The turf war: can we do better?

doctor shaking hands

Another prominent GP has criticised recommendations pharmacists prescribe and dispense low-risk scripts and vaccinations – but called for a more conciliatory approach

Dr Edwin Kruys has written on his Doctor’s Bag blog that he shares GP stakeholder group concerns about the findings of the Queensland inquiry into the pharmacy sector, particularly those regarding scope of practice.

Last week was a “low point in the communication and relationships between health groups in Australia,” wrote Dr Kruys, RACGP past vice president, who is now involved with the BridgeBuilders collaboration.

“Medical groups including the AMA and RACGP indicated they will not support the recommendations,” he wrote.

“This is hardly surprising as the results of the deliberations by the parliamentary committee led by Chair Aaron Harper MP are not based on mutually agreed principles or a collaborative care model.

“Although the report repeatedly mentions a shared prescribing model, the recommendations, if implemented, will not result in effective collaboration. 

“For example, checking the MyHealthRecord (which is not always available or complete) or calling a health-line can hardly be seen as supporting team care and collaboration with treating doctors. 

“Cooperation between pharmacists and medical teams should be more than a box ticking exercise.”

His criticism of the inquiry’s recommendations follow that of other GPs, including AMA national president Tony Bartone, who said pharmacists had a conflict of interest around prescribing; AMA Queensland president Dulip Dhupelia, who said the state Health Minister Steven Miles should not “bow to the pharmacy lobby’s greed;” and Dr Evan Ackermann, who criticised the findings over ownership in particular in the MJA.

But Dr Kruys also wrote that Australia’s health professionals can “do better,” and need to reach out to each other for understanding.

“Community pharmacists feel that their scope of practice is restricted and that they can contribute in a more meaningful way to patient care,” he said.

“Medical groups are concerned that more prescribers can lead to fragmentation of care and poor health outcomes, especially in the absence of meaningful collaboration.

“Both arguments are valid and should be explored further. There is always a better way but this requires a willingness to work together and find mutually agreed solutions.”

Dr Kruys says he believes health practitioners and their stakeholder organisations can move beyond media releases such as that issued by the AMA Queensland following the release of the Queensland recommendations, or pieces such as this by Pharmacy Guild Victorian branch president Anthony Tassone, published by the AJP.

He cited recent discussions organised by the PSA between doctor and pharmacy groups as an example of a positive move towards understanding.

“Although doctors and pharmacists may never agree on everything, which is absolutely fine, we must find a better way forward in the interest of our patients,” wrote Dr Kruys.

PSA national president Dr Shane Jackson told the AJP that the organisation will continue to highlight that pharmacists should be able to prescribe in a collaborative model.

“Those sector specific models will help guide discussions around what the collaborative prescriber would do,” he said.

“Doctors and consumers should be involved in the co-design of those models of care which focus on patient-centred care by improving the use of medicines and the accessibility of healthcare providers.”

As for scope of practice, he reiterated that pharmacists can do more in Australia’s health care system, and “that pharmacists’ significant skills, expertise and training are underutilised”.

“There has been some commentary about what are the issues that pharmacists are trying to solve, for example by addressing pharmacists prescribing,” Dr Jackson said.

“The issues that we are solving are around quality and safety of medication use.

“It centres around having accessible patient-centred care and utilising a workforce that has an opportunity to address patient safety and quality use of medicines.”

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