‘Ugly truths’ about pharmacy prescribing?

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Doctor publication takes aim at pharmacists and the recent push for prescribing rights during the Qld inquiry

The Medical Republic publisher Jeremy Knibbs, a veteran of the medical publishing industry in Australia, has penned a piece slamming the pharmacy push for prescribing rights.

In his editorial ‘Five ugly truths about the pharmacy prescribing push’, Mr Knibbs highlights the recent Inquiry into the establishment of a pharmacy council and transfer of pharmacy ownership in Queensland.

His article follows GP outcry at the Inquiry recommendations to expand the role of pharmacists, including in relation to the prescribing of medications.

Mr Knibbs shares his “Ugly Truth No 1 – If you’re organised, you’re powerful”.

“The pharmacy lobby is highly organised, and highly connected. That’s not illegal. Neither is a ‘shock and awe’ carpet-bombing submissions campaign targeting a state government inquiry that might provide pharmacists with the best chance in five years of accessing the world of prescribing. Something they’ve been pushing now for nearly decade,” he says.

“The pharmacy lobby knew what was happening. And they were organised to the point where nearly 90% of all the submissions were arguing in favour of changes that would see the pharmacists’ role expanded.”

Mr Knibbs’ argues that there is no evidence base for pharmacist prescribing.

“The conclusions reached by the report are made primarily on the say-so of the submissions of the interested parties and the assessment of the committee.

“Submissions from the doctor lobby groups are largely dismissed in favour of the arguments made by the many pharmacy submissions and witnesses,” he says.

Finally Mr Knibbs shares his “Ugl(iest) Truth. No 5 – Money talks louder than patient safety.”

“The pharmacy lobby may well scream blue murder, but the reality surely is that the push to have pharmacists prescribe, and all the work done by them in influencing this Queensland inquiry, is almost entirely about money.”

He argues that pharmacists are facing serious disruptive market challenges to their identity in the forms of artificial intelligence, web-based information health resources and online buying.

“The world is changing, and pharmacists desperately need to find a new place in a rapidly evolving healthcare professionals food chain. An obvious place to go is up the food chain, or in this case the prescribing chain,” he writes.

“Importantly, as they have already done with vaccinations, this creates a whole host of other retail up-selling and commercial opportunities. 

“This leads us to perhaps the ugliest truth of the whole pharmacist prescribing push. It’s about money not the best interests of the patient,” Mr Knibbs concludes.

A Guild spokesperson referred to the piece as “conspiracy theory ramblings”.

“There aren’t enough hours in the day to straighten out the misconceptions and perverse interpretations in this piece,” he said.

Pharmacist prescribing is supported by almost all domains of the profession – not just community pharmacy – including hospital pharmacy and academia.

The Society of Hospital Pharmacists of Australia (SHPA), the Pharmaceutical Society of Australia (PSA) and the Pharmacy Guild of Australia all put in submissions to the inquiry calling for prescribing rights to be extended to pharmacists.

“There are various models of prescribing that could be considered ranging from supplemental through to independent prescribing by pharmacists. It is beneficial to community health outcomes to have pharmacists being able to prescribe PBS items for long-term, stable chronic conditions,” said the SHPA in its submission.

The Guild welcomed the findings of the Queensland parliamentary inquiry, saying it will pave the way for pharmacists to operate to the full extent of their training.

“Research clearly shows there are so many benefits to implementing this common sense move that will bring Queensland into line with other states and comparable countries,” said Qld Guild president Trent Twomey.

At a Cairns public hearing, Mr Twomey pointed out that pharmacists already prescribe.

“We prescribe unscheduled medications, we prescribe Schedule 2 medications, we prescribe Schedule 3 medicines and in fact under the continuing dispensing protocols in the emergency supply provisions we already prescribe Schedule 4s,” he said.

“The difficulty is at the moment there are restrictions under the Health (Drugs and Poisons) Regulation and the Medicines Act and the Health Act 1953 which prevent pharmacists from practising to our full scope of practice.

“There is a big difference between independently and autonomously initiating treatment of an S4 medication as in, ‘We’re going to diagnose schizophrenia and provide a drug,’ which we heard from the Royal Australasian College of Physicians, to somebody who is already on a chronic medicine, they have run out and we need to ensure a continuity of care.”

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