The domino effect: making sense of upcoming practice changes

Industry
By
Chloe Hava
-
scope of practice

It’s an exciting time for pharmacists, who are on the brink of providing a range of new vaccines and services. Read on to find out how the scope of practice announcements impact you.

The general practitioner (GP) shortage crisis, increased pressure on the healthcare system and several successful pharmacy trials have led health departments around the country to re-evaluate pharmacists’ scope of practice.

Here’s a rundown of key changes in:

Victoria

What was announced: 

  • Pharmacist-initiated prescription renewal for oral contraceptive pill
  • Minor ailments program
  • Increased range of vaccines, with a focus on travel health

 $19 million investment in a 12-month pilot, due to commence in July 2023.

Pharmacists should be able to provide oral contraception, administer travel vaccines and treat minor illnesses such as common skin conditions, with a pharmacy prescribing trial for uncomplicated Urinary Tract Infections (UTIs) also in the works.

What is funded?

Under the pilot, pharmacists will receive $20 per consultation and patients are required to pay no more than the current PBS co-payment for any medicines required. Victoria will be the first Australian jurisdiction to fund pharmacists to deliver these services with no out-of-pocket costs to patients.

When will it happen?

From July 2023.

How will it happen?

PSA’s Victorian State Manager Jarrod McMaugh MPS said it appears that the existing Secretary Approval, enabling pharmacists to provide vaccinations without a prescription from another health professional, will be adjusted to remove an ‘except for travel medicines’ stipulation. 

Tasmania

What was announced?

On 24 November, Tasmanian Premier and Minister for Health Jeremy Rockliff announced intentions to expand pharmacists’ scope of practice. 

What is funded?

To be determined. This will be part of the scope of practice review

When will it happen?

The PSA Tasmania State Manager Ella van Tienan MPS indicated that a review will take place within a 6-month time frame, with the ‘entire scope of practice for pharmacists in Tasmania on the table’.

Any changes to scope of practice will be announced after the review

What else is happening?

In the meantime, the Department of Health is looking at ways to immediately extend pharmacists’ role, including expanded Continued Dispensing arrangements to include: 

  • oral contraceptives
  • antidepressants for patients on stable therapy
  • medicines for the treatment of migraine, eczema, asthma, and emphysema.

Pharmacists will also be able to administer a broader range of prescribed vaccines, including for the prevention of shingles and travel vaccines.

Northern Territory

What was announced?

Last week (22 November), the Northern Territory Parliament passed the Medicines, Poisons and Therapeutic Goods Legislation Amendment Bill to allow timely access to medicines based on clinical need.

What is funded?

Nil

When will it happen?

It is anticipated these changes will be enacted in early 2023.

How will it happen?

The key change for pharmacists is regarding scheduled substance treatment protocols (SSTP), where a prescriber can authorise other health professionals to administer Schedule 4 or Schedule 8 medicines. This could be useful for the administration of long-acting injectable buprenorphine in a remote community, for example.

The Chief Health Officer can also authorise pharmacies to provide up to 1 month supply or a PBS pack during an emergency such as a cyclone, flood or fire, as opposed to the current 7 day limit.

Western Australia

What was announced?

The Government announced on 22 November that patients will be able to access NIP funded vaccines in line with the SASA from a community pharmacy.

What is funded?

The cost of the vaccine will be fully funded. The government is not funding costs associated with vaccine administration.

When will it happen?

From 22 November patients can access more government-funded vaccines from their local pharmacist including:

  • >11 years of age: Pertussis (dTpa) and human papillomavirus (HPV) vaccines
  • >Year 10 of schooling and up: Meningococcal ACWY vaccines
  • >16 years of age: Measles Mumps, and Rubella (MMR) vaccines.

How will it happen?

Community pharmacies can order government-funded vaccines via Onelink. 

Initially up to five doses of vaccines can be ordered and order limits will apply to all vaccines after the initial order. 

‘Pharmacists should then charge an administration fee to administer the vaccine,’ PSA WA State Manager Mayli Foong MPS added.

What else is happening?

On the agenda is a free influenza vaccine campaign for 2023. The PSA and other pharmacy organisations are currently in discussions with the WA Department of Health about the campaign.

South Australia

What was announced?

On 17 November, South Australian Labor MP Jayne Stinson announced her intention to set up a parliamentary inquiry to improve access to medicines for UTIs.

What is funded?

To be determined

When will it happen?

A motion for the inquiry will come before parliament this Thursday (1 December).

What else is happening?

Pharmacists in the Riverland have responded to increased rates of Japanese encephalitis, said NT/SA Branch Manager Helen Stone MPS.

‘Under an agreement with SA Health, select pharmacists can currently vaccinate patients against JEV,’ she said.

‘Access to the NIP influenza program will continue in 2023 following the success of the rollout to community pharmacy in 2022.’

The PSA SA/NT Branch is fighting for pharmacists to be able to administer more vaccines. Read more about the PSA NT/SA Branch’s vaccine advocacy work here.

New South Wales

What was announced?

  • Pharmacist UTI prescribing pilot
  • Increased vaccine formulary for pharmacists, including travel vaccines
  • Pharmacist prescribing trial for oral contraceptives and other minor ailments

What is funded?

The NIP and state-government vaccines are funded. 

Consultation fees and costs of prescribed medicines will be paid by consumers

When will it happen?

Vaccine changes came into force 14 November

Prescribing trial and UTI pilot to commence early 2023

How will it happen?

In 2023, NSW will initiate a UTI pharmacy prescribing pilot, along with pharmacists prescribing trials for oral contraceptives and medicines for ear infections or minor ailments. 

‘For the UTI pilot, the expression of interest is currently open for research institutions in NSW to conduct the clinical trial,’ said PSA State Manager Amanda Fairjones MPS.

Depending on patient eligibility, some of the vaccines are available via the National Immunisation Program (NIP), such as the Poliomyelitis vaccine for patients aged  5 –19. The vaccines include:

  • Hepatitis A 
  • Hepatitis B 
  • Japanese encephalitis
  • Poliomyelitis
  • Typhoid (IMI formulation) 
  • Zoster vaccine (Shingrix only).

Queensland

What was announced?

  • UTI prescribing to become permanent
  • North Queensland Pharmacy Scope of Practice Pilot

What is funded?

Unclear.

When will it happen?

In mid-October, Queensland Health Minister Yvette D’Ath announced that pilot scope had been finalised, and should start in the second half of 2023 and run until May 2025.

The Urinary Tract Infection Community Pharmacy Service was permanently enabled from 1 October 2022 under the Extended Practice Authority.

How will it happen?

The Queensland Government will work with PSA and other stakeholders to design and implement a trial, which includes administration of a wider range of vaccines.

Pharmacists will also be able to prescribe medicines for several mild to moderate conditions such as nausea and vomiting, reflux, rhinitis, mild skin conditions, and acute mild musculoskeletal pain.

Other services that will be available in pharmacies include oral contraceptive prescribing, oral health screening, weight management, and smoking cessation.

‘Pharmacists can get involved by ensuring they are trained to deliver vaccinations, trained to deliver the UTI service, and maintain PSA membership to keep abreast of the latest developments via member communications,’ said PSA Queensland State Manager Nicole Floyd MPS.