26 April 2022

PSR Director steps down, slams Qld pharma pilot

KnowCents Pharmacy PSR

Lack of access to the PBS not only means patients pay more, but keeps pharmacists beyond the watchdog’s reach.

The Director of the Professional Services is stepping down in July to return to academia – and has lashed the North Queensland Pharmacy Scope of Practice Trial on her way out for its lack of external oversight and potential for patient harm.

After more than five years as head of the watchdog, Professor Julie Quinlivan will take up the post of Dean of Medicine, Biological Sciences, Pharmacy, and Radiation Sciences at Curtin University in Western Australia, according to the PSR’s latest quarterly update.

Her replacement will be chosen by whoever wins the 21 May federal election as the government is now in caretaker mode.

In the update, the PSR joins the AMA, two GP colleges and National Council of Primary Care Doctors and multiple petitioners in condemning the pharmacy prescribing trial, saying it puts patients in harm’s way and cannot be policed.

The update says Professor Quinlivan raised concerns with the Department of Health in February, saying the “proposed pathway for pharmacy prescribing appears to have no external independent regulatory or compliance oversight that allows external evaluation of inappropriate practice in relation to prescribing”.

“The trial is also inconsistent with Commonwealth legislation that identifies the clinicians that may prescribe medications, and this does not include pharmacists. These are two significant concerns.”

The Department of Health told The Medical Republic in March that the trial was “not consistent with Commonwealth medicines policy”, but this is the most extensive criticism of the trial by a Commonwealth agency yet.

It says the PSR can be called on to review conduct of prescribers under the Pharmaceutical Benefits Scheme and their employers, and goes on to list the many failings for which prescribers under the PBS have been pinged in the past; these include:

  • Failing to adequately examine, or record the examination of, the patient in respect of the presenting complaint
  • Failing to take, or record, an adequate history relevant to the presenting complaint or the medication being prescribed
  • Failing to make, or record, an appropriate diagnosis or differential diagnoses
  • Failing to advise, or adequately advise, the patient of relevant alternative treatment modalities, or make a record of that advice
  • Failing to ask about, or record, the medication or other products or substances the patient is currently taking that might interact with the prescribed medication
  • Failing to advise the usual treating general practitioner of the prescription (if the person under review is not the usual treating general practitioner)
  • Failing to take adequate steps, or detail a plan, to limit or reduce the patient’s dependence on addictive medication

But the key words are “under the PBS”.

Pharmacists are not on the Commonwealth’s list of clinicians eligible to prescribe under the PBS – namely doctors, dentists, optometrists, midwives and nurse practitioners. But that doesn’t make it illegal for them to prescribe, as authority to prescribe rests with the states and territories.

This means not only will patients have to pay full price under the pilot, but the pharmacists will be beyond the reach of the PSR.

The DoH told TMR: “The Professional Services Review performs functions under Commonwealth legislation, associated with prescriptions written under the Pharmaceutical Benefits Scheme, and services rendered or requested under the Medicare Benefits Schedule or the Child Dental Benefits Scheme. It does not have responsibilities or ‘jurisdiction’ for other Australian Government programs, or state and territory programs.

“Any questions relating to the North Queensland trial, including compliance arrangements, should be directed to Queensland Health.”

Professor Quinlivan told newsGP that PBS prescribers were subject to surveillance, but this was lacking in the North Queensland trial: “All PBS prescriptions are recorded and prescribing patterns of concern can be identified and evaluated after review of medical records,” she said. “This external regulatory oversight is missing in the pharmacy trial.”

And she said the trial effectively ignored the role of the TGA in determining which medicines were over the counter and which were restricted to prescription-only, such as the contraceptive pill.

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4 Comments on "PSR Director steps down, slams Qld pharma pilot"

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23 days 13 hours ago
Whilst for many reasons above I don’t support pharmacists prescribing I don’t agree totally with the pbs reasoning. If patients don’t have health care cards there is usually no price difference- esp for antibiotics but also many other medications. PBS places unnecessary restrictions on prescribing. Many patients would rather get 6 months of their statin or bp meds at once rather than go to pharmacy once a month. If we know the patient and their medical conditions well this is reasonable. For many compliance will be better if they can do that. A bit less Big Brother monitoring is not… Read more »
memgoss Goss
memgoss Goss
26 days 20 hours ago

The question is: when is the Queensland health minister going to step down over this? – she has steadfastly supported this debacle form the outset.

27 days 19 hours ago
I think a lot of doctors don’t quite grasp the difference (or lack thereof) in costs between private and PBS scripts. This article states patients have to “pay full price under the pilot”, but for most people without healthcare cards / pension cards, this is actually the same price as a PBS script. Majority of medications prescribed by GPs are no different in pricing – antibiotics, antidepressants, PPI, metformin, etc. In fact, one is more restricted due to prescribing under the PBS compared to private. With Keppra, are you sure the patient has tried a different anti epileptic before? A… Read more »
Peter Bradley
Peter Bradley
27 days 19 hours ago

Fair comment Jimmy, but the price of meds is not really the crucial concern of the PSR, (and for once they are in lock-step with the rest of us medicos), re this pilot. It is the total lack of proper oversight and analysis of the scheme and how inappropriate it is in the context of what is considered safe medical care.