Prescribing drugs of dependence in general practice, Part A


3. General practice systems of care
3.4 Staff education and competency
☰ Table of contents


The Standards requires all GPs in the practice to be appropriately qualified and trained, have current Australian medical registration and participate in continuing professional development (CPD).20 All doctors must provide medical care to a standard that could reasonably be expected of clinicians in their positions. Practitioners should only prescribe drugs of dependence when they have demonstrated competency. This may have particular relevance to general practice registrars.

General practices should promote and support GPs to use non-pharmacological interventions. This may include simple interventions including patient drug information in the GP software, or promoting different cognitive and behavioural strategies and other allied health therapies as part of multidisciplinary care.

Practices should consider the needs of registrars. While some may view registrar exposure to these issues as an expected part of training, others may view this as a management of an occupational risk. It may not be beneficial for the registrar, or the patient, for a registrar to act without close supervision in highly complex situations, particularly early in their training.

Experiences, practices and training received by registrars in hospital may not always be appropriate for general practice. Before prescription of any benzodiazepines or opioid analgesia, all registrars should complete basic training on orientation to the medical practice. This will enable registrar prescribing rights and responsibilities to be individually negotiated and agreed with GP supervisors. Prescribing is to be monitored until an agreed training program has been completed.20

Examples of practice policy regarding limited prescribing rights are available in Appendix D.2 in the PDF version.

Other staff members may need training regarding identification of a high risk situation. For example, reception staff who are able to identify potential drug-seeking behaviour can ensure those patients are scheduled to see doctors experienced with this level of risk.

 

3.4.1 Dependency programs

GPs who wish to offer an addiction/opioid treatment program need to be suitably qualified and trained in addiction medicine. They should also have organised support from colleagues, including addiction specialists and services, and be involved in ongoing professional development.20

Dependency programs often require advanced administrative support services, care coordination, advanced clinical teams (eg case managers, nursing and allied health staff to support appropriate care provision) and quality assurance programs. However, for relatively straightforward cases there is no evidence that extensive on-site support is needed35 and, therefore, depending on community need, practices may consider encouraging GPs to get training and authority to prescribe for opioid substitution. 

  1. The Royal Australian College of General Practitioners. Standards for general practices, 4th edition. Melbourne: RACGP; 2013.
  2. Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev 2011;(10):CD004147.