Bigger risk, no reward, in expanding pharmacist scope
The AMA is often accused of engaging in a ‘turf war’ when it warns against pharmacists and other healthcare practitioners expanding their scopes of practice – for example, into prescribing.
The Review is being conducted as part of the current Community Pharmacy Agreement (CPA) between the Government and the Pharmacy Guild of Australia. The CPA provides the framework for Government funding to medicine wholesalers and pharmacies in return for delivering and dispensing PBS and RPBS medicines to the public.
The Review is looking at whether there might be better ways to remunerate pharmacists and utilise their skills, and whether the regulations limiting the location of pharmacies should relaxed.
Our submission to the Review emphasises that the AMA fully supports pharmacists undertaking roles within their scope of practice. That means those activities and clinical services that are covered in their core education and training.
The AMA highly values the contribution pharmacists make to improving the quality use of medicines, such as by ensuring medication adherence, improving medication management, and providing education about patient safety.
We therefore support many of the community-based programs funded under the CPA, such as medicine reviews and Aboriginal and Torres Strait Islander services.
The AMA is also open to alternate models of funding that would encourage and reward a focus on professional, evidence-based interactions with patients. The AMA agrees that pharmacists’ expertise and training are underutilised in a commercial pharmacy environment where they are distracted by retail imperatives.
With this is mind, the AMA has called for Government funding to support pharmacists working within a general practice to contribute to the delivery of high quality care for patients. You can see the full details of this proposal on our website.
However, over the last few years the Pharmacy Guild has pushed for a range of pharmacy services to be funded under the CPA as an extra source of income, which represents an expansion of pharmacists’ scope of practice. This includes prescribing Schedule 4 medicines; providing advice on nutrition, weight loss, smoking cessation, pregnancy and baby care; and managing chronic diseases such as asthma and diabetes.
Under the Health Practitioner Regulation National Law Act governing the practice of registered health practitioners, the national boards are responsible for setting the accreditation standards for education and training for the knowledge, skills and professional attributes to practise.
By lobbying for these types of services to be funded under the CPA, the Pharmacy Guild – representing for-profit business owners – is trying to drive expansion of the scope of practice of a health practitioner. The Pharmacy Board of Australia has not been involved in any way.
This is not an appropriate way to design a health care system to meet the future needs of the community.
To ensure patient safety and cost-effectiveness for the health care system, the AMA maintains that any expanded scopes of practice by non-medical health practitioners should be underpinned by transparent and consistent processes which satisfy the following important questions:
- does the change in scope of practice introduce any new risks to patient safety?
- is the change to scope of practice rationally related to the practice of the profession and to the core qualifications and competencies of their profession?
- is the change in scope of practice consistent with the evolution of the health care system and the dynamics between health professionals who work in collaborative care models?
- are training opportunities for other health practitioner groups diminished?
- is the cost to the health care system lower than the current service offered, taking account supervision costs?
If, in the future, pharmacists’ core education and training covers medical services, and pharmacists wish to have those services attract Government subsidies, then those services should be assessed for safety, efficacy and cost effectiveness in the same way as other health practitioner services. That means evaluated and funded under Medicare.
In the meantime, the AMA will continue to defend against profit-driven and unevaluated expanded scopes of practice.
Published: 18 Oct 2016