we’re seeing in the healthcare system,” explained Guild national councillor Catherine Bronger, at whose Sydney pharmacy the paper was launched.

“We know that the Australian population are really finding it difficult getting to see their GPs and their emergency departments are being blocked up with people with common ailments.

“We have a network that is evenly distributed throughout Australia that is just sitting there waiting to help fix some of the issues that we have,” she told AJP.

The flu vaccine is only “the tip of the iceberg in terms of what pharmacists can do,” she said, adding that pharmacists could perform autonomous prescribing for medicines such as oral contraceptives.

Pharmacist prescribing could help patients get better treatment for common issues, said Mr Tambassis.

He is confident there is no concern that some pharmacies wouldn’t follow protocols and therapeutic guidelines when prescribing antibiotics and other medicines.

Pharmacists are well trained to do more in healthcare, having undergone “half a decade” of training prior to being registered, he emphasised.

However the Australian Medical Association (AMA) posted a scathing response to the policy paper, saying health professionals should stick to their respective scopes of practice.

AMA President, Dr Tony Bartone, said that “if the Pharmacy Guild wants pharmacists to be doctors, then pharmacists should spend 10 to 15 years studying for a medical degree.

“GPs study and train for more than a decade to provide quality holistic care for individuals and families through all stages of life,” he said.

“The Guild claims that a pharmacist’s ‘half a decade training prior to being registered’ is sufficient to practise as a doctor, with all the complexity and specialised skills and knowledge that entails. This is simply not true or possible.”

Dr Bartone said he did not believe that community pharmacists on the ground would agree with the Guild’s push for pharmacists to take over the work of doctors.

“GPs know the medical histories of their patients and their families. The enduring long-term and trusted doctor-patient relationship is at the core of safe, high-quality health and medical care in Australia,” he said.

“Undermining or diluting this relationship, as the Pharmacy Guild is proposing, is irresponsible and dangerous.”

Read the Guild’s full policy paper here

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  1. Debbie Rigby

    Wrong message used by the Guild – always going to get this response from medical organisations. It’s not about freeing up GP time.Should be about helping patients with better medication management.

    Perhaps the focus should also be about doing what we do now, well.

    As an example, OTC SABAs. A survey published in BMJ Open shows extreme overuse with OTC SABA (salbutamol) inhalers in Australia:

    70% of survey participants overusers
    31% use 5-12 puffs/day – 6% use >12 puffs/day
    74% don’t use regular preventers
    18% had no diagnosis from GP
    47% have uncontrolled asthma
    overusers more likely to use oral steroids to manage worsening asthma symptoms

    The researchers saw these alarming figures as an opportunity for greater community pharmacist intervention:

    “This study uncovers a hidden population of people who can only be identified in pharmacy with suboptimal asthma, coexisting rhinitis, poor preventer adherence and, in some cases, no asthma diagnosis.”

    • Thomas Petrucci

      Unfortunately, a common response from these patients when asked if they have seen their doctor for a preventer is “$100 to see a doctor then $40 for the script, Ill just have the $8 Asmol thanks “

    • Ron Batagol

      I agree, Debby
      To state the obvious at the outset- pharmacists, within any or all regencies of practice, are not trained as differential disease diagnosticians.
      Therefore, it is not the case of pharmacists taking over the role of clinician diagnosis!
      However, having said that, a lot of work has been done and is being done, to implement collaborative prescribing frameworks, within which pharmacists have an important role to play.
      1.The Pharmacy Board, as I understand it, is finalising a discussion paper that will include the outcomes of its 2018 forum,and
      a range of consultation questions to help the profession further explore its role in prescribing.
      These questions will cover topics including:models of prescribing that can be pursued by the pharmacy profession, including the supporting evidence, identification of gaps in evidence that may need to be addressed by the profession, and issues
      that need to be considered and addressed to assess the regulatory need for an endorsement for prescribing of scheduled medicines.
      2. Within the Hospital setting, in SHPA’s Submission to the Pharmacy Board of Australia’s ongoing consideration of the pharmacist prescribing issue , it was noted that, in Queensland, research has demonstrated that collaborative prescribing in a major public hospital in Brisbane resulted in a 90% error-free
      rate compared to medical prescribing which had a 26% error-free rate ( which, I suspect, doesn’t surprise any of us!.)
      3. At a broader level, in “PHARMACIST PRESCRIBING BY 2020? WHAT YOU NEED TO KNOW” (AJP
      Professor Lisa Nissen, a pioneer in this area, noted that “there are well-constructed frameworks already in place for prescribing for all professionals.
      -The Health Professionals Prescribing Pathway (HPPP) provides a clear view of how practitioners should prepare for prescribing – including the NPS Prescribing competencies which show the standard of training that should be met and the HPPP also
      provides the governance framework that overarches prescribing practices.
      She also pointed out State and territory legislation and registration standards would pull this all together.
      And finally, the key point:“
      “Consultation and collaboration with the whole health care team and particularly consumers will be paramount to shaping the approach that will work best for the future”.

  2. Greg Kyle

    Having the guild push this opens the profession up to ambit claims like those just made by the medical lobby & it’s various mouthpieces because they are only interested in pharmacies, and not pharmacists. Make this about pharmacists and the “building up business” claims fade into oblivion.

  3. M M

    One of my colleagues described it as “Forced Scope” while I find it “Scope Creep” – we need to get the basics right first before stepping up.

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