Professor Stephen Duckett argues that pharmacists should be allowed to prescribe under all three models set out by the PBA
Stephen Duckett, the Grattan Institute’s program director of health, has thrown his weight behind pharmacists’ push to expand their role into prescribing of medications.
In a submission to the Pharmacy Board of Australia’s discussion paper, Professor Duckett argues that pharmacists should be allowed to prescribe under all three models set out by the PBA: autonomous prescribing, prescribing under supervision, and prescribing under a structured prescribing arrangement.
“Autonomous prescribing should be restricted to pharmacists employed in large hospitals, and prescribing under supervision should be restricted to hospitals and selected larger practices,” he writes.
Professor Duckett, a former secretary of the federal Health Department, says pharmacists’ role could be expanded to what it is in England and Scotland, and to a lesser extent The Netherlands, Canada and the US, without undermining GPs.
He says for pharmacists to share prescribing in primary care, they would have to work closely with GPs, and never initiate or change a prescription without being “subject to some form of accountability”, as they would be in a group practice setting.
Professor Duckett says pharmacists could also assist in chronic disease management, including by reviewing medication, adjusting doses or discontinuing medication, issue repeat prescriptions and identify adverse reactions.
He says hospital pharmacists might also prescribe under a doctor’s supervision.
When the PBA last month released the discussion paper and called for submissions, RACGP President Harry Nespolon told The Medical Republic pharmacists “should stick to their perfumes and probiotics and let doctors do the prescribing”.
He raised concerns about commercial conflicts of interest, incentives towards overmedication, antibiotic stewardship and lack of training.
Since most Australians could access a GP within 24 hours, it was “a solution looking for a problem”.
And AMA President Tony Bartone has previously told The Medical Republic that patients would not benefit.
“It is well known that the more that other non-medical health professionals are involved in prescribing, the higher risks of medication error and adverse reactions,” he said.
But Professor Duckett said pharmacists had specific expertise in medication and medication interactions.
“With more people with comorbidities, and hence more medication and medication interactions, increasing involvement of pharmacists in medication management and prescribing could plausibly lead to reduction in the risk of medication errors and adverse reactions, contrary to the AMA claim,” he told The Medical Republic.
He said the tight provisions of the proposal would not allow conflict of interest issues to arise.
“What I have proposed is that in primary care settings, pharmacist prescribing should be undertaken within guidelines developed jointly by the pharmacist and the GP. This should address the potential conflict of interest that pharmacists may face.”
