The RACGP has refused to sit on a secret-squirrel standards group, and a consumer survey shows support for limited pharmacist prescribing.
As the ACT follows NSW into pharmacist prescribing for UTIs, the RACGP has boycotted a stakeholder reference group on standards for the controversial expansion of scope.
In NSW, Premier Dominic Perrottet has confirmed that the controversial pilot is slated to go ahead in April and will allow community pharmacists to diagnose and prescribe for uncomplicated cystitis in adult women.
Late last week, ACT Health Minister Rachel Stephen-Smith announced that the territory would be joining the trial from day one, currently set for April Fool’s Day.
Ms Stephen-Smith’s announcement only covered the UTI portion of the NSW prescribing trial and did not make mention of the oral contraceptive pill component.
The OCP component, which is technically part of a separate trial even though it also involves pharmacist-led prescribing, will start in NSW on 1 July. It’s not clear if the ACT trial will include OCPs, though a quote in Ms Stephen-Smith’s press release, attributed to Pharmaceutical Society of Australia ACT branch president Olivia Collenette, said pharmacists “with appropriate further training, can make oral contraception and UTI treatments more accessible for all Canberrans”.
Ms Stephen-Smith’s office did not respond to TMR’s request for clarification before deadline.
ACT Health indicated to TMR that it would be working with NSW Health to understand whether ACT pharmacies would be able to participate in the OCP portion of the trial.
Late last week the RACGP confirmed it would not participate in the Australian Pharmacy Council stakeholder reference group, responsible for developing pharmacy prescribing accreditation standards.
RACGP vice president Dr Bruce Willett told newsGP that the main reason for this was the requirement to sign a non-disclosure agreement.
“We feel that this should be an open process and open to community and patient scrutiny,” he said.
A spokesman for the Pharmacy Guild of Australia told industry publication Australian Journal of Pharmacy that it remained “open to cooperation” with GPs.
“The Guild’s priorities remain working towards solutions for Australian patients and their local communities,” they said. “The RACGP must have other priorities at this time.”
Meanwhile, a small survey conducted by the Consumers Health Forum has found that consumers remain open to community pharmacy prescriptions, albeit with a limited scope.
“Only one in four people [of 131 surveyed] were opposed to pharmacists being able to give prescriptions as a blanket rule, and then less than one in 10 were opposed to them being able to do it [even] in repeat prescriptions,” said James Ansell, a research and policy officer at the CHF, in a webinar hosted by the organisation. The full survey has not been published.
Nearly a fifth of respondents believed that community pharmacists should be able to issue new prescriptions, just over half believed they should “in some circumstances”, a quarter did not believe pharmacists should be able to prescribe at all and 1% voted “unsure”.
Mr Ansell said respondents in favour of pharmacy prescriptions believed that pharmacists “had a good idea of [the consumer’s] overall health” and were “happy for that pharmacist to give them advice”. They also believed that pharmacists were a cheaper and more efficient “first point of call” when compared to GPs.
Most respondents believed there should be restrictions on the types of medicines and situations which pharmacists were allowed to prescribe, i.e. “minor, seasonal, long term, recurring” medicines as opposed to “complex, high risk or addictive” medicines that required “close dosage management”. They said pharmacists should not be able to diagnose conditions that were “completely new” or “abnormal”.
“There is this middle ground pharmacists could be fulfilling … getting access to medications, particularly when it’s in a rural location or afterhours situation and other pathways are no longer available,” Mr Ansell said.
When it came to issuing repeat prescriptions 49% of respondents were entirely in favour and 41% voted “in some circumstances”.
People felt that “repeat prescription appointments are often a waste of everyone’s time … and that’s time that the GP could be spending with another person with a more serious concern”, Mr Ansell said.
Desirable reforms would include improvements in infrastructure and interoperability, “so that a pharmacist has a consultation room so people can have a private conversation in a safe space and that [the record of it] isn’t a siloed record, but interacts with My Health Record or the GP’s record”, he said.
