Pharmacy led pushes for extended, independent scope of practice threaten to erode the quality of primary health care provided to Aboriginal and Torres Strait Islander people
The National Aboriginal Community Controlled Health organisation (NACCHO) represents 145 Aboriginal and Torres Strait Islander Community Controlled Health Organisations nationally. They have around 550 sites located in urban, regional, remote and very remote locations providing comprehensive team based primary health care. Donnella Mills, Chair of NACCHO states, “Our community controlled health services (ACCHOs) are the Australian leaders in coordinated, multidisciplinary primary health care. Our clinics work through large multidisciplinary teams made up of Aboriginal and Torres Strait Islander health workers and practitioners, nurses, pharmacists, general practitioners, and non-GP specialists. ACCHOs currently employ three nurses or Aboriginal and Torres Strait Islander health workers for every one GP and have developed effective models for integrating pharmacists within primary health care teams. This coordinated multidisciplinary primary health care is improving access and quality of care.”
Pat Turner, CEO of NACCHO says, “Industry groups continue to push for expanded scope of practice, without the integration within a primary health care team. This is most notable in the pharmacy sector where expanded scope trials are being conducted in areas with large numbers of Aboriginal and Torres Strait Islander patients. This expanded scope includes administering vaccines, diagnosis of medical conditions, prescribing medicines and screening for health conditions. The expanded scope proposed for pharmacists is clearly “out of scope” with current practice, as it requires changes to legislation, and a minimum of an additional year of education for pharmacists to perform activities such as prescribing.
“These trials threaten to further fragment care for priority conditions such as otitis media and hearing loss, hepatitis management, and further exacerbate the crisis in antimicrobial resistance seen in many Aboriginal and Torres Strait Islander patients. Whilst there has been years of consultations and various task forces and committees reviewing scope of practices and access to care for patients, including the recent Medicare Strengthening Taskforce, which had representation of a range of clinicians involved in delivering primary health care, the same cannot be said of this pursuit by private pharmacy.”
“Aboriginal and Torres Strait Islander peoples are confronted all the time with the lack of culturally safe access to services including access to pharmacies. Our sector has experienced the misuse of specifically designed Indigenous health programs being used by mainstream organisations and not fulfilling the intentions of these program. For example, some mainstream General Practices undertake the 715 health checks for Aboriginal and Torres Strait Islander patients without producing a patient health plan. The burden then falls on the ACCHO to develop the health plan.”
There are several issues with pharmacists providing extended clinical services that are illogical and discordant with national policy. Pharmacists do not have the holistic medical training required to safely diagnose and prescribe. The duration and specificity of pharmacy training is inherently incomparable to the up to 12 years of training undertaken by a GP. The separation of commercial interests and dispensing roles is a central part of Australia’s healthcare system and helps safeguard patient safety.
There are volumes of peer-reviewed research and data that reject the pharmacy industry’s claim that consumers want a broader health care service from pharmacists, and direct comparison between overseas pharmacy models is risky, particularly with regards to priority patient groups such as Aboriginal and Torres Strait Islander peoples and those living in rural and remote areas. For example, the introduction of pharmacist prescribers is likely to lead to a rise in antimicrobial resistance as has been demonstrated overseas. Further, global academic research cited that supports pharmacist “extended scope” is principally led by pharmacists, for whom this topic has been biased by researchers’ commercial or professional interests. Claims that Australia is catching up with overseas pharmacist models of care are misleading. Each country applies differing prescribing models, education and training standards as well as registration requirements.
State governments would appear not to have duly considered Commonwealth medicines policy and advice from the medical community and recommendations from the Therapeutic Goods Administration (TGA) by establishing protocols outside regulatory processes and they would appear to be using the Extended Practice Authority – Pharmacists to effectively down-schedule medicines and bypass safety mechanisms and external independent regulatory oversight processes that are in place for patient safety. This places patients at risk, especially as there is evidence that pharmacists do not follow protocols. This risk is compounded by the lack of compliance auditing.
NACCHO is concerned to see a more thorough and transparent process for an evaluation of increasing the scope of practice for the private sector pharmacists before Governments agree to the Guild’s proposal.