After-hours errors common: pharmacists

home doctors

Pharmacists complain of “continual” script errors by after-hours doctors, just a few months after crackdown announced on home visits

Some pharmacists have expressed concerns to AJP regarding the prescribing practices of after-hours doctors.

Harry*, a pharmacist and medical student who funds his education by working nights and weekends, says he finds “continual errors” on prescriptions written by after-hours doctors.

“We seem to get a lot of problems in the evening and weekend shifts from them,” says Harry.

“I’ve also seen items written on the reverse of scripts and all sorts of things.

“[Some doctors are] friendly enough but others in the past have been quite rude. It can be quite difficult to diffuse these situations when patients come in desperate for medication, having paid to see a doctor, only to have a script that isn’t legal.”

A Victorian pharmacist, who prefers to remain anonymous, says Harry’s comments reflect what pharmacists have been seeing for some time.

“The majority of errors that we see at the pharmacy level are the doctors not understanding the PBS system,” the pharmacist told AJP.

“Usually they’re handwritten scripts, which is a problem in itself – sometimes you literally can’t read it. And you need to have an understanding of the PBS.

“During the day, doctors have an option to call up the pharmacist and ask about a script, but those that work after hours are less likely to do so as it’s not easy to get in touch.

“Our young doctors that are qualified and working huge hours at public hospitals cannot work as a GP because they are not qualified, but the overseas-trained doctors, struggling with our [PBS] system, can visit your house,” says the pharmacist.

“I’m sure even doctor groups would agree the whole after-hours thing is a mess.

“For accreditation, clinics need to nominate an after-hours service, so the after-hours thing has grown but has not been nurtured. The money, most would agree, would be better spent in helping existing clinics stay open later.”

At-home services under fire

After-hours medical services have been under fire very recently.

In September 2017, News Corp revealed unpublished Medicare data showing 70% of the 1.86 million after-hours house calls in 2015-16 were made by non-vocationally registered GPs and GP trainees.

Throughout last year, a Medicare Benefits Schedule Review Taskforce was tasked with reviewing urgent after-hours primary care services as funded through the MBS, with the final report handed down in October.

The Taskforce found after-hours healthcare was “often provided by less qualified clinicians”.

The RACGP submitted to the Taskforce that while it was supportive of after-hours medical services, “in the interests of patient safety they absolutely must be offered by suitably qualified doctors”.

The Australian Medical Association agreed that while access to after-hours GP services is “critical”, there is a need for proper training.

“The AMA wants to see a model of after-hours care that ensures medical deputising services (MDSs) – the companies that provide the after-hours services in many cases – employ doctors with the right skills, training and supervision, and are properly accredited,” said AMA President Dr Michael Gannon.

In December, the Federal Government announced changes to after-hours care as part of a $409 million savings package in its mid-year budget update.

New guidelines for after-hours services have now been provided.

According to these new guidelines, after-hours deputisers will be barred from writing new scripts without the permission of a patient’s regular GP, reports the Australian Doctor publication.

Patients will also no longer be able to book home visits in advance, and a qualified GP will need to assess whether a visit is necessary.

“The changes to after-hours arrangements will mean doctors are able to provide the best care to their patients, and that after-hours services are provided by an appropriate doctor to people who require genuinely urgent treatment,” said Health Minister Greg Hunt on the announcement.

*Name has been changed

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