Medical degrees: accept no substitutes

Peak bodies are having their say on pharmacy prescriber qualification standards.

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As the countdown to pharmacist-led prescribing in North Queensland steadily ticks closer, the Australian Pharmacy Council is taking its first round of submissions on accreditation standards.

Given that the first cohort of 175 community pharmacists have already begun training for the North Queensland extended scope of practice trial, it seems unlikely that standards will be developed in time to capture this particular group.

The APC is an independent body authorised by the Pharmacy Board of Australia. The board is also providing the funding for this education standard project.

For the first of what is set to be three rounds of consults, stakeholder groups – including the RACGP, AMA, ACRRM, Pharmaceutical Society of Australia and the Pharmacy Guild – were asked to respond to a 105-page APC environmental scan and literature review.

The main theme of the RACGP’s submission was concern over the conflation of diagnosing and prescribing skills.

Around 85% of a GP’s work, it argued, will rely on having a good working knowledge of at least 167 common conditions.

“It is unreasonable to expect pharmacists to take on this level of risk and it is unsafe for patients who may have alternative diagnoses missed in addition to the elevated risk of an incorrect diagnosis, or a delayed diagnosis of a significant medical or surgical condition,” the college said.

It also took aim at the “implied message” in recent pharmacy pilots that structured, protocol-based prescribing is a lower risk model.

Algorithms and checklists, which protocols tend to be based on, are generally unable to synthesise all the relevant information about a patient and the full complexity of their condition.

“Structured prescribing/protocols that are being used in decision making when supplying medicines for management of symptoms of very minor ailments (where symptoms are likely to resolve themselves over time) presents quite a different level of risk to the use of structured protocols where diagnosis of a medical condition is required,” the college said.

“Flowcharts cannot replace a decade of medical training.”

In terms of training standards, the RACGP said that pharmacists who intend to diagnose prior to prescribing should complete the same level of training as a GP.

Even pharmacists who intend to prescribe collaboratively within a team-based setting, it argued, should at minimum complete a graduate certificate level qualification and do a six-month, full-time practical placement within a general practice team.

In another section of the report, the RACGP offered some terse feedback to the APC on its March stakeholder forum, which was conducted online.

Registrations for the forum closed earlier than expected, preventing interested GPs from attending, the college said.

It also described an incident in which attendees were sorted into breakout groups for discussions. At least one RACGP staff member was not assigned to a breakout room so was unable to participate in some discussions.

The college also said it was “curious” that some facilitators were key researchers and said that independent facilitation would have removed conflicts of interest.

The AMA’s submission to the APC was much shorter than the RACGP’s, standing at just two pages.

“There is no training program for pharmacists other than a medical degree that will provide the training and experience required to autonomously prescribe,” it said.

The association criticised the fact that training standards were being developed after the proverbial horse (the North Queensland scope of practice trial) had bolted (started enrolling participants).

Because trials are commencing with unaccredited training and have “bypassed nationally agreed processes and regulatory arrangements”, the AMA said it “questioned the point” of providing input and felt there was no guarantee that standards will be applied or observed.

“The reality is that these trials, and the approach taken by state governments, will make reform discussions much harder in the future,” the AMA said.

“They have bypassed critical checks and balances in the system and done nothing more than undermine our confidence in a system that should operate for the protection of patients.”