A somewhat unlikely alliance comprising the RACGP, AMA, the Australian College of Nurse Practitioners, the Council of Presidents of Medical Colleges and a chemist group has come together to warn against the rapid expansion of pharmacist-led prescribing.
In an open letter sent to the Pharmacy Board of Australia and state and federal health ministers, the motley crew of healthcare provider organisations urged the authorities to put patient safety first.
It comes in the context of the pharmacy board’s ongoing work to develop an endorsement for scheduled medicines for pharmacists.
“This is not about professional roles or boundaries,” the letter said.
“This is about ensuring the health system works safely for everyone, especially older Australians and those with complex needs. Most health conditions are not straightforward.
“Symptoms can be unclear at first, shared across many conditions or changing over time. A correct diagnosis often cannot be made in a single visit.”
The letter acknowledged that all parties agreed on the importance of expanding access to care, with the caveat that it must be done safely.
Safe care, it said, depended on continuity, accountability, connected information and systems that detected harm early.
The letter also called on governments and regulators to ensure that safety systems were in place before roles were expanded.
Among the open letter’s co-signatories was aged care pharmacist Michael Bonner, CEO of Choice Chemist and Choice Aged Care.
“I’m a pharmacy guild member and I’m a member of all the other peaks, so I’d like to consider myself relatively agnostic,” he told The Medical Republic.
“Our focus is patient safety, and it’s also collaborative models of care, and … everything we do in Choice Aged Care and Choice Chemist is collaborative.
“[Residential medication management reviews] are collaborative. Home medication reviews are collaborative. The Aged Care Onsite Pharmacist measure is collaborative.
“We’re working with GPs, we’re working with nurses … I’m certainly happy to support positions that reframe discussions in a way that’s going to meet the needs of the patients and the care system that we’re working in.”
Mr Bonner said he was concerned about the “increasingly adversarial nature” of the debate around pharmacist prescribing, and that he felt the open letter appropriately framed the situation in terms of patient safety.
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“It was acknowledging that pharmacists can and already are doing prescribing activities,” he said.
“But the key is for that prescribing to be based in patient safety and team-based connected pathways, which we’re supportive of.”
He also pointed out that ensuring pharmacist care was connected could mean giving pharmacists access to the MBS to bill for consultations and clinical services.
“We’re the only non-medical prescriber that is unable to access the MBS for consultations and clinical services,” Mr Bonner said.
“If we’re expected to be providing team-based connected prescribing roles, or any clinical role for that matter, my position is that all of those roles need to be built within that infrastructure, including the funding framework.
“I extend that to things like medication reviews and the Aged Care Onsite Pharmacist measure, [which] I think would be better suited to MBS funding, having pharmacists being able to support and participate in case conferences and care planning activities – which we’re already doing, but we’re not actually funded to do it in the way that all other registered health professionals are permitted.”
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