‘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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  1. Nicholas Logan

    THIS after the good doctor wound up with egg on his face after warning people not to get their flu vaccination too early (in pharmacy).

  2. Michael Ortiz

    The following statement is interesting as the medical organisations are actively resisting changes in health care delivery by other health professionals.: “No amount of training, other than the completion of a medical degree and specialist training, would be sufficient to support autonomous pharmacist prescribing.”

    Does this imply that Nurse Practitioners, Optometrists and Dentists should not be able to prescribe??

    There are enough examples around the world of Pharmacist prescribing. (UK, Canada and NZ). Pharmacists have been prescribing S3 products for decades in Australia.

    Pharmacist prescribing is a natural evolution of their professional role and autonomous prescribing may take longer as it requires a higher level of expertise. It is reasonable to expect, that over the next decade, that pharmacists will be given expanded authority to prescribe medications and that appropriate pharmacist training will be undertaken.

    Nurse practitioners only do two drug therapy courses: 1. Pharmacological Therapies in Advanced Practice of medication and 2. Quality Use of Medicines in Advanced Practice out of 12 courses over 18 months to become a nurse practitioner who can prescribe autonomously.

    The article above implies that financial gain is the primary driver for pharmacist role expansion. One could argue the the medical associations are protecting income and they would do better to
    collaborate and co-operate with pharmacists with a goal of improving patient outcomes.

  3. Irvine Newton

    When the medical profession starts talking about the health and welfare of “their” patients, you have to wonder about the many thousands or more of people who are denied appropriate treatment simply because they have a particular form of illness that most (read nearly all) General Practitioners flatly refuse to treat.
    By way of example, in Victoria, approximately 45% of community pharmacies provide pharmacotherapy services (ORT) to opiate dependent people , whilst a miserably low 5% of “General” Practitioners provide a prescriber service. But what about the other 95%? How can they justify this outrageous denial of treatment to a cohort of people needing urgent medical care?
    Which begs the question. If medicos will not treat these people, then how do we address the problem which will no doubt get worse as more people will be identified via Real Time Prescription Monitoring as having a drug use issue and the fact that many of the prescribers with large client numbers are ageing and presumably can’t go on forever. What have the AMA and RACGP really done to address the problem? Sure they offer training, but how many then pursue the role?
    The reality is that there is an urgent need to expand the prescriber base and that may mean nurse prescribers but also committed, appropriately trained pharmacists. This is not a peculiarly Australian problem. In Scotland, pharmacists have been providing a GP co-operative service for some years and by any standard, it has been an outstanding success. So why not for Australia?

    Let’s remove the politics and the turf wars and start thinking about the people crying out for help and provide true patient focused care.

  4. Tony Lee

    It’s all about territory.
    There is substance in the arguments on both sides of this 100 Year War, with Pharmacy led by the Guild currently thrashing a disorganized RACGP.

  5. Doctors can do the diagnosing and pharmacists can do/support the prescribing based on their diagnosis

  6. Correct me if I’m wrong but my general impression of how we do things is that pharmacy groups will bring forth a proposition to expand professional services to which it is then met with backlash and vitriol from the GP groups. Then there’s an ongoing debate with statements made in the media about how they reject the proposition etc etc.

    Why don’t we actively involve the GP groups and have them included in the planning, strategising and implementing of clinical programs? As long as they come with an open and rational predisposition, I can only see benefits for the diversity of views and for our professional relationship in general. Dr Nespolon makes some valid points above, and I can completely empathise with his sentiments. Perhaps this could be avoided or minimised if the plan was made in conjunction with our medical colleagues and any concerns were addressed during the planning phase? #StrongerTogether

    • Jarrod McMaugh

      Alexander, there are two points I want to make here.

      1) Your suggestion is good. So good, in fact, that if you think about it…. this is probably how it **is** done.

      2) You note the vitriol and backlash from medical groups. I would point out to you that the nature of this vitriol is (generally) to catastrophise, scaremonger, and to underminde the public’s perceptions of pharmacists abilities and professionalism.

      Can you name a time when pharmacists have done this to any other group? Pharmacists criticise the *arguments* of other professions… but you don’t see comments from pharmacists that question another profession’s abilities or role. That may give you an insight into the first point I made.

      • If this is how it is done, then why are the GP groups backlashing. It makes no sense.

        Putting a proposal forward and having the GP’s accept the proposal is not negotiating.

        If you want an answer to this turf war, then this is a way forward. If the GP groups are the problem where they are just unwilling to participate at all, then I suppose they have accepted their own fate.

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