Pharmacy moving fast, breaking things

In a few short years, Australia has gone from having a very narrow scope of practice for pharmacists to having one of the widest in the world. What could go wrong?

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As Australia becomes a world leader in pharmacy clinical scope of practice, GPs are getting increasingly frustrated. 

Speaking at a conference earlier this month, as reported in the Australian Journal of Pharmacy, Pharmacy Guild president Professor Trent Twomey lauded the speed at which scope of practice has expanded in Australia.  

“[At] the World Pharmacy Council in Lisbon, in Portugal, when we compare[d] the clinical scope of practice – that is, the … services that you can provide all of your patients with – we’ve gone from the bottom of the pack to one of the world leaders,” he told delegates.  

State, territory and national governments are showing no signs of stepping on the brakes, either; this year’s scope of practice review is roundly expected to recommend expanded roles for all allied health professionals.  

Professor Twomey also hinted at a wide-ranging, Queensland-style pharmacist-led prescribing trial for NSW and Victoria, reportedly telling audiences that he “look[ed] forward” to commitments from both premiers.  

RACGP president Dr Nicole Higgins said the piecemeal nature of state-by-state pharmacy trials made it difficult for the health workforce in general to adapt.  

“What [the rapid expansions in scope] have meant is that there hasn’t been the time for [in-depth] evaluations or to have a nationally consistent approach around how everybody works within primary care,” she told TMR.  

“What we need to recognise is that pharmacists are trained differently. When they see patients present with symptoms, they’re trained to give them medicine.” 

In a matter of days, a trial of pharmacist-led prescribing for four skin ailments – shingles, plaque psoriasis, atopic dermatitis and impetigo – is set to begin in NSW.  

Training is an online module run by the Pharmaceutical Society of Australia. Start to finish, it’s meant to take five hours.  

Newcastle GP Dr Max Mollenkopf told TMR that while most health workers can competently follow treatment guidelines, it takes highly trained professionals to diagnose.  

“[A patient last week] came through with a rash which had been treated with steroids, and then steroid and an antifungal from two different pharmacists, but they actually had shingles,” he said.  

“And because they had delayed their presentation [by going to the pharmacy] they were now outside of the window for antivirals.” 

While it’s possible that Dr Mollenkopf’s patient saw pharmacists who hadn’t done the online skin ailment training yet – the trial itself was only announced on 27 June – it’s the principle of expanding scope in the name of access that bothers him.  

“I absolutely think there is a role for multidisciplinary care for patients and there is no question that there should be multiple types of health professionals providing different services to patients,” he said.  

“What I find problematic is when there are professionals who are not qualified in a field who are then seeking to provide further services under the guise of access.  

“A pharmacist does not have the same skills in diagnosing a rash as a GP; dermatology forms a core part of our training.”