Queensland's proposed prescribing changes pander to vested interests and would duplicate and fragment care, doctors say
GPs say vested interests are behind a Queensland parliamentary committee’s recommendations to allow pharmacists to provide “low-risk” emergency care, vaccinations and repeat prescriptions.
RACGP President Dr Harry Nespolon said he was “completely shocked” by the committee’s findings, saying they would put patients at risk and irreversibly damage the health system.
The committee said the state’s Department of Health should develop options for pharmacies to provide low-risk emergency and repeat prescriptions, such as for the contraceptive pill, and low-risk vaccinations including travel vaccinations, under a framework to minimise risk.
The framework could include: consultation with a GP utilising the 13HEALTH advisory service; limits on the number of times a prescription may be issued within a set period; on-site testing; and a requirement that the pharmacist consult a 13HEALTH GP or have regard to the patient’s medical record via a MyHealthRecord.
“Any change in pharmacists’ scope of practice should be underpinned by appropriate credentialing and training for the services to be delivered,” the committee said.
Dr Nespolon said the move was driven by the commercial interests of pharmacy owners and would impinge on GP care for patients and their ability to monitor medications.
“At the end of the day, this announcement comes as a result of extreme lobbying by the Pharmacy Guild. Sadly, the recommendations clearly incentivise business needs over patient care, a compromise we simply can’t afford to make,” he said.
“Pharmacies as both dispensers and prescribers represents a clear conflict of interest, especially within a commercial sales-driven environment.”
Dr Bruce Willett, Chair of RACGP Queensland, said the proposed changes would only duplicate and fragment care and waste health resources.
“This is the wrong solution to the problem,” Dr Willett said.
“If there are perceived access or patient convenience issues, this can be addressed through new and innovative models within the existing system. De-railing what has worked for decades will not achieve the intended outcome.”
The RACGP, AMA, ACRRM and other medical colleges had warned the committee of direct risks to patients posed by the proposal, he said.
AMA President Dr Tony Bartone said patients would be the big losers if the prescribing recommendations were carried out.
“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,” the Melbourne GP said.
The outcome was at odd with the move to introduce the medical-home concept in Australia, with GPs coordinating care with full access to a patient’s medical history.
“GPs currently work closely with their pharmacist colleagues on a daily basis, and respect the unique skills they bring to the care of patients, particularly with respect to the quality use of medicines,” Dr Bartone said.
The report ignored the well-understood need to strengthen coordination of care and opened up a serious conflict of interest for pharmacists, who would gain from prescribing medications and then dispensing them, he said.
The recommendations come as the Pharmaceutical Society of Australia is preparing to host talks by a UK expert as part of its campaign to secure an expanded scope of practice for pharmacists by 2020.
PSA President Dr Shane Jackson said Australia was “missing out” because its pharmacists did not have Schedule 4 prescribing rights, while pharmacist prescribing was an established part of practice in the UK.
“It make no sense that dentists, nurse practitioners, midwives, podiatrists and optometrists can prescribe, while pharmacists, the medication specialists, cannot,” Dr Jackson said.
Ravi Sharma, the National Clinical Lead for Clinical Pharmacy and Genomics at NHS England, will speak at PSA events in Melbourne and Sydney on October 22 and 25, respectively.
“PSA is leading the agenda in Australia to ensure pharmacist prescribing becomes a reality by 2020, and we are excited to help share Ravi’s experiences with this model in the UK,” Dr Jackson said.
