‘We’re not going to change our minds.’

Pharmacist prescribing is “more likely about supporting their business model,” a leading GP says

The RACGP has again hit out at the concept of pharmacist prescribing, describing it as working outside their scope of practice in its submission to the Pharmacy Board’s consultation on the matter.

“The RACGP does not support the expansion of pharmacists’ scope of practice beyond their core function of medicine advice and dispensing, into prescribing,” the submission says.

“The provision of medical services by health professionals lacking the necessary medical training or registration is an inappropriate and unsustainable solution to address the health needs of Australians.”

The RACGP says it “strongly opposes” the three models proposed by the Pharmacy Board.

The three proposed models include autonomous prescribing; prescribing under supervision; and prescribing via a structured prescribing arrangement; in the context of pharmacy practice.

The RACGP says that the Board’s discussion paper “fails to address why pharmacists should work outside their scope of practice and prescribe medications,” and that “pharmacists do not have the knowledge to support safe prescribing and are not equipped to provide opportunistic preventive care and chronic disease management”.

It also says that “the business needs of a pharmacy may be prioritised over the needs of patients” and that “patients will be exposed to unnecessary risk, including increased incidences of medication misadventure”.

Rather than alleviating the burden on GPs, time-related and indemnity-related burden would increase, it says.

“It appears that the consultation is considering ‘how’ pharmacists should prescribe, without appropriately considering whether pharmacy prescribing is appropriate at all,” the RACGP says in its submission.

“The increasing push to expand the scope of pharmacy, subjects patients to the risks of fragmented care and wastes valuable and finite health resources.”

It says that the convenience of pharmacy does not necessarily equal quality health care.

“Pharmacists simply do not have the healthcare training required to safely deliver healthcare services, the RACGP writes.

“Expanding the pharmacist scope of practice to prescribing may result in unusual (and sometimes serious) conditions not being recognised and managed appropriately.”

The submission states that the first suggested model, autonomous prescribing, is “inappropriate” and would lead to a “two-tier primary healthcare system where patients who cannot access GP services (eg due to cost or geographic location) may instead see a pharmacist as their first point of contact”.

“No amount of training, other than the completion of a medical degree and specialist training, would be sufficient to support autonomous pharmacist prescribing. It is not possible to substitute the years of study and clinical practice undertaken by a specialist GP, or other medical specialist, with a minimum level of clinical experience and a postgraduate qualification.”

The submission also opposes prescribing under a structured prescribing arrangement, and prescribing under supervision.

RACGP president Dr Harry Nespolon later told newsGP that “this has very little to do with good patient care”.

“It’s more likely about supporting their business model,” he told the RACGP publication.
“You can cut it and splice it as many ways as you like, but no one has answered the question about why we need to do this.
“Until they can make a case for it, we’re not going to change our minds.”

Anthony Tassone, president of the Pharmacy Guild’s Victorian branch, expressed disappointment at the RACGP’s stance.

“It’s not up to Dr. Nespolon or any peak body to define the scope of practice of another autonomous profession,” he said. “That is a matter for the regulating Board, policy makers and the public.

“What I and other pharmacists can do in their practice isn’t at the behest of the RACGP. Just like pharmacy bodies don’t dictate to doctors what their place in the team should be.

“The fact that the RACGP has categorically dismissed all three models of pharmacist prescribing, despite clear evidence of patient benefit in other jurisdictions speaks volumes to attitudes to collaboration for delivery of patient care.

“We’ve heard it all before from the RACGP and other doctors groups. Not so long ago, vaccination apparently wasn’t in the scope of pharmacists but it didn’t take long for the profession to get behind it, the public support it and record numbers of Australian were immunised against the flu in 2018.

“Patients stand to benefit the most when the health professional team can practice to their full scope to deliver care and work together.

“This can particularly be the case where there may be gaps in access to care especially in rural and remote areas.”

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