Consultation on the proposed national pharmacist prescribing standard has opened. Let the games begin.
Pharmacist prescribing is set to become a permanent feature of the Australian healthcare system – but exactly what it looks like will be determined over the next few months.
The Pharmacy Board of Australia and AHPRA opened consultation on the proposed national prescribing standard for pharmacist prescribing on Monday.
What an endorsement can (and cannot) do
At a basic level, the endorsement will introduce a nationally consistent qualification and education standard that pharmacists would need to meet before they could prescribe.
Because no national standard currently exists, the amount of training that pharmacists have to do before they can participate in a state or territory prescribing trial is up in the air.
For instance, a pharmacist prescribing UTI medicines in one state may have undergone a vastly inferior training course to a pharmacist prescribing UTI medicines in a neighbouring jurisdiction.
Bringing in an endorsement takes the responsibility for deciding how much training each pharmacist must do to prescribe away from the states and into federal hands.
What the endorsement cannot do, however, is stop pharmacist-led prescribing; while the federal government would control training standards, states would still set the rules for the types of scheduled medicines that pharmacists can prescribe.
“It’s important to remember that this proposal is not about allowing pharmacists to prescribe or not,” Pharmacy Board of Australia chair Dr Cameron Phillips said.
“It’s about setting a nationally consistent standard to ensure that all pharmacists who are prescribing have the same level of education to do so safely.”
What’s in the endorsement?
Here’s the catch: the endorsement had to explicitly say which classes of scheduled medicines the endorsed pharmacist was qualified to prescribe.
Technically, prescribing is already considered a core role for pharmacists – but it is limited to schedule 2 and 3 medicines.
There are some situations where this extends to schedule 4 medicines.
So far, most of the state and territory pharmacist-led prescribing trials have focussed on expanding the range of schedule 4 medicines prescribed by pharmacists.
The pharmacy board consultation paper asks stakeholders to choose between two options – authorise pharmacists to prescribe all schedule 2, 3 and 4 medicines or authorise pharmacists to prescribe all schedule 2, 3, 4 and 8 medicines.
The board itself is supporting the second option, which would put medicines like oxycodone and tapentadol in the pharmacist prescriber’s remit if the state they practiced in decided to allow it.
“Some stakeholders expressed concerns that there are risks to the public, particularly in some practice settings if pharmacists prescribed Schedule 8 medicines whereas others expressed support in circumstances including hospital discharge, emergency care and continuity of access to medicines in palliative care and opioid substitution treatment,” the consultation paper read.
Mandatory use of real-time prescription monitoring systems would help address some of the concerns around patient safety, the board noted.
In response to concerns about the inherent conflict of interest in prescribers also being dispensers, the pharmacy board referred back to its code of conduct and standards of practice.
It also issued additional tips like “act in the best interests of patients when … giving or arranging treatment or care” and “[do] not allow any financial or commercial interest … to adversely affect the way in which patients are treated and inform patients when interest could be perceived to influence the care provided”.
Related
To be clear, no states or territories are currently allowing pharmacists to prescribe schedule 8 medicines.
Including them in the endorsement would only matter “should the prescribing of Schedule 8 medicines by pharmacists in particular circumstances be considered for authorisation by one or more state or territory”.
“If further changes to the scope of pharmacist prescribing were to be explored by states and territories, for example, authorisation to prescribe certain Schedule 8 medicines in particular circumstances and practice settings, safe prescribing of Schedule 8 medicines would need to be underpinned by competence to manage patient needs in presenting circumstances,” the pharmacy board said.
“Under Option B, pharmacists would be qualified to prescribe such medicines, within the parameters of authorisations set out in medicines and poisons legislation.”
What else is in the consultation?
The consultation specifically asks stakeholders – medical colleges, advocacy bodies and consumer organisations – if there are any medicines which pharmacists should not be qualified to prescribe, if the conflict of interest information needs to be changed or added and if there could be any unintended impacts for scheduled medicines.
Buried in the appendices of the consultation document is also a reference to a forthcoming pharmacist prescribing trial in aged care in an unnamed state or territory.
The public consultation is open until 15 June.
