Autonomous prescribing the only way

The Pharmacy Board of Australia’s proposals for collaborative or supervised prescribing by community pharmacists have been rejected by the Pharmacy Guild of Australia.

The Guild believe autonomous prescribing for Pharmacists is the only possible option. It has published the reasoning for this stance in a response to the recent discussion paper in which the Board proposed three prescribing options: autonomous, under supervision or through a structured arrangement with a doctor.

The Guild has focused its comments on Autonomous Prescribing as it doesn’t believe that the other two options are feasible and won’t address any of the public needs for improving medicines access and management.

In their response, The Guild state that if pharmacists are to address the public need for improving medicines access and management then all pharmacists across the community pharmacy network need to practice to their full professional scope but neither of the first two options allow this.

“Pharmacists are as trusted as general practitioners by the Australian public and this trust can be leveraged so pharmacists can administer basic healthcare services to drive down costs to patients and the health budget, reduce waiting times, and increase accessibility. Autonomous pharmacist prescribing would improve access to treatment options for simple conditions that can be managed by a pharmacist – including after hours and weekends when access to other health care professionals is limited or non-existent,” the response states.

“The other models are dependent on another prescriber and would therefore be less effective. If pharmacist prescribing is to contribute to the delivery of sustainable, responsive and affordable access to medicines then prescribing has to be autonomous. Prescribing under a structured prescribing arrangement or under supervision relies on another health care professional and will therefore not be flexible enough to meet the needs of all Australians who for example may live in a rural or remote area where there is no or very limited access to a medical doctor or nurse practitioner. Other examples include after hours, palliative care, aged care or addiction medicine where an autonomous pharmacist prescriber will be able to provide the necessary care.

“The Autonomous Pharmacist Prescriber will be no different to a Nurse Practitioner where the pharmacist will provide the necessary care within their individual scope of practice and work collaboratively will other members of the health care team, with the primary purpose being to best meet the health needs of the consumer. Pharmacists in Australia have already proven with influenza vaccination programs that they can be trained to prescribe and administer vaccines with reporting to the Australian Immunisation Register (AIR). Where a service is not an undergraduate competency the Australian pharmacy sector has proven that retro-fitting is possible with additional training to achieve this competency and deliver the services to Australians.

The Guild cites overseas experience that suggests it is not worthwhile to progress such models as Structured or Under Supervision and that efforts should be concentrated on Autonomous Prescribing as the single most appropriate goal.

“We believe that “structured” or “under-supervision” models would become a barrier to pharmacists participating in regional and remote areas where a supervisor would be unavailable. Ironically, it is these remote and rural areas where an autonomous prescribing pharmacist would improve access to medicines and treatment for simple conditions.”

The full Guild response can be viewed here.

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