Federal Health Minister urged to step in as concerns mount over pharmacist prescribing

Pharma News: Momentum has been building as State and Territory governments have responded to the expanded scope of practice and prescribing for community pharmacists.

In addressing pharmacists at Australian Pharmacy Professional conference (APP) 2023, the Pharmacy Guild President, Professor Trent Twomey, said “It is no secret that the health system is stretched to breaking point. Patients can’t get into to see their GPs in a timely manner. GPs are refusing to bulk bill, while GPs are deserting regional, rural and remote areas in droves. It doesn’t take a genius to see just how we as community pharmacists can help ease pressure on the system.

“With the North Queensland Pilot underway, with UTI and Oral Contraceptive Pilots under development in NSW and VIC set to go live soon, together with the North Queensland Pilot mirrored statewide in NSW, a review of scope in Tassie and a recent parliamentary committee inquiry into a UTI pilot in South Australia – the momentum is undeniable.”

Ongoing opposition by the Australian Medical Association (AMA) has led to the organisation’s engagement with the Minister for Health and Aged Care, Mark Butler, on this matter. A letter from the AMA President, Professor Steve Robson, highlighting significant concerns with the proposed pharmacy prescribing trials has received a response from Minister Butler.

While the Minister’s response noted that he has minimal influence in state policies, he has promised he will give consideration to raising some of the AMA’s concerns with the health ministers. The Minister also confirmed that medicines prescribed by pharmacists are not eligible for PBS subsidy and patients will not receive an MBS rebate.

The AMA letter specifically sought the Minister’s views on how these trials had undermined the Therapeutic Goods Administration (TGA) and the Poisons Standard in particular. The trials announced in many states will allow pharmacists to prescribe Schedule 4 medicines, such as the oral contraceptive pill which was only reaffirmed as a Schedule 4 medicine in 2021.

During his speech at APP 2023, Professor Twomey also referred to pharmacy interns being able to apply the expanded scope of practice.

He said “Interns are now able to study under the North Queensland Scope of Practice Pilot in cohort 2. This means by March 2024, interns working in the Pilot area will also be able to assist patients with prescribing for everyday health conditions and the chronic disease states covered within the Pilot.”

Royal Australian College of General Practitioners (RACGP) President, Dr Nicole Higgins said this information should send a shiver down the spine of the Queensland politicians.

“Many patients would be very worried that a pharmacy intern thinks that they can do the same job as a GP. It’s bad enough that this pilot will see pharmacists diagnosing, treating, and prescribing for a host of complex medical conditions outside of a healthcare team completely unsupervised and out of their depth. Now we learn that newly registered pharmacists will be rolling up their sleeves and taking part in this pilot,” she stated.

Queensland-based GP, Dr Liesel Whyte, described this move as “seriously concerning”.

She said on social media “This ‘trial’ is actually trialling how close one can get to the sun without getting burnt. We talk about ‘number needed to treat’ for positive outcomes. I wonder what the ‘number needed to harm/burn’ will be in this situation.”

The AMA letter to Minister Butler also noted that these pharmacy trials will make reform discussions much harder in the future as they have “bypassed critical checks and balances in the system that are intended to protect patients”. This includes the formal position of the Pharmacy Board of Australia, which is that autonomous prescribing is outside of the scope of pharmacists, and the Health Professionals Prescribing Pathway Project Final Report.

The AMA has confirmed that it will continue to engage with Minister Butler on these issues.

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