28 June 2022

PSA wants brakes on pharmacists’ ‘full scope’

Pharmacy Political

Conflicts of interest must be avoided, and greater collaboration and team care encouraged, the professional body says.

The Pharmaceutical Society of Australia has called Queensland’s UTI pharmacy pilot a “conflict-of-interest risk”, and says such risks needs to be controlled if pharmacists are to practise to their full scope.

In a white paper released yesterday, the PSA calls for greater collaboration and team-based primary care, reflecting a different emphasis from the Pharmacy Guild and other supporters of the Queensland UTI and pharmacy prescribing pilots. Critics of these pilots say they can lead to GPs being shut out of the primary care process.

The PSA says the activities of prescribing and dispensing should be separated.

“Pharmacists should continuously be empowered to practise to full scope, undertaking pivotal roles as primary health care providers and medicine experts,” the paper says. However, “the need for on-going quality measures and evaluation is not negotiable”.

The white paper proposes a range of measures and reforms.

“To achieve success, we need capacity and capability in our workforce; community pharmacists need recognition and remuneration which they deserve; and the community pharmacy practice model needs to innovate to achieve sustainability, consistency and quality.”

The PSA will push for “the separation of dispensing activities from the provision of professional services and new pharmacist prescribing initiatives”.

“This could include:

  • prescribing under protocol/structured prescribing arrangements with adequate checks and balances and auditing to ameliorate conflict-of-interest risk (e.g. continued dispensing, S3M, UTIPPQ, among others)
  • collaborative prescribing under supervision of another practitioner to build appropriate checks and balances on prescribing
  • autonomous prescribing which separates prescribing and dispensing (with limited exceptions) and extends to S2/S3/ unscheduled medicines”

Conflict of interest is not limited to prescribing and dispensing, the PSA says, but also includes recommending unnecessary care where the health professional has a vested interest in that care.

“Pharmacists have an obligation to work with other health professionals to achieve best possible evidence-based care for patients and must not recommend unnecessary care, or channel patients towards sub-optimal care and dubious practices,” the paper says.

While backers of the Queensland pilots have focused on how they can reduce GPs’ workload, they have placed less emphasis on how they work with GPs and other primary care providers. The PSA paper takes a different tack.

“Pharmacists embrace collaborative care models, increasingly working in interdisciplinary team environments to remove silos and deliver bespoke treatment plans to optimise patient health outcomes,” it says.

“The future of primary health care practice involves greater collaboration in general practice, community-controlled health centres, residential aged care facilities, and the disability sector. All medical organisations agree on the benefit of having collaborative team-based care, information transparency, shared responsibilities, and a patient-centric treatment approach.”

The paper calls for a community pharmacist minor ailments and urgent care program to be developed. This would integrate community pharmacist services into primary and urgent care, with pharmacists, pharmacy staff and GPs all given briefing information on referral pathways.

“We have seen significant shifts in the roles of community pharmacists in the last few years, and there’s no doubt they will continue to change,” says PSA national president-elect Dr Fei Sim, who led team that wrote the white paper. “It is important that we look at what is working and where we can improve.

“Community pharmacists and general practitioners together can strengthen our primary health care system, alleviating the pressure on our emergency departments and hospitals.”

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