Story from the Sydney Morning Herald

Nurse and pharmacy prescribing powers to be probed in new review

Written by Natassia Chrysanthos

Nurses, paramedics, pharmacists and physiotherapists will push for greater powers to prescribe medicines or treat patients, as a review of health professionals’ roles examines how to boost capacity in Australia’s strained primary-care system.

Federal Health Minister Mark Butler has commissioned Professor Mark Cormack, the former chief executive of Health Workforce Australia and ACT Health, to lead the review, which was recommended by the government’s strengthening Medicare taskforce earlier this year.

But the process threatens to fuel tensions among health practitioners, with the Australian Medical Association already warning against giving various professions more independent roles in the workforce.

Cormack’s review, titled Unleashing the Potential of our Health Workforce, will consult states, territories and health professions, and report back to the government in the second half of next year.

With Australia facing a shortage of GPs and rising out-of-pocket fees, Butler said for too long, many health workers had been unable to work to their full potential.

“Whether it is nurses, pharmacists or allied health professionals, in a global health workforce shortage we need everyone working as close as possible to the top of their scope,” he said.

Butler has indicated he wants pharmacists to do more in the health system and promised to expand their remit to help compensate them for cuts to handling and dispensing fees in the move towards 60-day scripts next month.

Queensland, NSW and Victoria have trialled prescribing of contraceptives and UTI treatments by pharmacists, while the Pharmaceutical Society of Australia’s national president, Dr Fei Sim, said they could also manage common ailments such as skin conditions and help triage patients.

“We want to do more to support our patients, and we have the skills and expertise to do more, but it is not possible to do more for less,” she said.

But the Australian Medical Association has been running a scare campaign against state government plans to give pharmacists more prescribing powers, claiming the measure threatens patient safety.

“The real danger is that this becomes an opportunity for a range of health professions to try to carve out more independent roles, which will inevitably result in more fragmented care, waste and higher long-term health system costs,” AMA president Professor Steve Robson said.

Robson said employing nurses and allied health professionals to work alongside doctors in general practices was an example of positive reform, “not just rearranging deck chairs at the cost of quality patient care”.

Royal Australian College of General Practitioners president Dr Nicole Higgins also said she wanted the review to be about more than “just role and task substitution”.

Australian Primary Health Care Nurses Association president Karen Booth said it was difficult to hear that nurses or pharmacists should not step in to support patient healthcare when they were sometimes the only medical professionals available.

She said the review should consider nurse prescribing within a multidisciplinary team, for example, giving qualified nurses the ability to issue repeat prescriptions for blood-pressure medication when they worked in a GP clinic.

“Nurses have extensive skills in health screening and assessment. They are also skilled in teaching patients how to look after their own health and wellbeing,” she said.

“The biggest problem is that, in many cases, the current Medicare funding system … doesn’t directly cover the cost of these activities.”

Grattan Institute health program director Peter Breadon said he would support greater powers for pharmacists and paramedics as well as regulatory and funding reforms that enabled nurses to do more for chronic disease management.

“One of the things that would be warranted but highly controversial would be a bigger pharmacist role in prescribing,” he said.

“If this is done in a structured way with GPs, there’s evidence this would be cost-effective and benefit patients. Doctors and pharmacists would need to collaborate to make that work.”

Allied health professions will also be involved in the review. Physiotherapists and paramedics, for example, say they should be able to refer people to specialists or for X-rays and other scans without going through a hospital or GP.

“It’s such a lost opportunity, and it’s not providing the best care for the patient at that time,” Australasian College of Paramedicine chair Ryan Lovett said.

The Australian Physiotherapy Association also says the review could explore physiotherapist prescribing of medicines related to their field in certain circumstances.

Read the article at The Sydney Morning Herald