Community pharmacy agreement - Government puts patients at risk

Dr Pesce said that the Government’s decision to allow pharmacists to dispense prescription medications without a prescription is a threat to patient safety by ignoring the skills and expertise of family doctors and the importance of the doctor-patient relationship.

“Current arrangements allow pharmacists to dispense emergency supplies of medications where a patient has inadvertently run out of necessary medication, so there is no reason to introduce these changes on the basis of patient safety,” Dr Pesce said.

“There has been no consultation with the AMA and the medical profession over this decision, which sends a dangerous signal to patients about access to prescription medicines,” Dr Pesce said.

“Every prescription medication requires a medical diagnosis of the patient.  This is the only way to ensure patient safety.

“So-called ‘medication continuance’ by pharmacists is not in the best interests of patient safety and quality care.

“The Pharmacy Guild acknowledges that pharmacists do not have the skills to initiate medications.  It follows that they also do not have the skills or the facilities to allow for reassessment of the patient to ensure optimum medication control.

“Pharmacists do not know the full medical history or individual management plan of patients, or if a patient has other conditions that may influence the prescription.

“Pharmacists do not have the skill set to provide holistic care for patients, and it is not their role.

“There is no evidence that shows it is safe for pharmacists to continue to dispense medications without a prescription, and without any medical review of the patient's condition. 

“In regard to the contraceptive pill, pharmacists cannot diagnose a patient to assess if there are potential problems such as blood clots, nor can they provide counselling about fertility and sexually transmitted infections.

“They do not have the knowledge base and it would be inappropriate to have such a conversation with a patient over a shop counter.  Even under the current arrangements, if emergency contraception dispensing is necessary, the pharmacist should ensure an appointment is made with the patient’s GP.

“Medication continuance is another name for pharmacist prescribing, but pharmacists do not have the training to prescribe.  Most pharmacies don’t even have adequate examination rooms for full assessment of a patient.

“By allowing pharmacists to issue scripts, the Government has introduced unacceptable compromises on standards in primary care.”

Dr Pesce said this decision casts a dark shadow over the Government’s primary care reform agenda.

“This decision sends a clear signal that the Government intends to carve up the traditional role of the local family doctor and hand pieces over to pharmacists without the certainty and security of a medical diagnosis,” Dr Pesce said.

“It is important that patients have continued access to their medication but to cut the doctor out of the equation is dangerous and irresponsible.

“There should never be a situation where a pharmacist continues a patient’s medication without a current doctor’s prescription and without contacting the doctor to ensure appropriate continuity of care.

“And there should never be a situation where a pharmacist continues a patient’s medication without a doctor’s determination of the clinical indication of the medication.

“This is a bad decision by the Government and the AMA will be protesting loud and long to the Minister and the Prime Minister.  If this is a taste of the primary care reform the Government has planned, the future of quality health care in this country is under serious threat,” Dr Pesce said.

Background:

• General medical education is a core safeguard in the provision of quality health care involving pharmaceutical agents;
• A comprehensive assessment of history, presentation, past history, co-morbidities and a general medical examination are a necessary part of adequately assessing a patient and the risks and benefits associated with prescribing a medication;
• Medical practitioners have significant experience prescribing for many years before entering community practice;
• Medical practitioners will generally work under supervision for between five and ten years before they work and prescribe unsupervised;
• Re-prescribing may require either increasing or decreasing the dose, which may require reference to pathology, which pharmacists cannot request or have the training to interpret; and
• Under State and Territory legislation, pharmacists are already allowed to dispense without a prescription in emergency circumstances in consultation with the doctor.  This arrangement does not need to be expanded.

4 May 2010

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               Geraldine Kurukchi   02 6270 5467

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