GPs question pharmacist prescribing scope

21 July 2010

BY RAJESH KUMAR

The Royal NZ College of GPs will work with the Pharmacy Council on further development of the proposed pharmacist prescriber scope of practice.

Submissions on the proposal closed last month and the council is currently in the process of compiling them into a composite document for detailed analysis and discussion by stakeholders.

While the New Zealand Medical Association has, in its submission, strongly opposed the proposal and has reiterated its objections to it dating back to August 2007 when the proposal was originally mooted, the college response has been more measured and conciliatory.

“General practitioners and patients greatly value the important contribution pharmacists make to patient care,” RNZCGP chief executive Karen Thomas says in the submission.

“The college strongly supports collaboration between health professionals. In the interests of effective and efficient healthcare and health promotion, it is vital that health workers work together with the common goal of improving the health of individuals and populations.”

The college says it is pleased to see pharmacist prescribers will be expected to understand rather than make a diagnosis.

“Doctors’ particular training teaches them diagnostic skills. Even for doctors who have received this lengthy training reaching an accurate diagnosis is frequently not straight forward. A correct diagnosis is necessary if the correct medication is to be prescribed – or in the words of the document ‘to optimise medicines related health outcomes’.”

Most GPs who individually contributed to the college submission have reportedly been reluctant or outright opposed to pharmacists gaining prescribing rights.

To this, the college says GPs interact frequently with community pharmacists, but seldom with hospital based pharmacists.

“Not surprisingly, the majority of the feedback which we received from members reflected the assumption that community pharmacists would become prescribers. Reading the consultation document did not give GPs reason to question this assumption.”

|The college thinks an explicit and unambiguous statement early in the document or in a covering letter would have enabled GPs to identify the actual gist of the proposal that a majority of pharmacist prescribers will be working in secondary care environment and that community pharmacists wishing to become prescribers will not be in a dispensing role and would not be able to own a pharmacy.

“Had a similar explicit statement featured in the consultation document, this would have enabled feedback from GPs to be more focussed on the types of scenarios which the

Pharmacy Council presented at the November meeting [to discuss the proposal] and less on the issues resulting from prescribing by community pharmacists.”

While the proposal says prescribing by community pharmacists may happen under exceptional circumstances, such as in isolated rural communities, and talks of clear separation of prescribing and dispensing roles, the college says it does not support pharmacist prescribing occurring in community pharmacies or by pharmacists who have an interest in one or are employed by a community pharmacy.

Many GPs also expressed concern around who would be held responsible in various situations where medication was stopped, altered or initiated by a pharmacist prescriber, particularly if this was without the GP’s knowledge. They said a patient’s GP should be informed of proposed medication changes, particularly if the medication was to be stopped.

The RNZCGP thinks the description of a collaborative environment in the proposal is not sufficiently robust.

“This is a very significant issue because the ‘collaborative environment’ is relied on to address major safety, quality and efficiency issues. The definition of a collaborative environment [in the proposal] focuses on the pharmacist having access to patient notes. This is essential for the purposes of communication, but not sufficient to produce safe, efficient and effective patient care.”

The Pharmacy Council proposes to work through these issues with the college. Meanwhile, NZMA in its submission to the proposal points out while pharmacists might undertake cardiovascular risk assessment or prescribe for minor ailments such as thrush, the treatment of the “minor ailment” is based entirely on the patient’s description of it.

“Without examining the patient the pharmacist can not know whether the problem is – say – thrush or something more serious such as gonorrhoea or any number of other medical conditions. Similarly CVD risk assessment requires some basic measurements and, unless the scope of practice were to include examination and diagnosis, the process will not be helpful to the patient.”

Read detailed submissions from the college and NZMA here:  NZMA submission   RNZCGPs submission

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