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09 Sep 2019

BY AMA PRESIDENT DR TONY BARTONE

We are in the middle of a well and truly long overdue public debate about scope of practice issues between GPs and pharmacists. The AMA and the Pharmacy Guild of Australia are the key protagonists.

This debate comes months away from the finalisation of the 7th Community Pharmacy Agreement (CPA), which involves billions of dollars for the pharmacy sector over the five years of the CPA.

The Guild is lobbying for pharmacists to take over more GP roles, while confronting their own battles from competitive forces within their own profession. The AMA is following the evidence and is lobbying against these moves. Meanwhile, the AMA and others are pushing the Government to change pharmacy ownership and location rules.

The pharmacy sector is significantly over-regulated. Only pharmacists can own pharmacies. There is no sensible reason for this. It is anti-competitive and results in patients and the community paying the price. But pharmacists can own medical practices, and some do. And now the Guild wants pharmacists to be doctors – but without the countless years of training and the experience in holistic medicine and patient care.

Our evidence of outcomes speaks for itself. The Guild’s are putting at risk those long achieved outcomes, measures which sees Australia lead the world ahead of places like the UK and Canada, the very places that are used as crucibles of evidence to justify the ill-conceived attempts to offer the Australian public an inferior solution under the Guild’s false promise of access and convenience.

Enough! The issues we are discussing here relate to more than just numbers or measures. It’s about the outcomes to patients. My patients. Your patients. The very patients we have continued to look after and provide the very best of care for.

The AMA is promoting a model of pharmacists working in general practice. This model offers convenience and safety for patients, and is backed by the Pharmaceutical Society of Australia (PSA), which represents individual working pharmacists, not the pharmacy owners.

Throughout this debate, the Guild, like a chameleon, changes colours according to who they are engaging with – governments, doctors, the media, and the public. But they try not to show their true colours. We will always seek to dispel the propaganda and provide the facts and the evidence about quality primary health care.

The facts and the evidence are clear – GPs are experts in quality primary health care. Their leadership of a multi-disciplinary care team of allied health practitioners in a patient-centred approach is evidence-based and results in the best outcomes for patients. This is what patients want. It is what our health system needs.

It is all about everyone working within their true scope of practice, and their training and their background in terms of that scope of practice.

Pharmacists and GPs work well together at the local community level to the benefit of patients. The key to that productive partnership is sticking to the roles for which they have trained.

If we look at the average GP, they have been trained for at least 10 years on current rates of training schedules, and that could even be longer with post-graduate and other additional work, which could be up to 14 to 15 years. How can The Guild claim that five years of pharmacy training is sufficient training to justify clinical prescribing as being within their scope?

And that clinical training, that clinical background, that direct patient contact in real life and death settings – founded on proper history taking, examination, diagnosis and formulating a management plan, as well as the grounding in all the health sciences that underpin their training – brings great benefit to patients and the health system. It is quality care and advice for all stages of life.

GPs provide continuity of holistic care. Nobody else can do that.

It is astounding that we still have to explain this reality to politicians, bureaucrats, and the media. But we do it. We must do it. We will do it. For the sake of our patients.

The growing tensions around scope of practice have called for strong action from the AMA. That is why we have formed the General Practice Pharmacy Working Group.

This Group will drive policy, strategy, and advocacy on pharmacy and dispensing, and provide the Government with strategic AMA general practice input to the 7th CPA.

It will work on developing new blueprints for dispensing, including doctor ownership of pharmacies, which would allow doctors and/or pharmacists to dispense from general practice.

The two priority issues are the pharmacy ownership rules and the pharmacy location rules.

The AMA has long called for the Commonwealth pharmacy regulations to be amended to enable pharmacies and medical practices to be co-located.

We support high-quality primary health care services that are convenient to patients, enhance patient access, and improve collaboration between health care professionals.

Co-location of medical and pharmacy services would clearly facilitate this.

Incorporating pharmacy services into general practice, including under the ownership of a medical practitioner, would improve patient care by allowing GPs to lead a team of co-located health professionals in providing multidisciplinary health care to patients at the local community level.

Many general practices already provide co-located services with pathology collection centres, and in-house psychologists, physiotherapists, dieticians, and podiatrists.

Adding pharmacy to the mix would have benefits for patients, pharmacists, and GPs.

This is world’s best practice. It’s available to our hospital-based in-patients right now. Why should community patients miss out on this opportunity?

The scope of practice debate has more chapters to come. So does the pharmacy ownership debate. And the whole CPA.


Published: 09 Sep 2019