Autonomous prescribing is the only feasible option out of three mooted plans for pharmacist prescribing, according to the Pharmacy Guild
The Pharmacy Guild has responded to the Pharmacy Board’s consultation on pharmacist prescribing by stating that this would be the “only effective method” to fulfil public need as described in the Board’s discussion paper.
The Board’s discussion paper, Pharmacist Prescribing, suggested three structures under which pharmacists could prescribe: autonomous prescribing; prescribing under supervision; and under a structured prescribing arrangement.
“Autonomous pharmacist prescribing would improve access to treatment options for simple conditions that can be managed by a pharmacist – including after hours and weekends when access to other health care professionals is limited or non-existent,” says the Guild in its submission.
“The other models are dependent on another prescriber and would therefore be less effective.
“If pharmacist prescribing is to contribute to the delivery of sustainable, responsive and affordable access to medicines then prescribing has to be autonomous.
“Prescribing under a structured prescribing arrangement or under supervision relies on another health care professional and will therefore not be flexible enough to meet the needs of all Australians who for example may live in a rural or remote area where there is no or very limited access to a medical doctor or nurse practitioner.
“Other examples include after hours, palliative care, aged care or addiction medicine where an autonomous pharmacist prescriber will be able to provide the necessary care.”
An autonomous pharmacist prescriber would be no different to a nurse practitioner, says the Guild, where pharmacists would provide care within their individual scope of practice, and in collaboration with other health team members.
“Pharmacists in Australia have already proven with influenza vaccination programs that they can be trained to prescribe and administer vaccines with reporting to the Australian Immunisation Register.
“Where a service is not an undergraduate competency the Australian pharmacy sector has proven that retro-fitting is possible with additional training to achieve this competency and deliver the services to Australians.
“Overseas experience would suggest that it is not worthwhile to progress such models as Structured or Under Supervision and that efforts should be concentrated on Autonomous Prescribing as the single most appropriate goal.
“We believe that ‘structured’ or ‘under-supervision’ models would become a barrier to pharmacists participating in regional and remote areas where a supervisor would be unavailable.
“Ironically, it is these remote and rural areas where an autonomous prescribing pharmacist would improve access to medicines and treatment for simple conditions.”
The Guild says that given international evidence, it does not believe any more evidence needs to be obtained to support such a mode, “as this particular model has been proven to be effective and safe in similar countries such as the UK and provinces in Canada such as Alberta”.
It says that by the end of the Seventh Community Pharmacy Agreement, all pharmacists who graduate from an Australian university be competent to be autonomous prescribers, subject to supervised practice and minimum clinical experience, should they wish to be endorsed as such.
“All currently registered pharmacists will be able to complete a continuing education course that will update their knowledge.
“Therefore autonomous prescribing will be embedded as a core competency for all pharmacists in Australia and the CPD requirements will be the same and be determined by the Pharmacy Board of Australia.”
The Guild also cautioned against the Canadian prescribing model’s variation between provinces, arguing that any such scheme should be implemented uniformly across Australian jurisdictions.
“For example, pharmacist vaccination was done on a state by state basis and therefore there are differences between the states and territories. The COAG has recently made a recommendation that there should be a process of harmonisation of pharmacist vaccination across the country and is currently working towards harmonisation.”