Pharmacy Board’s measured step on prescribing

The Pharmacy Board of Australia has recognised that pharmacists should be able to prescribe under two monitored models of prescribing, in a move welcomed by PSA.

In a position statement released this month,¹ the Board’s vote of confidence in pharmacist expertise states that there are no regulatory barriers to pharmacists prescribing ‘via a structured prescribing arrangement or under supervision within a collaborative healthcare environment’. 

However, autonomous prescribing, which would require ‘additional regulation via an endorsement for scheduled medicines’ and to develop a registration standard for endorsement of registration has been effectively ruled out. The Board concluded its statement with the declaration that it ‘is not making an application for approval of endorsement for scheduled medicines at this time’.

PSA’s National President Associate Professor Chris Freeman told Australian Pharmacist: ‘I am very pleased that the Pharmacy Board has concluded that under the National Law there are no regulatory barriers in place for pharmacists to be able to prescribe collaboratively under two of the three models outlined in the Health Professionals Prescribing Pathway [HPPP].’² 

The three models of non-medical prescribing outlined were: 

• prescribing via a structured prescribing arrangement
• prescribing under supervision 
• autonomous prescribing.

‘The Pharmacy Board’s position aligns very closely to the position on pharmacist prescribing that PSA had put forward during the consultation phase,’ A/Prof Freeman said.

Based on extensive mapping work, including competency mapping and broad stakeholder engagement, the board decided that pharmacists do not need to complete additional formal post-graduate studies to prescribe under a structured prescribing arrangement or under supervision. 

Any gaps in competencies could be addressed through suitable continuing professional development (a requirement to maintain general registration), by completing short courses and/or local site credentialing. Current pharmacy programs of study may only require minor changes to equip graduates to prescribe via these models.¹

With A/Prof Freeman’s extensive experience working in general practice and community pharmacy, he foresees the benefits of pharmacist prescribing to patients. 

‘Collaborative prescribing agreements within general practice, aged care, hospitals, and community pharmacy can address concerns about patients not reaching treatment goals, improve the monitoring of adverse events, and in aged care could go a long way to reducing the medication-related misadventure that occurs in this setting,’ he said.

‘”Prescribing via a structured prescribing arrangement” and “prescribing under supervision” can be progressed immediately, and implementation of these models through, for example, expansion of continued dispensing for chronic disease medicines, can address a significant proportion of the administrative burden that community pharmacists see day to day with patients running out of their medicines.’

In its submission to the Pharmacy Board, PSA told of surveying pharmacists, interns and students to inform its response. From that survey, A/Prof Freeman reported that ‘96% of respondents agreed pharmacists are already well placed to prescribe under a structured prescribing arrangement or under supervision’.

‘The majority of respondents said they would prescribe under the proposed models, with 57% saying they planned to prescribe under a structured prescribing arrangement as soon as it was implemented,’ he said.

The Pharmacy Board’s position statement recognises the implications for state and territory governments that need to make changes in legislation to authorise pharmacists to prescribe.

A/Prof Freeman confirms that it is now incumbent on state and territory governments to review their medicines and poisons legislation and remove any unnecessary barriers to pharmacists ‘prescribing via a structured prescribing arrangement’ and ‘prescribing under supervision’.

He also believes that authorising pharmacists to undertake autonomous prescribing should be developed in the future. 

‘This will be the next evolution of this journey,’ A/Prof Freeman said. ‘However, this will require post-graduate qualifications and endorsement on a pharmacist’s registration. Autonomous prescribing is only likely to be taken up by a relatively small number of pharmacists and confined to specialised areas of practice, dominantly outside of the community pharmacy setting. That is why it is so important that we first focus on the prescribing via a “structured prescribing arrangement” and prescribing “under supervision” models as they are likely to have the biggest positive impact on patients and our profession.’

References

1. Pharmacist prescribing – Position statement. 15 October 2019. Pharmacy Board of Australia. At: www.pharmacyboard.gov.au/News/Professional-Practice-Issues/Pharmacist-Prescribing-Position-Statement.aspx 
2. Health Professionals Prescribing Pathway 2013. At: www.aims.org.au/documents/item/400
3. Pharmacist prescribing on the way. PSA Media Release 16 October 2019. PSA. At: www.psa.org.au