To prescribe or not prescribe

Pharmacist prescribing is the next step forward to better patient accessibility, according to the Pharmacy Guild of Australia.

The Pharmacy Board has released discussion papers about pharmacists prescribing and asked for submissions from both sides of the debate.

One option would see pharmacists increase their training to prescribe without approval from other health professionals.

Pharmacy Guild of Australia WA president Andrew Ngeow believed allowing pharmacists to prescribe was a natural progression.

Mr Ngeow said the development would not be too different from what pharmacists were already doing with vaccinations, emergency contraception and scheduled medications.

“Pharmacists are already well placed geographically,” he said.

“We are already trusted and are already seeing the people so it seems like a logical movement.”

Mr Ngeow estimated around 1.3 million Australians have delayed accessing health services based on cost and availability with many unable to see a doctor to get the medications they needed.

Mr Ngeow said allowing pharmacists to prescribe would increase accessibility, decrease wait times, decrease costs to the government as well as the patient.

The Pharmacy Guild understood pharmacists would need additional training and governance for the development to work but the details have yet to be determined.

Former Australian Medical Association WA president Richard Choong said the years of education and experience doctors had in diagnosis needed to be considered.

Dr Choong said the development would be a whole new territory for pharmacists and would put a greater burden onto their already stretched time.

“You can’t learn about everything in a year,” he said.

“Doctors’ experience and training programs can amount up to around twelve years and that just puts you at a junior level.”

Dr Choong is also the current chair of the WA Primary Health Alliance and said he would rather have all the health professionals working in their area but much closer together.   

Dr Choong warned role substituting doctors was dangerous and it would be better to further a well-established relationship between doctors and pharmacists by incorporating pharmacists into general practice.

“Everyone knows their role but we want to see better integration for improved patient outcome,” Dr Choong said.

A spokesperson for the Consumer Health Forum of Australia said they were cautious but accepted pharmacist prescribing as a possible way to reform health care.

They said the potential regime needed to be closely evaluated with an emphasis on emerging safety issues and patient experience and outcomes.

“Consumers have made it clear that they want more collaboration between pharmacists and treating doctors and see their services as complementary rather than substitutes for each other,” the CHF spokesperson said.

“We need to make sure we do not compromise safety and quality for convenience.”

Currently in Australia doctors, dentists and selected nurse practitioners have prescribing rights.

However, Dr Choong said nurse practitioners’ impact was very small as only a handful could prescribe, and they often worked only in niche areas.

Trials had been rolled out in Queensland allowing pharmacists to prescribe antibiotics for UTI infections and a supply of the contraceptive pill.

Mr Ngeow said while Western Australia was still lagging behind the trials were a big step forward.

Overseas in the UK and Canada pharmacists are also allowed scope to prescribe.

Mr Ngeow said Australia could learn from overseas successes, but he was always hesitant to simply replicate models.

“Whilst there’s going to be similarities there is going to be differences,” Mr Ngeow said.

“I think overall the principle still applies.”

Mr Ngeow said pharmacists would refer to doctors when they could not handle a situation, much like doctors would to specialists.

He also said patients would still have a choice on who to visit for prescriptions.

“It comes down to the patient choice and providing the best health system to ensure that people live well,” Mr Ngeow said.