The power to prescribe:
Who should have it?
 
 

The power to prescribe:
Who should have it?

A couple of weeks ago at a media conference, a Pharmacy Guild representative was photographed wearing a stethoscope over his white smock. The image triggered an adverse reaction among GPs; some asked how a pharmacist would use the instrument, others whether the event was a costume party.

The heated response suggests the national conversation over whether pharmacists should be able to extend their limited prescribing rights is gaining heat, rather than cooling. So what’s the debate all about? Let’s look at the key parties and what they say is at stake.

Party one: Pharmacists (represented by The Pharmacy Guild of Australia and Pharmaceutical Society of Australia)

Many pharmacies already offer vaccination services and support for chronic disease management. Trials have been conducted in several states, focused on providing assistance to people with conditions such as urinary tract infections (UTIs).

Pharmacists believe they can do even more to assist Australians who need help with common conditions and will be coming to them to collect medications anyway.

Backed by the Queensland government, the Guild initiated the North Queensland Pharmacy Scope of Practice Pilot, pencilling it for December 2023 and kicking it off in April 2024. Under the pilot, conditions pharmacists can now treat include acne, hay fever and eczema. For the full list, see About the pilot | Queensland Health

The Queensland Government has since moved to make the North Queensland pilot statewide.

Party two: Governments

Governments are trying to solve a supply and demand problem. It’s hard to get a GP appointment just about anywhere — and generally harder the further you are from a state capital.

Queensland Premier Steven Miles said: “Our Government is committed to making sure Queenslanders can access good quality healthcare, no matter where they live across the state.

“We know our hardworking pharmacists are more than capable to deliver these services – for common health conditions – and divert people away from our emergency departments and GPs.

“I am really proud that Queensland is leading the nation with this initiative.”

Queensland Health states: “Pharmacists are highly qualified and trusted members of our healthcare teams. Providing pharmacists with additional clinical training and supporting them to practice to their full scope, will enable them to help and support their local communities.”

Party three: General Practitioners (represented by the Royal Australian College of General Practitioners (RACP) and Australian Medical Association)

Doctors say that medications cannot be safely prescribed without a holistic, longitudinal view of the patient’s medical history, as best understood by their usual GP. They say the pilot puts vulnerable people at risk and that a previous trial allowing pharmacists to prescribe antibiotics for UTIs led to incorrect diagnoses and serious conditions going untreated, increasing overall healthcare costs.

Party four: Healthcare consumers (represented by you and I)

While most people prefer a long term relationship with a GP who knows you and your family, getting an appointment when you need it isn’t always easy or affordable. Some people go to hospital emergency departments (or virtual versions) for free help.

Other consumers are opting for convenience, using telehealth providers that offer quick access to scripts and more, but might not have time to hear your health history, (if you can remember it). For this group of consumers, getting help from the pharmacy you’re going to anyway, may be a no-brainer. However, the services are not free. Fees of up to $55 per pharmacist consultation may limit take-up.
Those with multiple or complex conditions are likely to have to wait for the next available appointment with their GP and hope for a cancellation to get in sooner.

Sparring partners

Back in March, the Medical Software Industry Association promised a ‘ding dong battle’ between the Guild, the RACGP and government, placing three key representatives on stage together in Melbourne.

Pharmacy Guild Victorian president Anthony Tassone said the prescribing issue was not about “pharmacists being GPs. It’s about pharmacists being the best professionals they can be…. solving problems for patient benefits.”

RACGP past president Dr Karen Price said she was concerned about the ‘taskification’ of general practice, which hindered longitudinal care. Dr Price said it can take 45 minutes to explore a patient’s medication history before writing an appropriate script. She said a UTI is a “retrospective diagnosis where there may be other issues that can’t be picked up by a pharmacist”.

Representing the Federal Department of Health and Aged Care, First Assistant Secretary (Medicare Benefits and Digital Health Division) Daniel McCabe said Australia faced “acute workforce challenges” and governments were trying to unlock the full potential of professionals who could deliver, “true multidisciplinary care”.

Dr Price said multidisciplinary care was great in hospitals and, while desirable, underfunded and challenging in general practice where, “the people who most need care can least afford it”.

Mr Tassone said doctors and pharmacists were all on ‘Team Patient’ but he and his peers were not rewarded for being part of multidisciplinary teams. “Are we part of the team or are we on the bench to make up the numbers?”

He said: “Patients don’t care. They care about getting care when they need it.”
It seems this conversation is far from finished.

Skin in the game

MediRecords provides secure, cloud-hosted electronic health records and prescribing functionality to healthcare professionals across Australia delivering face-to-face and virtual care.

Further reading:

A Missed Opportunity
 
 

A Missed Opportunity


Matthew Galetto - Founder and CEO

How the Australian Government Failed to Maximise the Potential of the GP Grants Program for Digital Health Adoption

The Australian Government recently launched the Strengthening Medicare – General Practice (GP) Grants Program, allocating $220 million over two years to support general practices and eligible Aboriginal Community Controlled Health Organisations (ACCHOs). The program aims to provide funding for improvements in patient access, support safe and accessible quality primary care, and enhance digital health capabilities.

As an observer of the digital health landscape both as a consumer (patient) and participant as a software vendor, I was eagerly awaiting the unveiling of the GP Grants program. I was hopeful that the grants would finally start to address the pressing issues of our time – a need to modernise digital health infrastructure, both private and public, focusing on standards and real-time information exchange at point of care. These are not just my observations; just about everyone working in the industry understands these problems, including the government itself within health departments and at the Australian Digital Health Agency (ADHA). And, of course, patients get it too. We all experience gross inefficiencies when we visit a doctor.

Recently I learned from a colleague working at a primary health network (PHN), that no further details regarding the eligibility of the grant funding have been provided. The government has seemingly failed to establish eligibility criteria that effectively address the challenges faced by our healthcare system and specifically primary care and GP’s.  I don’t even think security of patient information is a requirement!

Could have, should have – if only I had lobbied harder!

Fast-tracking the benefits of a more connected healthcare system is crucial for improving patient care, reducing medical errors, and making healthcare more efficient. The adoption of Fast Healthcare Interoperability Resources (FHIR) and other interoperability standards can enable seamless communication between different electronic health record systems, thus facilitating information exchange and collaboration among healthcare providers.

Unfortunately, the current GP Grants Program does not set specific eligibility criteria that focus on the adoption of cloud, security, FHIR or other interoperability standards – not even clinical coding standards! As a result, the program risks missing a critical opportunity to substantially enhance digital health capabilities across GP practices.

The government’s lack of focus on cloud services, security, FHIR and interoperability adoption is concerning, considering the many issues GP practices face due to siloed databases and technology platforms designed a couple of decades ago. The current state of healthcare data systems not only hinders efficient patient care but also creates additional administrative burdens on healthcare providers. By not setting clear eligibility criteria targeting these issues, the GP Grants Program will not bring about much-needed improvements in digital health and interoperability.

Unfortunately, there is a history in the Australian healthcare industry for key stakeholders and decision makers to listen to the voice of the ‘market share’, rather than the innovators, start-ups and disruptors looking to make a difference. It’s a chicken and egg scenario, no market share equals no influence, no influence equals no change. If only I had lobbied harder for change!

What could have been, should have been. Recommendations for Improvement

To maximise the potential of the GP Grants Program, the Australian Government should have considered the following recommendations:

  1. Set clear eligibility criteria that prioritise funding for GP practices adopting cloud, security, FHIR and other interoperability standards to ensure a more connected healthcare system.
  2. Encourage collaboration between GP practices and technology vendors to develop innovative solutions that address the challenges of siloed databases and improve data sharing.
  3. Establish clear guidelines on how the grants can be used for enhancing digital health capabilities, including specific recommendations for addressing interoperability and data sharing challenges.
  4. Look to other jurisdictions like the US, which have successfully modernised their digital health ecosystem. The US implemented the 21st Century Cures Act in 2016 which was well funded, mandated standards, promoted innovation, stimulated research and development and encouraged the use and uptake of web-based API’s. This had the effect of uplifting an entire ecosystem and encouraging a raft of new digital health entrants.

An Unintended Consequence: How the GP Grants Programme May Impede Digital Healthcare Reform

While the additional funding provided by the GP Grants Programme is undoubtedly beneficial for practices, there is a valid concern that it may have unintended consequences.

If practices invest grant money in outdated technologies, they essentially lock themselves into using these systems for the next 3-5 years, as assets typically depreciate over this period.

This potential outcome of the GP Grants Program could have a perverse impact on the government’s ability to implement much-needed digital healthcare reforms. By inadvertently supporting continued use of outdated technology, the Program may slow the adoption of innovative solutions such as cloud, security, API’s, FHIR and interoperability standards. In turn, this could delay the realisation of a truly connected and efficient healthcare system, which is an urgent priority.

It is disheartening to acknowledge that Australia is already lagging behind many other countries in terms of modern cloud-based digital health solutions. This funding, if not appropriately directed, will only serve to widen the gap between Australia and other nations leading the charge in healthcare innovation. The prospect of falling further behind should be a wake-up call for the government to re-evaluate the GP Grants Program and ensure it truly supports the advancement of digital health capabilities across the country.

It is never too late!!

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