Dr Bartone - ABC Radio Melbourne - Pharmacist scope of practice

16 Aug 2019

Transcript:   AMA President, Dr Tony Bartone, ABC Radio Melbourne, Breakfast with Jacinta Parsons and Sami Shah, Friday, 16 August 2019

Subject:   Pharmacist Scope of Practice

SAMI SHAH:            Here's an interesting thing. Pharmacies are now considering, or at least they want the Prime Minister and the Government to consider overall, changing the system to allow us to go to a pharmacy in Melbourne and get a travel vaccination, or maybe a prescription for contraceptive pills, directly from the pharmacist. Or what if you can even get treatment for complaints like urinary tract infections? And once you get all of those, being able to claim a rebate on them. That's always been the purview of a GP but, what if that was transferred to the pharmacist?

Tony Bartone is the President of the AMA, the Australian Medical Association. He's not so hot on this idea. Good morning, Tony.

TONY BARTONE:  Good morning, Sami.

SAMI SHAH:            What's wrong with pharmacists being able to do just to a little bit of medicine work?

TONY BARTONE:  Well, it's about everyone working within their true scope of practice, and their training and their background in terms of that scope of practice. So, if we look at it as an average GP, they have been trained for at least 10 years on current rates of training schedules, and they could even be longer in some occasions, be it with post-graduate and other additional work. And that clinical training, that clinical background, that patient contact, and grounding in all those health sciences that underpins their training, brings all that information and experience in terms of not just prescribing or not just giving an injection, it's about taking a history, it's about diagnosing, it's about ruling out any other intercurrent problems, and formulating a management plan.

JACINTA PARSONS:         Surely though, Tony, we've heard so much that the GPs are under pressure, there are so much that they are required to do these days, we saw the great success of the flu vaccine being administered by chemists. Things like travel vaccines surely don't need to be seeing a GP to get those.

TONY BARTONE:  So, travel vaccination is a very complex field. It varies even in terms of the country that you’re attending, in terms of past vaccinations, other medications, other conditions that you’ve got, age of the children and other people travelling with you. It's such a complex area. It's not just, you know, roll up your sleeve and have a jab.

So it's extremely- the whole premise around this is that we're trying to sort of make the delivery of medicine, delivery of clinical care very piecemeal, have a little bit, you know, stick a little bit in here and do a little bit there and put all of these little pieces together and hope that we come up with a continuous, non-fragmented clinical care with quality outcomes.

And that's the problem. You need to have teams working together in a collaborative model where everyone works their true scope of practice. Now, obviously, pharmacists are excellent at medication management. That's their training, that's their grounding, that's their background. And working with the clinician, they can then ensure that patient outcomes are maximised in terms of that interaction and that interplay in terms of medication management.

But we have a considerably detailed policy in terms of how we like to have working models with pharmacists in our practices to aid quality outcomes of our patients. So, it's about, you know, ensuring that we've got the right model for the right time and the right place. And the furphy of trying to solve the problem of access - this is not how you try and solve a problem, by creating a duplication and a fragmentation of …

SAMI SHAH:            [Talk over] Of the system.

TONY BARTONE:  … of health resources.

SAMI SHAH:            We're speaking with Dr Tony Bartone, President of the AMA, 1-300-222-774. Would you like to able to get vaccinated at the chemist? Do you think it would help to relieve some of the pressures on the medical system? Dr Bartone does not think so.

Tony, this has been done in New Zealand and Canada before. It's not an entirely novel idea in terms of never having been tried before and, according to some of the details we've gotten from there, it's actually helped achieve immunisation rates and decrease death tolls in those countries. The Grattan Institute's health economist Stephen Duckett agrees with it. At this point, what is your major concern?

TONY BARTONE:  Sami, I'll try to be very, very clear about this. It's not just the administration of the vaccination, it's management of the condition around the vaccination, around the actual opportunity that you have with a patient. So, the opportunity for further preventative or primary care intervention, looking at other issues which may be prevalent at the time. It's not just the episodic attendance for that vaccination …

JACINTA PARSONS:         [Interrupts] Do you think though that the centralisation now of our medical records which you were talking about the fragmentation, isn't that going to answer some of those issues? We're going to have our information in one spot so when we go and see a chemist to get something to happen, if that needs to be followed up on, that information's there.

TONY BARTONE:  The centralisation of medical records that you referred to is, one, a long way off still in terms of utility and, two, is never going to be a replacement for the clinical desktop file that is up currently on your GP's consulting room. That will be more complete, more detailed and more extensive than anything that you will find in the cloud.

JACINTA PARSONS:         Very interesting to get your perspective this morning. Dr Tony Bartone, President of the AMA, very clearly saying that they certainly do not want pharmacists to be taking over some very core and important business that GPs are currently doing; things like immunisations or even the travel vaccinations.

SAMI SHAH:            That's right. 1-300-222-774. Do you agree with Dr Tony Bartone? Do you think it should remain centralised with the general practitioners? Or have you gotten a vaccination from a pharmacist and found the experience to be fairly trouble free?

16 August 2019

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