Pharmacist prescribing is not safe: Presidents of 15 specialist medical colleges condemn assault on TGA schedule
The presidents of Australia’s specialist medical colleges have spoken out against the dismantling of the TGA scheduling system to allow pharmacists to prescribe S4 drugs.
The warning comes amid increasing alarm at state governments that have decided to ignore the intent of the scheduling system to protect patients from adverse medication events.
The Council of Presidents of Medical Colleges represents the leaders of all 15 specialist colleges, covering dermatologists, physicians, pathologists to gynaecologists, surgeons and GPs.
“We are concerned that a move to pharmacy prescribing is inconsistent with good practice and the established TGA scheduling system, which protects patients from potential harm,” its chair, Adjunct Professor Vijay Roach, told Australian Doctor.
“Prescription of S4 medications should not be within the purview of non-medical practitioners.”
“When it comes to pharmacist prescribing, who is responsible if there are side effects or complications, or if the patient is not responding to treatment?” the Sydney obstetrician and gynaecologist asked.
“What processes are in place? Medical conditions requiring S4 medication require medical input prior to and/or after treatment. The medication may not be the only assessment required.”
Both Victoria and NSW have announced trials of pharmacists diagnosing and treating uncomplicated UTIs and skin infections.
The Queensland Government has taken the model further with its prescribing trial in the north of the state, which covers a population of 630,000, including Indigenous communities.
The pilot, the target of AusDoc’s pharmacy prescribing campaign, will involve 350 pharmacists diagnosing and treating conditions ranging from asthma to impetigo as well as managing CV risk factors among patients with type two diabetes and hypertension.
They will also be given powers to change dosages without medical oversight.
And while the full list is still being determined, previous consultation documents state that pharmacists would prescribe 52 medicines including metformin, glipizide, dapagliflozin, rosiglitazone and varenicline.
Pharmacists will also provide hormonal contraception, despite the TGA rejecting a down-scheduling request in 2021 because of the safety concerns.
Under the TGA’s scheduling criteria, S4 substances are restricted to medical practitioners, dentists and veterinarians.
According to a 2018 Australian Health Ministers Advisory Council paper on scheduling policy, these criteria are based on the likelihood that the substance will “contribute to communal harm” — for example, the development of resistant strains of micro-organisms.
But last week, outgoing TGA chair Professor John Skerritt said the watchdog’s powers were restricted because ultimately state governments had the legislative power to determine the practitioners who could prescribe specific medications.
“I think it is a valid question for health professionals, and indeed policymakers, to ask about the future of medicine scheduling when you have got this contradiction,” he told Australian Doctor.
“I have seen the list of conditions the pharmacist prescribers are going to be able to prescribe against in [the North Queensland pilot].
“What I have not seen is what substances — what S4s and S3s — are in scope and not in scope.”
He added: “I will give you an example: one of the things that the Queensland Government has on a list for pharmacist prescribers is smoking cessation.
“I do not know whether, at this stage, the Queensland Government intends for [treatment options to include prescribing] quite powerful drugs — like bupropion, for example — which is also an antidepressant.”
Professor Roach said medical care could not be “fragmented into components”.
“It isn’t just about prescribing a drug, having an X-ray or being referred to a specialist.
“Healthcare is about broad and holistic assessment of the patient, and this requires medical expertise.
“Asthma, diabetes, hypertension and infections may respond to simple treatments, but they are often part of a complex picture.”
You can sign the petition calling for the North Queensland pharmacy prescribing pilot to be stopped by clicking here.
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