Prescribing expansion should alarm GPs

Avant has raised concerns over expanded pharmacist prescribing into complex care, warning the proposed move risks patient harm and calling for nationally agreed "red lines" to ensure safe prescribing.

The comments come amid growing debate about the future scope of pharmacist prescribing, following the release of the Pharmacy Guild's Rewriting the Script report and a separate proposal from the Pharmacy Board of Australia that would allow pharmacists to obtain an endorsement to prescribe medicines, including Schedule 4 and Schedule 8 prescription medicines, after completing additional training requirements.

While improving access to healthcare remains an important policy objective, Avant says the prescribing debate must be grounded in patient safety and an understanding of the complexity involved in prescribing decisions.

The complexities of prescribing

Avant Chief Medical Officer Professor Steve Robson said many GPs would be concerned about proposals that continue to expand prescribing authority into increasingly complex areas of care without first establishing clear safety principles.

“GPs understand better than anyone that prescribing is not simply writing a script. It requires diagnosis, clinical judgement, an understanding of competing risks and often ongoing management of complex patients,” Professor Robson said.

“The question isn't who can prescribe. The question is what level of diagnostic capability, clinical training and ongoing oversight is required to prescribe safely.”

Patient safety must remain the priority

The concerns are informed by Avant's experience as Australia's largest medical indemnity insurer. An analysis of Avant claims found medication-related issues were involved in around one in six matters resulting in regulatory action or claim for patient compensation, making prescribing one of the leading contributors to serious medico-legal matters.

Professor Robson said improving access to care should not come at the expense of quality and safety.

“Every expansion of prescribing authority should be accompanied by an equally rigorous assessment of the risks that expansion creates. Patients deserve access to care, but they also deserve confidence that prescribing decisions are being made safely.”

Avant is calling for the development of a nationally consistent prescribing framework involving doctors, pharmacists, regulators, governments, patient representatives and medical indemnity insurers. Such a framework would establish evidence-based principles for determining when prescribing authority can be safely expanded and where appropriate limits should remain.

Consequences for patients

Dr Mark Woodrow, senior emergency physician and General Manager Medical Advisory Services at Avant, said pharmacists remained an important and valued part of Australia's healthcare system.

“Pharmacists are highly skilled professionals and make an important contribution to medication safety, patient education and improving access to care, particularly as part of multidisciplinary teams,” Dr Woodrow said.

“As an emergency physician, I regularly see patients whose presentation is the result of inappropriate prescribing or a missed diagnosis rather than the condition that was initially suspected.

“I've seen patients arrive at emergency departments after blood pressure medications have worsened their kidney disease or heart failure. I've also seen patients treated for what appeared to be a urinary tract infection who were in fact suffering a different condition requiring urgent emergency care.

"Those examples aren't an argument against pharmacists. They're a reminder that prescribing can never be separated from diagnosis and clinical judgement, which often begins with our GPs.”

Further resources

Avant - Submissions collection

Avant - Advocacy collection

Avant - Submission to the public consultation on the proposed endorsement for scheduled medicines for pharmacists (PDF)