NSW to lead expansion of pharmacists’ scope of prescribing, despite pushback from AMA, RACGP and NACCHO

Pharma News: A report* commissioned by the Pharmacy Guild of Australia has suggested that 6.5 million GP consults a year would be shifted to pharmacies if state and territory governments let pharmacists diagnose and treat 13 conditions.

Under an election pledge proposed by the NSW Liberal and Nationals Government, Premier Dominic Perrottet said the pharmacy plan would allow people to book online to see a pharmacist or simply walk into their local pharmacy for free consultations relating to the repeats of the contraceptive pill and urinary tract infection (UTI) treatments during a 12 month trial period.

“This is about making it easier and quicker for people, particularly women, to access important prescription medications and treatments,” Mr Perrottet said.

“It’s harder than ever to get into a GP and that’s why these changes will make a real difference to people who need to access a range of prescriptions and treatments. It’s clear changes are needed at the federal level to help our GPs but NSW is not going to sit back and wait, instead we’re fast-tracking these important reforms to give people the care they need now.”

Last year, Canadian health care expert, Professor Ross Tsuyuki, visited Australia to share his research supporting pharmacists practising to their full scope to deliver better patient outcomes.

The Pharmacy Guild of Australia, Queensland Branch President, Chris Owen, said “Pharmacists in other Organisation for Economic Co-operation and Development (OECD) countries like Canada, the United Kingdom and parts of New Zealand are able to practice to their full scope. Evidence is showing that this is providing real and tangible patient benefits. The research shows improvements in the management of hypertension, HbA1c (diabetes),  hyperlipidaemia (high cholesterol), cardiovascular risk, uncomplicated urinary tract infections, and so on, but also cost-savings and, importantly, patient preferences.”

“Clinical trial evidence has demonstrated that the benefits of pharmacist intervention, including education, consultation and/or prescribing, can help to reduce blood pressure, achieve better patient outcomes and save the healthcare system $15.7B over thirty years (Tsuyuki et al. 2017),” said Prof Tsuyuki at the Australian Pharmacy Professional Conference and Exhibition (APP2022).

The Royal Australian College of General Practitioners (RACGP) and other health groups including the Australian Medical Association (AMA) have previously warned that experiments such as the North Queensland Pharmacy Scope of Practice Pilot are fragmenting care and leading to poorer patients health outcomes. The College expressed strong concern that other jurisdictions, including New South Wales and Victoria, are following suit and handing more prescribing powers to pharmacists without due regard for patient safety and wellbeing.

The RACGP also pointed to “extraordinary comments” made by Pharmacy Guild President, Trent Twomey, at the National Australian Pharmacy Students’ Association Congress last month where he “labelled GPs ‘twits’ and said that greater funding was not required for general practice”. Also, he described the idea that pharmacists should only prescribe medications when working in cohort with a medical practitioner as “bloody insulting”.

RACGP President Dr Nicole Higgins said “The speech is nothing short of astonishing, it should send a shiver down the spine of politicians everywhere. The language used, the brazen way he addresses very serious healthcare issues and the underlying arrogance informing this speech demonstrates that the Pharmacy Guild should be approached warily.”

The National Aboriginal Community Controlled Health organisation (NACCHO) has also pushed back on the independent scope of pharmacist practice saying it threatens to erode the quality of primary healthcare provided to Aboriginal and Torres Strait Islander people.

Pat Turner, CEO of NACCHO, said “The expanded scope proposed for pharmacists is clearly “out of scope” with current practice, as it requires changes to legislation, and a minimum of an additional year of education for pharmacists to perform activities such as prescribing.

“These trials threaten to further fragment care for priority conditions such as otitis media and hearing loss, hepatitis management, and further exacerbate the crisis in antimicrobial resistance seen in many Aboriginal and Torres Strait Islander patients. Whilst there has been years of consultations and various task forces and committees reviewing scope of practices and access to care for patients, including the recent Medicare Strengthening Taskforce, the same cannot be said of this pursuit by private pharmacy.”

NACCHO pointed to several issues with pharmacists providing extended clinical services that are illogical and discordant with national policy. Pharmacists do not have the holistic medical training required to safely diagnose and prescribe. The duration and specificity of pharmacy training is inherently incomparable to the up to 12 years of training undertaken by a GP. The separation of commercial interests and dispensing roles is a central part of Australia’s healthcare system and helps safeguard patient safety. 

Despite the continued resistance, Health Minister Brad Hazzard said many pharmacists already help women in need of emergency contraception, so extending the scope of what they can prescribe enhances their role in providing this care.

“The community pharmacist has an important role to play in providing healthcare and allowing them to do more will benefit patients and help ease the pressure on other healthcare providers, including GPs and hospitals,” Mr Hazzard said.

Minister for Women, Regional Health and Mental Health Bronnie Taylor said the trial will make a huge difference to women across the State, particularly those living in rural and regional NSW.

“The NSW Liberal and Nationals Government has heard loud and clear that the process of getting a script for your UTI or your birth control pill needs to be made simpler. We know that the GP shortages in the bush are blowing out appointment wait times to days and even weeks. This reform will ease the pressure on primary care and ensure women are able to get the help they need, when they need it,” Mrs Taylor said.

Under the NSW pharmacy plan, the government will:

• Cover the cost of the patient consultation fee for the treatment of UTI and the contraceptive pill;
• Commence the prescribing trial for the treatment of UTI on 1 April 2023; and
• Accelerate the commencement of the trial for the renewal of oral contraceptive pill prescriptions to 1 July 2023 and allow pharmacists to extend an original script issued by a GP or nurse practitioner in the past 2 years.
  

NSW Health will work with participating pharmacists who will be required to undertake additional training for these specific conditions to ensure safe prescribing practices.

The NSW Government has partnered with the University of Newcastle to design and implement the clinical trial. Data gathered from the clinical trial will be used to inform any future changes to the role of pharmacists in the healthcare system.

Since November 2022, under the NSW Government’s pharmacy reforms, pharmacists have also administered certain vaccines within the National Immunisation Program (NIP), privately funded, and COVID-19 vaccines to selected consumers .

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*The report’s public release has been blocked by EY due to copyright, according to the Pharmacy Guild of Australia