21 October 2019

Guild ready to go it alone on prescribing push

Pharmacy Policy

The Pharmacy Guild of Australia says it has a “clear pathway” to autonomous prescribing, based on a position statement from the Pharmacy Board of Australia that expresses no such ambition.

While the Board says pharmacists should be able to prescribe under supervision or in a structured arrangement if states and territories amend their legislation, it says autonomous prescribing would require it to move regulatory mountains – a task it has no plans to undertake.

“Under the National Law, the Board has no regulatory barriers in place for pharmacists to prescribe via a structured prescribing arrangement or under supervision within a collaborative healthcare environment,” it says. “However, prescribing under these models requires changes in state and territory medicines and poisons legislation to authorise pharmacists to prescribe and these are matters to be determined by state and territory governments.

“The Board’s view is that autonomous prescribing by pharmacists requires additional regulation via an endorsement for scheduled medicines. This would require the Board to make an application to the Ministerial Council for approval of endorsement for scheduled medicines under section 14 of the National Law and to develop a registration standard for endorsement of registration. An application could only occur after completion of preparatory work to develop a case proposing the need for an endorsement as outlined in the AHPRA Guide1.

“The Board is not making an application for approval of endorsement for scheduled medicines at this time.”

The Pharmaceutical Society of Australia welcomed the prospect of collaborative prescribing.

“‘Prescribing via a structured prescribing arrangement’ and ‘prescribing under supervision’ can be progressed immediately, and implementation of these models through for example, expansion of continued dispensing for chronic disease medicines can address a significant proportion of the administrative burden that community pharmacists see day to day with patients running out of their medicines,” PSA national president Associate Professor Chris Freeman said.

AMA president Dr Tony Bartone said the Board’s position stance “protects the safety of patients and prevents pharmacists from conflicts of interest”.

The Guild, however, interpreted the second part of the statement as a blueprint for autonomous prescribing and enthusiastically offered its help to start the process.

“The statement by the Board outlines a clear pathway and process to achieve autonomous pharmacist prescribing and the Pharmacy Guild urges the Board to proceed towards this objective in the interests of Australian healthcare consumers,” it said in a media release.

“The Board noted that [an application to the Ministerial Council] could only occur after the completion of preparatory work to develop a case for autonomous prescribing. The Pharmacy Guild stands ready to assist in the development of this case.”

Earlier the AMA released its 10 minimum standards for prescribing, in an undisguised jab at the Guild. These include that prescribing by non-medical health practitioners “should only occur within a medically led and delegated team environment” and that there must be “no pecuniary or non-pecuniary benefit to the prescriber related to the choice of medicines prescribed or the dispensing of those prescribed medicines”.

The Guild’s spokesman Greg Turnbull responded: “The last time we looked, the AMA wasn’t a regulatory authority so their minimum standards have no standing in relation to pharmacists.”

Asked about conflict of interest, he referred The Medical Republic to the words of Canadian pharmacist Ross T. Tsuyuki, as quoted by Guild national president George Tambassis earlier this year: “One of the hallmarks of being a health care professional is that we put the patient’s needs first … So to suggest that pharmacists would do otherwise is, frankly, insulting.

“Would you say the same about a physician who gets paid to do procedures like surgery, endoscopy, bronchoscopy, echocardiography or heart catheterisation? Or a dentist who gets paid for the procedures he or she recommends?”

The independent NPS MedicineWise refused to be drawn on the contest between pharmacists and doctors, or on the conflict of interest issue. It referred us to its 2012 Prescribing Competencies Framework, which is currently being revised.

“Good prescribing involves a complex range of skills and to ensure patient safety, all prescribers, regardless of professional background, should demonstrate adequate competency before they are able to prescribe,” a representative said.

“NPS MedicineWise recognises the need for, and value of, a consistent and standard approach to prescribing for all health professionals with prescribing rights.”