Safety over convenience
BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE
The Queensland Government has agreed to run pharmacy prescribing trials following its pharmacy inquiry. This potentially undermines patient safety and quality prescribing. It also flies in the face of the framework agreed to by the Australian Health Practitioners Regulation Agency (AHPRA) and the Coalition of Australian Governments (COAG) to ensure a nationally consistent and transparent process for non-medical health practitioners to prescribe or expand their prescribing. Not only is there a risk of facilitating disparate prescribing rights and education standards from one State to the next, prescribing and dispensing should be kept separate to help ensure patient safety.
Pharmacists provide an important and independent set of eyes when dispensing prescribed medications. A fundamental part of their role in dispensing medications is to assess the prescribed dosage is safe and appropriate, check for allergies, contra-indications or drug interactions. They are an important safety mechanism to ensure that patients do not receive an inappropriate medication or dosage, and that patients understand how to safely and effectively use the medication. Cloud that view and patient safety will undoubtedly be compromised, and compromised for a false premise, that of enhanced access to care. Quality of care will have been sacrificed to meet a constructed convenience.
The Pharmacy Guild wilfully promotes the idea that accessing general practice is difficult or costly. Yet, the data on patient experiences published by the Australian Bureau of Statistics, disputes this. Of those who saw a GP for urgent medical care, two thirds were seen by a GP that day and within four hours. Less than two in ten reported waiting longer than ‘they felt’ acceptable for an appointment. Only four per cent of patients who saw a GP in the last 12 months delayed or did not see a GP due to cost.
For the AMA, it is indefensible that the patient protections currently in place are trying to be circumvented by those with a pecuniary interest in both prescribing and dispensing. Given that pharmacies receive a dispensing fee from Government for each PBS medication they dispense, it is easy to see they would have a conflict of interest if pharmacist staff could also prescribe such medications.
Safe, high quality patient care depends on multidisciplinary teams of health practitioners, led by a medical practitioner, working together within their scopes of practice. Four years of training in pharmacy can not be compared to the 10-14 years of training undertaken by a GP. Training that delivers the required competencies to autonomously prescribe as described in the Health Professional Prescribing Pathway.
What the AMA wants to see is non-dispensing pharmacists integrated within general practice and working collaboratively with GPs and patients to enhance patient medication adherence, improve medication management and provide education about medication safety. Working within a medically-led and delegated team environment, where collaborative arrangements are formally documented and core competencies for safe prescribing are achieved and maintained, provides the best opportunity for pharmacists to fully utilise their training and expertise, within their scope of practice and without fragmenting care.
Pharmacists have a role in supporting quality care. The AMA does not dispute this. But it is in conjunction with GPs and other medical practitioners within appropriate prescribing and therapeutic protocols. What the AMA does dispute is that pharmacists be enabled to independently and autonomously prescribe S4 and S8 medicines. In addition, the AMA will strongly oppose any model of prescribing by pharmacists where the pharmacist is connected to a retail pharmacy.
Published: 15 Aug 2019