Pharmacy prescribing model set to spread

By Geir O'Rourke

12 Oct 2022

Pharmacy prescribing looks set to expand in another state, with the NSW Health Minister declaring restrictions need to go in response to GP shortages.

It comes amid growing concern over moves in Queensland, which now allows pharmacists to prescribe antibiotics for uncomplicated UTIs following a controversial 18-month pilot.

The sunshine state is also rolling out a “Scope of Practice” trial, with pharmacists to be allowed to diagnose and prescribe for a range of common conditions including nausea and vomiting; reflux; rhinitis; mild skin conditions and acute mild musculoskeletal pain.

 The Queensland pilot will also allow pharmacists to provide health and wellbeing services including hormonal contraception, weight management and support for quit smoking interventions.

Originally due to start in June covering the northern part of the state, the pilot is on track to start in the second half of 2023.

And in an interview last week, NSW Health Minister Brad Hazzard said he had asked his asked his department to explore a similar trial.

“There’s a very clear message from COVID that is that pharmacists have been able to step up where needed to fill gaps,” he told The Sydney Morning Herald (link here).

“There are parts of the state where it is extremely tough to get in to see a GP and there are some conditions, like UTIs, that I think lend themselves to the possibility of pharmacists having an expanded scope of practice.”

And on Friday the Pharmacy Board of Australia announced it would develop accreditation standards for independent prescribing in response to the potential changes.

The move would reverse its position statement from 2019 where it said it would not push for autonomous prescribing as medicines scheduling and legislation were outside its remit.

The recent political moves by state governments had prompted a rethink, the board said.

“If state and territory governments determine that pharmacists can make an important and safe contribution to the delivery of healthcare to the public by prescribing a wider range of medicines autonomously and if pharmacists are authorised to do so, accreditation standards for pharmacist prescribing education programs would be an important resource to ensure that pharmacists complete an accredited and approved education program and are competent to prescribe,” it said.

“The board has decided to develop accreditation standards now, for completion by December 2023, so that they can inform future development of models of autonomous prescribing by pharmacists and the education programs that pharmacists would need to complete.”

“If autonomous prescribing models and corresponding education programs emerge before the board publishes the proposed accreditation standards, the standards, once published, could be used to review any existing pharmacist prescribing education programs.”

The AMA has already come out against the idea, labelling an move to autonomous pharmacist prescribing a “dangerous quick fix”.

“The AMA is completely opposed to this with good reason. While we know pharmacists play a really important role in the health system, they are not qualified to diagnose patients,” said Federal AMA president Prof Steve Robson.

“Quite simply, this decision is flawed and puts patients at risk. It takes up to 15 years to become a qualified general practitioner. You can’t simply replace those skills with a few months of training.”

“Allowing pharmacists to diagnose and prescribe independently isn’t the answer to these [GP shortage] problems and we know from evidence from the earlier UTI trial these models of care will lead to misdiagnosis and missed diagnosis. In the long term this will only fragment care and put more pressure on our health system.”

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