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20 Apr 2015

By Associate Professor Robyn Langham, Chair, Medical Practice Committee

AHPRA and the Chairs of the National Boards have convened a Prescribing Working Group (PWG) with the aim of developing a governance framework to support the development and review of National Boards’ regulatory policy for prescribing scheduled medicines. 

I represent the AMA on the PWG.

The AMA welcomes the establishment of the PWG.

In our view, the Intergovernmental Agreement and the Health Practitioner Regulation National Law Act 2009 have not delivered adequate safeguards for determining the competencies for prescribing rights. 

This has been demonstrated by the fact three health professions in recent years - optometry, nursing and midwifery, and pharmacy - are taking different approaches to expand their scopes of practice with respect to prescribing.

More recently, the Physiotherapy Board applied to the Australian Health Workforce Ministerial Council for approval to endorse the registration of physiotherapists for scheduled medicines under the National Law, before the Board had worked through the process of ensuring appropriate accreditation standards and programs of study for prescribing practice were available.

The approaches adopted by these Boards have not conformed with the frameworks set out in the National Prescribing Service (NPS) Competencies Required to Prescribe Medicines, which establishes the competencies that health professionals need in order to safely, appropriately and effectively prescribe, or in Health Workforce Australia’s Health Professionals Prescribing Pathway (HPPP), which provides a structure for health professional National Boards and Accreditation Councils to make their education requirements, competency standards and assessment processes nationally consistent.  

There is no high level evidence that independent non-medical prescribing is safe for patients or cost‑effective for the health system.

The current process of Ministerial sign-off on ad hoc approaches to non-medical prescribing that do not involve first establishing the education and training standards, practitioner competencies, and accredited education and training courses, is not sufficient to safeguard patient safety or the quality use of medicines.

For the work of the PWG to be effective, there needs to be a mechanism for establishing a rigorous governance framework that requires the Boards to work together to ensure consistent standards of education and training, and of practice, underpinning prescribing rights. This would provide the community with the necessary assurance that new prescribing rights are adopted safely, in accordance with the NPS and HPPP frameworks.

Importantly, the process of expanding scope of practice to prescribing scheduled medicines needs to be supported by a robust review mechanism that validates regulatory policy compliance and rationalises cost effectiveness.

The evidence base for safety and cost-effectiveness is unlikely to increase without arrangements by the professions or their Boards to evaluate and review the expanded scopes of prescribing practice they adopt.

The AMA will continue its strong advocacy for robust regulatory oversight for safe practitioner prescribing practice. 

The PWG meets quarterly by teleconference, and the next meeting is scheduled for 7 May.

Published: 20 Apr 2015