Concerns about training are at the heart of GPs’ opposition to expanding pharmacists’ scope of practice.
The Pharmacy Board of Australia has announced forthcoming accreditation standards for pharmacist prescribing education programs by the end of 2023.
Yesterday’s announcement comes as pharmacy groups push for the Queensland UTI prescribing program – now a permanent fixture in the state – to be expanded into other parts of Australia.
The standards, to be developed by the Australian Pharmacy Council at the board’s request, would qualify and equip pharmacists to prescribe autonomously “in accordance with any emerging authorisations set out in state and territory medicines legislation”, the board said.
“Autonomous prescribing” refers to prescribing other than that done via a structured prescribing arrangement or under supervision (such as under a collaborative arrangement between the pharmacist and the patient’s GP).
Following an 18-month program trial, community pharmacists in Queensland can now prescribe a course of antibiotics to women under 60 years of age who present with the symptoms of an uncomplicated UTI.
According to The Sydney Morning Herald, NSW Health Minister Brad Hazzard has asked the state health department to consider running its own trial.
However, AMA Queensland vice-president Dr Nick Yim told TMR earlier this week that his team would be working closely with their counterparts at AMA NSW if a new trial were to go ahead.
The pharmacy board’s announcement clearly anticipates this kind of expansion.
“If state and territory governments determine that [authorised] pharmacists can make an important and safe contribution to the delivery of healthcare to the public by prescribing a wider range of medicines autonomously, accreditation standards for pharmacist prescribing education programs would be an important resource to ensure that pharmacists complete an accredited and approved education program and are competent to prescribe,” the board said.
It said it would monitor developments in proposals for pharmacist prescribing and would “continue to provide advice in the public interest”.
The board has asked the Australian Pharmacy Council, the accreditation authority for pharmacists, to put together the standards. The development process will include wide-ranging consultation, including with the public, pharmacists, governments and other healthcare professions.
The board aims to have the accreditation standards completed by December 2023. This would allow them to inform the future development of models of autonomous prescribing and the education programs that pharmacists would need to complete.
Standards could also be used to review any prescribing models and corresponding education programs that emerge before the end of next year.
Pharmacy Guild national president Professor Trent Twomey welcomed the announcement, saying the decision would help improve patient access to medicines.
“Autonomous pharmacist prescribing will improve access to treatment options for patients with conditions that can be managed by a pharmacist,” Professor Twomey said.
“The autonomous prescribing model is necessary if pharmacist prescribing is to contribute to the delivery of sustainable, responsive and affordable access to medicines for patients.”
However, the AMA’s Dr Yim, a former pharmacist himself, said the Guild kept “changing the goalposts” in terms of pharmacists’ scope of practice.
“It’s all well and good doing an online course, but an online course is totally different to supervised practice in this realm,” he said.
Writing in MJA Insight this week about pharmacist prescribing and “top of scope” practice in primary care, Associate Professor Louise Stone warned of the danger of “unconscious incompetence”. She said any move to effectively extend any practitioners’ scope should entail, among other things, monitoring outcomes (not just “satisfaction”), while measuring cost and ensuring benefit.
