‘Pot shot’ doesn’t help GP-pharmacist relationship

doctor wearing boxing glove

A GP and regular pharmacy critic has claimed there would be “regulatory incompetence on a grand scale” were pharmacist prescribing permitted

Dr Evan Ackermann, a Queensland GP and chair of the RACGP’s national standing committee on quality, has gone on the attack against pharmacist prescribing in Medical Observer magazine.

Pharmacist prescribing rights have been on the agenda for some time.

PSA president Dr Shane Jackson recently said that it is a “travesty” that they do not yet have them, while suggesting such rights are likely to be extended to pharmacists by 2020.

Pharmacist scope of practice is also currently being examined by a current Queensland Parliamentary Inquiry, and the Pharmacy Board recently held a stakeholder event at which three models of pharmacist prescribing were examined.

But giving pharmacists these rights would open a “Pandora’s Box,” Dr Ackermann says.

“The term ‘pharmacist prescribing’ is a clinical oxymoron, one I imagine many of us would never have expected to hear, let alone experience, when we entered medicine,” he writes.

“Why raise the issue at all? The pharmacist scope of practice is being rapidly automated and, with financial changes in the pharmacy sector, community pharmacists are looking at role expansion in order to stay relevant.”

Medication reviews and pharmacy-led health screening offers have “serially failed” to show a positive impact on health outcomes, argues Dr Ackermann.

Pharmacist prescribing is a “fundamental tool” for other concepts including Minor Ailments Schemes and the monitoring of chronic diseases, he adds.

“In fact, many pharmacists see the development of My Health Record and the data it will make available as overcoming some of the key obstacles to prescribing — namely not having to make a diagnosis and having access to a patient’s personal health information.”

He says that rather than Australia needing to catch up to the international landscape on prescribing rights, “Australia has a much more advanced primary healthcare system than many other countries and this results in better health outcomes.

“Simply copying the actions of health systems with poorer outcomes is no justification for new services.”

The retail nature of community pharmacy is “not conducive to professional services,” he says.

“If recent history with codeine has taught us anything, it’s that the presence of a pharmacist does not ensure safe and effective use of pharmacist-only medications.”

He also refutes that pharmacist prescribing is “for patients,” saying that “if the policy intent is safe and convenient access to medication, pharmacy bodies and regulators could easily increase dispensing amounts”.

“In my view, prescribing is for pharmacists, not for patients. And adding prescribing rights in the context of decreasing income from PBS dispensing would be a recipe for overprescribing,” Dr Ackermann writes.

“Society gives the responsibility to prescribe to many health professionals, including doctors, nurses and allied professions. These prescribing rights are based on societal need, provided by qualified groups and in settings conducive to professional services.

“Pharmacy prescribing is a quantum difference on many levels. Inadequate training, a progressively poor environment and lack of oversight should all weigh heavily against the introduction of this service.

“The risk-to-benefit equation looks very bleak and it would amount to regulatory incompetence on a grand scale if pharmacist prescribing was sanctioned in a retail setting,” argues Dr Ackermann.

PSA’s Dr Jackson expressed disappointment at the piece, saying that it was unfortunate that individuals including Dr Ackermann were attempting to derail collaborative efforts by “throwing rocks”.

“I get frustrated at trying to refute these points, but I will say that prescribing is within the scope of practise for pharmacists and has been for a long period of time,” Dr Jackson tells the AJP.

“As a profession, and certainly the PSA understands that, we will need to navigate the concerns about separation of the prescribing function and the dispensing function. Absolutely, that needs to be addressed.

“But we’re talking about a collaborative model, where the pharmacist will enter into arrangements with medical practitioners. If you look at it from a community pharmacy perspective that would likely be potentially limited to start around prescription extension and prescription modification – again, all within the collaborative framework.

“There may well be a more independent process that occurs where there is that separation from the dispensing function: for example, pharmacists working in the hospital setting, or in a general practice, or in an aged care setting.

“But there are prescribing models that can be implemented across the whole spectrum of pharmacy, from community pharmacy to more independent practice, and this latest pot shot is not helpful for the relationship between doctors and pharmacists.

“This should be about partnerships, about collaboration and working together on models of care that actually benefit patients – and we will continue to do that.”

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