Limit pharmacy sales, allow GP dispensing: RACGP

Strict limitations should be set on the types of products that can be sold in community pharmacies, says the RACGP

This is one of 11 recommendations about pharmacy made by the Royal Australian College of General Practitioners in its submission to the King pharmacy review, in which it also says pharmacists should not expand their services and recommends increasing GP dispensing to address the issue of after-hours medicines access.

“For a large cohort of patients, interactions with community pharmacy are episodic and ad hoc,” the College writes. “A pharmacist does not have comprehensive knowledge of a patient’s history or the appropriate medical training on which to draw in order to provide safe and quality medical care, spanning triage, diagnosis and treatment.

“Seeking to duplicate general practice services in pharmacy will thus result in serious health risks to patients.

“Yet, in recent years, community pharmacy has sought to expand to include services traditionally provided within the general practice setting, such as vaccination and ‘minor ailments’.

“Pharmacists are not adequately trained to deal with the complexities that come with vaccination programs, including appropriate counselling prior to administration and the management of potential adverse reactions, including anaphylaxis.

“Pharmacy settings also do not provide the necessary safe, private and comfortable setting to discuss confidential patient details prior to administering a vaccine.”

The RACGP also slams the provision of “sickness certification” and repeat prescription by pharmacists as an “unnecessary duplication” of the GP role.

The RACGP says it believes a retail business model within the health care environment is inappropriate, and it has concerns about the promotion of OTC and non-evidence-based medicines, including the sale of vitamins and supplements.

“Non-evidence-based products must not be sold as complementary or alternatives to evidence-based medicines,” it writes.

“The sale of non-evidence-based and OTC medicines can have serious health implications for patients, and could encourage a patient to delay or dismiss consultation with a registered medical practitioner or reject conventional medical approaches, resulting in serious and sometimes fatal consequences.

“In addition to the pressure faced by pharmacists, patients may also feel a similar pressure to purchase unnecessary products from a pharmacist given a pharmacist’s position of trust and perceived authority in medical expertise.”

The College recommends that strict limitations should be placed on the types of products that can be sold within community pharmacy, and that the “atypical” model of retail and healthcare in community pharmacy should be discouraged.

Meanwhile, the submission also suggests that additional incentives to pharmacy to provide access to after-hours medicine is unnecessary and that GPs could dispense instead.

“Patients visiting a GP outside of normal business hours may have an expectation of access to prescribed medicines,” the submission says.

“The Pharmacy Review raises a proposal of an incentive payment to support pharmacies to operate after hours.

“Given that a number of pharmacies already have extended business hours, an additional incentive is unnecessary unless a clear case regarding access to medications after hours can be articulated.

“To promote a cost-effective and coordinated health system, a more efficient option would be to allow GPs who are already offering after-hours services to dispense a range of commonly used medications when necessary.”

The College also recommends that the location and ownership rules should be replaced by incentive-based methods of increasing and maintaining patient access to PBS medicines.

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