Largest medical indemnity insurer warns pharmacist prescribing crosses safety line

Australia’s largest medical indemnity insurer, Avant Mutual, has escalated its warnings over proposals to significantly expand pharmacist prescribing into increasingly complex clinical domains, including cardiovascular disease, arguing the reforms have now crossed a critical safety threshold.

Referencing the Pharmacy Guild’s Rewriting the Script report, Avant has raised alarm about a potential rise in patient harm driven by misdiagnosis or inappropriate prescribing, at the same time as the Pharmacy Board moves toward endorsing pharmacists’ registration to prescribe all medications, including high-risk Schedule 4 and Schedule 8 “drugs of addiction” medication, after just ten additional hours of professional training.

Avant Chief Medical Officer, Professor Steve Robson, said improving access to healthcare is an important objective, but policymakers should understand that prescribing is already a significant driver of medical negligence claims and regulatory notifications, even among highly trained and experienced doctors.

“Avant would not normally enter these public debates with pharmacists, but we’ve reached the point where medical indemnity insurers need to highlight the very real risk of patient harm,” Professor Steve Robson said.

An analysis of Avant’s medical indemnity claims found medication related issues were involved in one in six matters resulting in regulatory action or patient compensation, making them one of the leading drivers of medical negligence claims and one of the higher risk activities in healthcare.

“Prescribing sits at the intersection of diagnosis, clinical judgement and treatment decisions, and when it goes wrong the consequences for patients can be tragic,” Professor Robson added. “Policymakers need to pause before assuming prescribing responsibilities can continue to expand into increasingly complex areas based primarily on projected efficiency gains or theoretical cost savings, rather than patient safety. Affordability should not come at the cost of quality, good patient care and ultimately lives.”

Dr Mark Woodrow, a senior emergency physician and General Manager Medical Advisory Services at Avant, said “Improving access should never be at the expense of quality and safety systems that have been developed over years for the benefit of patients. We should never underestimate the complexity of prescribing or the importance of getting the diagnosis right.”

As an emergency clinician, he regularly sees patients whose presentation is the result of inappropriate prescribing or missed diagnosis rather than the condition that was initially suspected.

“I’ve seen patients arrive at emergency departments after blood pressure medications have worsened their kidney disease or heart failure,” Dr Mark Woodrow explained. “I’ve also seen patients treated for what appeared to be a urinary tract infection who were in fact suffering an alternative diagnosis requiring urgent emergency care. Those examples aren’t an argument against pharmacists. They’re a reminder that prescribing can never be separated from diagnosis and clinical judgement.”

Professor Robson said the debate had now moved beyond whether pharmacists had a prescribing role to where the boundaries should be drawn.

“Every expansion of prescribing authority should be accompanied by an equally rigorous assessment of the risks that expansion creates,” he said. “The question isn’t who can prescribe. The question is what level of diagnostic capability, clinical training and ongoing oversight is required to prescribe safely. From our perspective as an insurer, the greater the complexity, uncertainty and potential consequences of error, the higher the threshold should be for expanding prescribing.”

Avant, which insures over 95,000 healthcare practitioners and medical students, is calling for nationally consistent prescribing framework is overdue, developed by doctors, pharmacists, regulators, patient representatives and governments, with input from indemnity insurers to establish clear, evidence-based principles for prescribing.

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