The AMA Queensland says that pharmacists should not have a wider scope of practice due to conflict of interest and lack of training
In its submission to the Queensland Parliamentary Inquiry into the pharmacy sector, the Australian Medical Association’s state branch has said that it agrees with the Pharmacy Guild on one point: that separation of prescribing and dispensing provides a safety mechanism.
But it disagrees that pharmacists should be permitted to prescribe medicines for some ailments, it says, as this would mean “this safety mechanism would be put at risk and exposes the pharmacist to an inherent conflict of interest”.
“If the scope of pharmacists or pharmacy assistants was to be extended, it is the view of AMA Queensland that it would be impossible for pharmacists to manage this conflict of interest in a way that would be acceptable to most parties.
“Beyond this inherent conflict of interest, there is also the concern that pharmacists may use the opportunity to upsell to patients. Upselling often involves the selling of products that have few, if any, proven health benefits.
“Our general practitioner members have offered many examples of upselling experienced by their patients, such as a pharmacist recommending Inner Health Plus when dispensing antibiotics or Glucosamine when the patient has their arthritis medication dispensed.
“Others have provided examples of when pharmacists have persuaded patients not to fill a script and use an over the counter medicine instead, without input from the original prescribing doctor.”
The AMAQ also says that GPs are “highly trained medical professionals” with on average 14 years’ training, compared to four for pharmacists.
“Pharmacists are not trained to diagnose, examine and investigate with pathology and radiology. GPs are,” the submission states. “There is already ample evidence which shows that men are less likely to visit their GP than women.
“AMA Queensland is concerned that allowing pharmacists to become prescribers would see both men and women lose out on vital consultations with their GP as they opt for convenience over better health outcomes.”
Such convenience is “potentially dangerous,” it says, stating that expanding pharmacist scope of practice runs “directly contrary to the best available evidence about how care should be delivered: long term continuity of care with the same doctor in a therapeutic relationship based on mutual trust and respect”.
“Taking shortcuts with your health is simply not worth it.”
The AMAQ also says that there is “no convincing evidence” to demonstrate the safety of non-medical prescribing in the UK.
“However, there is compelling evidence of better outcomes where pharmacists and GPs work together in a collaborative model for the betterment of the patient, as part of the non-prescribing and non-dispensing pharmacist model.”
The submission says that at a time when Queensland coroners are calling for a real time prescription monitoring system to ensure the control of medicines scheduled S4 and above to reduce deaths, it is “inappropriate to potentially make it even easier for people to obtain drugs by allowing pharmacists… to prescribe and dispense them”.
The AMAQ also provided a joint submission with the RACGP in which the two bodies argued that the more prescribers, the greater the chance of misadventure, “particularly if a pharmacist is generating the prescription in a time poor retail environment”.
It also stated that it agrees with the Federal AMA’s position that broader ownership of pharmacy businesses should be permitted.
“The current ownership restrictions prevent the development of healthcare models that could benefit patient care. For example, co-located medical practitioners and pharmacists would facilitate coordinated and enhanced care for patients, as well as increase convenience for patients,” it says.
“Under current regulations, this model is only possible under very limited circumstances.”
In the introduction to the AMAQ’s submission, its president Dilip Dhupelia echoed his previous comments to the media about the inquiry.
“Pharmacists do not have the education, training or skills to independently formulate medical diagnoses, independently interpret diagnostic tests, prescribe medication, issue repeat prescriptions, or decide on the admission of patients to, and discharge from, hospital,” he wrote.
“The move to expand the scope of practice for pharmacists away from collaborative care relationships puts patient safety at risk, exposes staff to medico-legal risk and rather than providing efficiencies in health care delivery, may prove to be costlier overall.”