So you want to be a pharmacist prescriber?

Following the success of the Queensland Community Pharmacy Scope of Practice Pilot, Queensland Minister for Health Tim Nicholls MP announced last week that pharmacist-prescribing for a range of acute conditions will become a permanent feature of Queensland’s health system.

It’s only a matter of time before this takes place in other jurisdictions across Australia.

To prepare pharmacists to step into this exciting new role, AP talks to PSA’s prescribing guru Jacob Warner about how to get there.

Pharmacists have always prescribed, but they have the potential to prescribe much more

Pharmacists have long been prescribing vaccines and over-the-counter medicines to patients.

While prescribing authority has traditionally been reserved for medical practitioners, nurses, and dentists, there’s a growing trend toward expanding prescribing rights to pharmacists. This shift aims to alleviate pressures on healthcare systems and enhance patient access to necessary medical treatment, reflecting a broader, multidisciplinary approach to patient care and medication management.

‘There is a clear desire from various state health departments for pharmacists to upskill in prescribing treatment for acute ailments and chronic disease management of certain conditions,’ Mr Warner said.

What does it mean to become a pharmacist prescriber?

Prescribing is an iterative process that includes collecting information, making clinical judgments, communicating effectively, and evaluating outcomes, ultimately leading to the initiation, continuation, or discontinuation of medication.

The Health Practitioner Prescribing Pathway (HPPP) outlined three principal prescribing models to ensure safe and effective prescribing by health professionals, such as pharmacists, who are not medical doctors:

• Structured prescribing: prescribers who have limited prescribing rights and operate within defined guidelines, protocols, or standing orders. This could entail pharmacists prescribing under various urinary tract infection pilots and programs.
• Prescribing under supervision: prescribers who perform their duties under the direct oversight of another authorised health professional. For example, resupply of oral contraceptive pills.
• Autonomous prescribing: prescribers who independently perform prescribing duties within their defined clinical practice areas, without needing direct supervision or formal approval from another healthcare professional. 

After undergoing training to participate in the Queensland Scope of Practice Pilot, pharmacists will have upskilled in a range of clinical topics to be able to independently diagnose certain conditions and be completely across:

• what medicines can be prescribed
• the dosages 
• potential adverse effects.

‘Pharmacists must be able to work collaboratively with the patient and develop a management plan, so it’s clear when they need to come back for reviews,’ Mr Warner said. ‘Pharmacists also need to know when to prescribe medicines and when to refer appropriately.’

What is the pathway to become a pharmacist prescriber?

For pharmacists to become a prescriber, they must first:

• hold general registration with the Pharmacy Board of Australia with no conditions on practice
• hold professional indemnity insurance.

Pharmacists then need to undergo required training through an accredited body that’s been recognised and approved by their State Health Department. For Queensland this would be Queensland Health and the approved training program would be PSA’s Pharmacist Prescribing Scope of Practice Training Program.

There are two arms of the training – a prescribing training program and a clinical practice training program. 

‘The prescribing training component revolves around the prescribing cycle, involving case studies, and also considers managing prescribing errors and cultural safety,’ Mr Warner said.

The clinical arm of the training involves deep understanding of conditions and how to manage them.

‘For example with acne, understanding the pathophysiology, the anatomy of the skin, how to diagnose it and classify severity, the management and treatment options, and monitoring of treatment after initiation,’ he said.

PSA’s prescribing training also uses AI technology, with participants interacting with an avatar.

‘After doing an online tutorial where you have case-based discussions with peers, you then interact with the avatar and put that knowledge into practice, including diagnosing the condition, counselling the patient and managing treatment,’ Mr Warner said. 

Documentation is important for management of patients and for the pilot requirements. Participants are required to submit case-dependant documentation as part of the interaction with the avatar, including a:

• patient management plan
• patient referral letter
• prescription. 

The clinical content is split into blocks.

‘For example, participants will do a dermatology block with five topics, followed by interactive AI case scenarios on dermatology,’ he said.

The interactive avatar also helps pharmacists boost skills in differential diagnosis.

‘Pharmacists can practice those skills in terms of diagnosing one skin condition over a pool of others,’ Mr Warner added.

What should pharmacists expect in terms of timeline, workload and practice experiences?

PSA’s training program is designed to allow self-paced learning, with much of the content being online and interactive – including tutorials and modules.

‘However, there are some in-person components, including a 3-day practical clinical skills workshop following completion of the online components, designed to teach the practical skills required and ensure competency to work as a prescribing practitioner,’ Mr Warner said.

‘Participants are then assessed via an objective structured clinical examination (OSCE) with a structured VIVA component.’

The overall program takes around 12 months to complete, with the consolidated face-to-face workshops helping to ensure there’s no duplication of content.

‘For example, taking blood pressure applies to weight management, hormonal contraception and cardiovascular disease risk reduction,’ he said. ‘We’ve consolidated all of the requirements to practice at expanded scope and put it at the end of the course as a practical clinical skills workshop so there isn’t duplication of teaching, so we wouldn’t teach taking blood pressure three times.’

After completing the course, pharmacists develop practical skills that may not have been part of their undergraduate degree, such as:

• debriding and suturing a wound
• chest auscultation for crackles or wheeze and being able to
• abdominal palpitation.

‘One of the biggest changes pharmacists will notice at the end of the course is having the practical clinical skills to help aid the diagnosis and management of these conditions,’ Mr Warner said.

What are the costs of becoming a pharmacist prescriber?

The full PSA training course with both components costs $11,495 for a non-member, with a $1,000 discount ($10,495) for Professional Plus Members.

Community pharmacists practising in Queensland may be eligible for a training subsidy of up to $7,000 for successful completion of these courses.

In terms of long-term costs, prescribing pharmacists are also required to have the appropriate setup, including equipment and consumables to run a consultation.

However, pharmacists are paid for the consultations. The consultation fees, as dictated by Queensland Health, include:

• brief consultation (<10 minutes) – $18.85
• standard consultation (between 10 to 20 minutes) – $35.45
• long consultation (>20 minutes) – $68.10.

How do I get started?

Registered pharmacists keen to become prescribers can enrol in PSA’s pharmacist prescribing course here. Pharmacists or pharmacy owners who want to participate in the Queensland Scope of Practice Pilot must also register to participate in the program. Pharmacy owners are required to complete the registration form on behalf of their pharmacy and all participating pharmacists working in their pharmacy.

‘Pharmacists and pharmacy owners must meet the participation requirements and be authorised by Queensland Health before they can deliver pilot services,’ Mr Warner said.

When will other jurisdictions follow suit?

According to Mr Warner, sooner rather than later.

‘Each jurisdiction has made announcements about pharmacist prescribing and have committed to different timelines,’ he said. ‘While some haven’t yet committed to specific conditions, it’s coming.’

And as PSA’s prescribing training program is nationally accredited by the APC, it can be rolled out nationally. 

‘The clinical content has been structured in a way that would apply nationally,’ Mr Warner said. ‘For each topic in the Queensland pilot, we’ve developed an in-depth module that’s nationally consistent, combined with a shorter module with jurisdiction-specific requirements.’

To learn more about PSA’s Pharmacist Prescribing Scope of Practice Training Program, click here.