New principles for pharmacists to deliver safer and high quality pharmacy services

Open Letter to Royal Australian College of General Practitioners

18 April 2019

 

I am writing to object to the egregious assertions made in the RACGP’s submission to the Pharmacy Board of Australia – ‘Pharmacist Prescribing’ and the public statements that your President, Dr Harry Nespolon, has made against pharmacists, our role in healthcare, and the future role of pharmacists with regard to Collaborative Prescribing.

 

The RACGP submission to the Pharmacy Board of Australia makes several unfounded and prejudiced statements in relation to pharmacists being able to prescribe.

 

Statements such as the “the provision of medical services by health professionals lacking the necessary medical training or registration is an inappropriate and unsustainable solution to address the health needs of Australians and that pharmacists simple do not have the healthcare training required to safely deliver healthcare services” are inflammatory, disrespectful and ignore the five years of university and clinical training undertaken by pharmacists, in addition to ongoing regulated continuing professional development similar to other health professionals.

 

Indeed, pharmacists have the greatest level of clinical training regarding medicines compared to any other health professional. Indisputably, pharmacists are the medicines experts.

 

The ageing population, increasing incidence of chronic disease, advances in medicines and health technologies, rising health care costs, evolving health service delivery models, and a need for a responsive health workforce are all factors which have contributed to health practitioners, other than medical practitioners, to be authorised to prescribe within their scope of practice. The RACGP should be well aware that Australia’s healthcare system rates poorly on access and equity, an issue Australian pharmacists are all too familiar with, given the rising out of pockets costs that are prevalent in accessing general practice and general practitioners.

 

These factors, in addition to the alarming incidence of medication-related harm, the availability and access to pharmacist care and our medicines’ expertise all add to the need for pharmacists to be able to do more in our health system, including prescribing, just as dentists, midwives, nurse practitioners, optometrists and podiatrists are able to in Australia.

 

We must recognise and acknowledge that pharmacists already prescribe medicines. As much as the RACGP might like to rewrite history, and to dismiss the vital role that pharmacists in the community play, consumers and pharmacists know that the care that they deliver benefits patients and our healthcare system. Pharmacists already make clinical assessment and diagnoses within their scope of practice and prescribe lower-risk medicines. The Pharmacist Only Medicines schedule, which allows a pharmacist to assess the clinical needs of the patient, make an assessment, communicate and discuss that assessment with the patient and allows them (based on the risk of the medicine) to supply that medicine as well. In this context based on the risk profile of the medicine, pharmacists do both – prescribe and dispense. This vital primary care function of triage and referral, may result in the pharmacist referring the patient to a General Practitioner for additional assessment, without the provision of a medication and with no out of pocket expense to the patient.

 

The PSA has been very clear about the separation of prescribing and dispensing functions according to the risk profile of the medicine. In addition, we believe that where the independent decision is made to initiate a schedule four or eight medicine, that this should be separated from the dispensing activity. Within a collaborative prescribing agreement between a pharmacist and a general practitioner that the pharmacist, pharmacists should be able to adjust the doses of prescribed medicines to reach treatment targets, to extend the life of a prescription and to order any necessary tests to monitor the safety of the medicine. This role should be able to be performed across sectors, within the hospital, within general practice and importantly because of the accessibility of community pharmacists, within community pharmacy – but again, within a collaborative care agreement.

 

The outrageous statement “that patients will be exposed to unnecessary risk, including increased incidences of medication misadventure” disregards the fact that there is already an enormous issue around medication-related harm in Australia, many of these medicines prescribed by general practitioners.

 

PSA’s report Medicine Safety: Take Care 2019 revealed the enormity of the issue of medication-related harm and its cost to our economy. The report found there were 250,000 hospital submissions annually as a result of medication-related problems with an additional 400,000 presentations to emergency departments due to medicine misuse costing $1.4 billion annually.

 

Three in five hospital discharge summaries, where pharmacists were not involved in their preparation, had at least one medication error and over 90 per cent of patients have at least one medication-related problem post-discharge from hospital.

 

The evidence is clear, pharmacists have significant potential to reduce the number of medication-related hospital admission and adverse medication events in Australia but are prevented from doing so due to barriers in fulfilling our scope of practice. As experts in medicines, pharmacists can identify medicines that are causing harm and reduce adverse events through monitoring, frequency of patient contact, and through our expertise and knowledge of how medicines interact.

 

RACGP’s statement that “the business needs of a pharmacy may be prioritised over the needs of patients” blatantly disregards the fact that GPs themselves work in a business that provides services that have their own potential conflicts of interests. All health professionals are subject to professional standards codes and guidelines which demand health professionals place the health and welfare of patients ahead of any other interest. In this context pharmacists are no different to general practitioners.

 

PSA has stated that clear risk frameworks would need to be put in place for any model for pharmacists’ prescribing to avoid business needs being prioritised over patients. Pharmacists should not be considered any different in the provision of health services to other health professionals.

 

PSA has argued that collaborative prescribing should be designed so that the pharmacist and the medical practitioner support each other. They are complementary roles that would be designed to actually address the safety concerns of patients in an already fragmented care system. PSA believes pharmacists, medical practitioners, other allied health professionals and consumers should all work together as part of a wider health care team for the benefit of patients.

 

Pharmacists have long identified and referred patients to doctors to help manage chronic disease and believe that any future collaborative prescribing model would strengthen and enhance these partnerships.

 

It is essential that all health professionals work together for the benefit of patients as part of health team and PSA is disappointed that RACGP has chosen to diminish the role of pharmacists and their role as a trusted, patient-focused health care professional rather than work together towards fostering relationships and models of care that will greater benefit all Australians.

 

Yours Sincerely,

Dr Chris Freeman

National President

Pharmacist-administered vaccination age lowered in the Australian Capital Territory

Pharmacists will be able to protect more Canberrans against vaccine-preventable diseases, ACT Health announced today in a move welcomed by the Pharmaceutical Society of Australia (PSA).

 

Pharmacists will be able to vaccinate more people following ACT Health’s announcement to lower the minimum age of pharmacist-administered vaccinations to 16 years.

 

ACT PSA Branch President, Renae Beardmore, congratulated ACT Health for allowing pharmacists to vaccinate more Canberrans.

 

“Allowing trained pharmacists to administer vaccines will significantly increase the immunisation rates within the community and reduce the incidence of vaccine-preventable diseases.

 

“The administration of vaccines by pharmacists complements the excellent work done by GPs, nurses, Indigenous Health Workers and other healthcare professionals. This change will increase immunisation and positively impact people’s health in the ACT.”

“As the peak body for pharmacists, PSA has advocated for many years to allow pharmacists to deliver more vaccinations to a wider range of patients and will continue to work closely with ACT Health to achieve this.”

 

Ms Beardmore commended Minister Fitzharris and ACT Health for making use of pharmacists’ expertise and training to better protect the community against vaccine-preventable diseases.

 

Media contact:   Michellé Mabille, Marketing and Communications Manager – 0487 922 176

Supporting collaborative prescribing to improve safe and effective use of medicines

The Pharmaceutical Society of Australia (PSA) supports collaborative prescribing of medicines by pharmacists to improve Australians’ access to safe and effective healthcare, in its response to the Pharmacy Board of Australia’s Public discussion paper on pharmacist prescribing.

 

PSA National President Dr Chris Freeman said PSA had advocated for collaborative pharmacist prescribing and recognised the work that had already been done to develop this role.

 

“PSA supports collaborative prescribing of medicines by pharmacists within a framework that allows them to practise to the full extent of their expertise,” Dr Freeman said.

 

“Pharmacists have more clinical training in medicines than any other health professional, they already perform clinical assessment and diagnosis within their scope of practice and prescribe other scheduled medicines. These activities are within the national competency framework for pharmacists.

 

“Prescribing Schedule 4 medicines is a logical next step and continuation of pharmacists’ role in medicines management.

 

“As stated in our Pharmacists in 2023 report, we are committed to enabling pharmacists to practise to their full scope by advocating for expanded roles and new opportunities in prescribing, consistent with their recognised competency framework.”

 

One of the actions for change outlined in Pharmacists in 2023 is to Facilitate pharmacist prescribing within a collaborative care model.

 

PSA surveyed pharmacists, interns and students to inform its response to the Pharmacy Board. Ninety-four per cent of respondents agreed pharmacists are already well placed to prescribe under a structured prescribing arrangement or under supervision.

 

The majority of respondents said they would prescribe under the proposed models, with 56% saying they planned to prescribe under a structured prescribing arrangement as soon as it was implemented.

 

In its submission to the Pharmacy Board, PSA outlined the core principles that must underpin pharmacist prescribing, including:

• Safety and wellbeing of the patient are fundamental priorities
• Patients are supported to receive patient-centred care in a timely manner
• Pharmacist prescribers have professional accountability and responsibility to patients as well as other members of the healthcare team
• The pharmacist prescriber works as a member of a collaborative care team with shared responsibility and implements highest standards of communication with patients and other team members
• Separation of prescribing and dispensing functions in a risk based framework.

 

“PSA looks forward to working with the Pharmacy Board and the wider profession to support pharmacist prescribers by establishing training and recognition requirements, enabling legislative and regulatory change, and developing a framework for collaborative prescribing across practice settings,” Dr Freeman said.

 

Media contact:   Michellé Mabille, Marketing and Communications Manager – 0487 922 176

PSA calls for greater support for pharmacists to improve Australia’s health

Following the announcement of the date of this year’s Federal Election, the Pharmaceutical Society of Australia (PSA) looks forward to working with an incoming Government to support a healthier Australia by making better use of the pharmacist workforce.

 

PSA National President Dr Chris Freeman said Australia had a world-class healthcare system, but it faced many challenges and pharmacists were well placed to increase access to care and improve patient and medicine safety.

 

“PSA looks forward to working with an incoming Government to improve medicine safety for all Australians by empowering pharmacists to better meet the needs of the community,” Dr Freeman said.

 

“Our Pharmacists in 2023 report outlines 11 key actions to improve the health of all Australians through better access to care, medicine safety and use of pharmacists’ expertise.

 

“To meet community health needs, we must ensure pharmacists can practise to their full potential, develop within a team of health professionals and have a quality agenda for the services they deliver.

 

“The public want to see pharmacists’ knowledge, and skills being put to full use. We need to remove the structural and funding barriers that are holding pharmacists back. It’s simply a waste of precious healthcare resources if we don’t have our pharmacists practicing to their full potential. It’s a disservice to patients and to the entire community to not fully utilise a ready and waiting health workforce to improve care.”

 

PSA seeks the following commitments from an incoming Government:

 

• Address the alarming rate of medicine-related harm in our health system by declaring medicine safety a National Health Priority Area (NHPA).

“Medicine-related problems cause 250,000 hospital admissions and 400,000 emergency department presentations in Australia each year, costing the healthcare system $1.4 billion annually. At least half of this harm is avoidable,” Dr Freeman said.

“Pharmacists are the stewards of medicine safety. Their primary responsibility at all times is to ensure medicines are used safely and effectively.

“Declaring medicine safety as a NHPA will provide much-needed awareness and investment.”

 

• Provide funding to embed pharmacists within healthcare teams, particularly in residential aged care facilities.

“Ninety-eight percent of people living in residential aged care facilities are taking at least one potentially inappropriate medicine,” Dr Freeman said.

“Embedding pharmacists in residential care facilities reduces the use of and harm caused by psychotropic medicines, opioids and antibiotics. We would like to see pharmacists embedded in every residential care facility in the country.”

 

• Accept the MBS Review Taskforce’s recommendations to allow pharmacists to access allied health items to provide medication management services to patients with complex care requirements.

“While GPs can include pharmacists in healthcare teams, this rarely happens because pharmacists are excluded from the list of eligible allied health providers and are therefore restricted by the current funding structures to be part of healthcare teams,” Dr Freeman said.

“Accepting the MBS Review Taskforce’s recommendations as a first step, will make better use of existing MBS services by fully harnessing the knowledge, skill and accessibility of pharmacists.”

 

• Align the incentives for pharmacists to support rural and remote communities with those of other rural and remote health practitioners.

“The seven million Australians living in rural and remote areas are more likely to have chronic conditions and poorer health outcomes than people in major cities,” Dr Freeman said.

“Pharmacists could play a much greater role in rural and remote areas, where they are often the only health provider. It’s only logical that the incentives for other health professionals to go, to stay and to be educated in the bush, should be available to pharmacists as well.”

 

• Include PSA as a signatory to the Community Pharmacy Agreement.

PSA welcomes recent commitments by the Federal Health Minister Greg Hunt that PSA will be a signatory to the 7th Community Pharmacy Agreement and from Labor’s Shadow Health Minister Catherine King to “early and inclusive” negotiations for the 7CPA.

“PSA believes the need to preserve the accessibility of community pharmacy for the delivery of health care services such as vaccinations, medication management and minor illness care. For this reason, and as recommended by the Review of Pharmacy Remuneration and regulation, PSA must be included as a signatory in the upcoming 7CPA.”

 

“Pharmacists are among the most accessible health professionals. Every day they use their clinical training to care for patients across the country,” Dr Freeman said.

“PSA looks forward to working with an incoming Government to empower pharmacists to do more to deliver better healthcare for all Australians.”

AHA to administer Community Pharmacy Programs funded under the Sixth Community Pharmacy Agreement

Australian Healthcare Associates (AHA) announces that it has been awarded a services agreement by the Australian Government to administer the 23 Community Pharmacy Programs funded under the Sixth Community Pharmacy Agreement.  AHA will commence administration of these important programs from 1 February 2019.

 

AHA was awarded this services agreement following a competitive tender process undertaken by the Department of Health and has substantial experience administering government programs.  Notably, AHA currently administers the Community Service Obligation (CSO) Funding Pool and the Chemotherapy Compounding Payment Scheme on behalf of the Department.

 

Richard Stock, AHA Founding Director, said, “Our aim is to build on the committed work of the Guild which has administered these programs over many years, to ensure professional and efficient payment for services to pharmacies and other stakeholders.”

 

AHA will engage the Pharmaceutical Society of Australia (PSA) to advise on and support the administration of these programs.

 

Dr Shane Jackson, PSA President, said, “PSA will provide subject matter know-how to assist AHA to ensure program administration is efficient and effective for pharmacies.  We will draw on our sector expertise and extensive network to deliver education and training, as well as coordinate communications and stakeholder management activities.”

 

In early 2019, AHA will:

• Establish a support centre and website; and
• Provide details to stakeholders of the transition arrangements for each program.

 

AHA will operate under the name ‘Pharmacy Programs Administrator’ for the administration of these programs and future media releases and communications will be issued under this branding.

 

–Ends–

Media Contact:
Jarryd Luke
0487 922 176

Changes to Self Care program

Changes to the Self Care program are coming soon. The Self Care program is designed for pharmacies to deliver improved health care to patients. It provides resources and training to educate pharmacy staff, add value to the patient’s experience, and aims to increase business growth with tailored health promotions and resources.

PSA summit to unite pharmacists and doctors for patient safety

August 17, 2018

The Pharmaceutical Society of Australia will host an inter-professional collaboration summit to explore how doctors and pharmacists can work together more effectively to support patient care through the safe use of medicines.

 

Prompted by a recent Coroner’s report into the death of a Melbourne man following complications of methotrexate toxicity, the summit will bring together leaders from key pharmacy, medical and consumer organisations at Pharmacy House in Canberra on 21 August 2018.

 

In handing down her findings, Coroner Rosemary Carlin said the patient’s unnecessary death resulted from key failings of the pharmacist and prescribing doctor to work collaboratively to effectively resolve a prescribing error. In particular, the coroner noted “Doctors and pharmacists should trust and respect each other, whilst retaining their independence. In dismissing her concerns, it appears that Dr Lim did not afford the respect she deserved. In dispensing the methotrexate despite her concerns, it appears that afforded too much respect, or at least lost sight of her role as an independent safeguard against inappropriate prescribing.”

 

PSA National President Dr Shane Jackson said the Coroner’s report highlights the need for a more collaborative relationship between pharmacists and doctors that recognises their respective roles and responsibilities while also acknowledging their independence.

 

“The summit will seek to develop a set of principles to support respectful and collaborative practice between pharmacists and doctors,” Dr Jackson said.

 

“It is time to work together on key principles that underpin the collaborative relationship between pharmacists and doctors, particularly regarding the safe use of medicines, for the benefit of our patients.

 

“We have invited other professional bodies to join the summit so together, we can empower pharmacists and doctors to meet their duty of care in regards to patient safety.”

 

-ENDS-

Media contact: 
Jarryd Luke
Communications Officer
0487 922 176