22 March 2023

RACGP: SA pharmacy prescribing plan a recipe for disaster

The Royal Australian College of General Practitioners (RACGP) is warning that expanding pharmacy prescribing powers across South Australia will compromise patient safety and wellbeing.

It comes following the Professional Pharmacists Australia’s (PPA) submission to the state’s Select Committee on Access to Urinary Tract Infection Treatment inquiry. The PPA, which represents more than 7,000 pharmacist and pharmacist technician members, has outlined a number of concerns including workforce shortages and doubts over the capacity of employee pharmacists to absorb further demands, particularly in rural and regional communities.

RACGP President Dr Nicole Higgins said the PPA’s warnings should be heeded.

“The South Australian Government should sit up, take notice, and listen carefully to what this union is saying,” she said.

“Pharmacy prescribing, including for urinary tract infections, is a recipe for disaster. Now we have confirmation from this union and professional association that pharmacists just don’t have the capacity to take on these additional responsibilities. The union’s state director Paul Inglis has said that workforce shortages and demands on pharmacists’ time are already resulting in high levels of work stress and burnout.

“So, any additional work, such as pharmacist prescribing, will only add to this burden. His submission also hits the nail on the head when it comes to why we have always separated prescribing and dispensing powers. Mr Inglis clearly states that his organisation is concerned about how the potential conflict of interest between prescribing and dispensing medications will be managed. I couldn’t have said it better myself, let’s stop this madness before it’s too late.”

The RACGP President said concerns raised in the submission regarding indemnity were particularly alarming.  

“The PPA submission raises fears about increases to professional indemnity insurance for pharmacists if their scope of practice is extended to prescribing,” she said.

“At the end of the day any increased costs will unfairly fall on working pharmacists. Many of the pharmacists that that I speak to, both locally and further afield, are very concerned about diagnosing and prescribing. They’re concerned that they’ll be put at risk because they are doing new tasks that we know carry significant risks. The skill of general practice is knowing when not to prescribe, having the ability to examine the patient, and be able to investigate for other causes.”

Dr Higgins said it was ominous that the push for pharmacy prescribing was being driven by the Pharmacy Guild and not by the interests of either pharmacist employees or patients.

“The Pharmacy Guild represents the pharmacy owners, not the workers,’ she said.

“Employee pharmacists are among the lowest paid health professionals in Australia and are often under immense pressure. GPs have a very good relationship with our local pharmacists, and we don’t want to see them put at risk because of commercial imperatives.”

RACGP South Australia Chair Dr Sian Goodson echoed Dr Higgins’ warnings.

“Pharmacy prescribing sounds good in theory, but when you look closely at what it actually involves it’s a very different story,” she said.

“What governments need to realise is that GPs train for well over a decade in diagnostics, as well as doing ongoing training for the rest of our working lives. We do so in order to be able to safely diagnose patients, and so there really is no substitute for GP care. If South Australia goes down the path of pharmacy prescribing, including for UTIs, we will see poor patient health outcomes.

“Along with many other medical bodies the RACGP has also long been arguing about risky moves to allow retail pharmacists to prescribe antibiotics and other medications. It can lead to overprescribing because when your only tool is a hammer every solution is a nail. Also, the introduction of more prescribers goes against antimicrobial stewardship efforts so now is definitely not the time to introduce additional prescribers as we fight one of the great public health challenges of the 21st century.

“We need serious investment in general practice care, not band-aid solutions that put pharmacy owner profits ahead of patient safety.”

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