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Increased role for pharmacists poor prescription for rural ills

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Calls to allow pharmacists in country areas to issue prescriptions and administer vaccinations would condemn rural Australians to substandard care, the AMA has warned.

The Grattan Institute, a think tank, has proposed that pharmacists be given a greater role in providing care in rural communities as a way to improve access to GPs for more serious medical conditions and concerns.

But AMA President Dr Steve Hambleton said it was a flawed idea that would compromise the standard of care rather than improve access to primary health services.

“GPs are the cornerstone of primary care for Australians, no matter where they live,” Dr Hambleton said. “The key to improving access to primary care for rural Australians is to provide greater support for GPs, not undermine them or have alternative health practitioners take over their specialised role.”

He said that pharmacists already had a very important role to play in rural health, by being pharmacists.

Dr Hambleton said the AMA has been working with the Pharmaceutical Society of Australia in a plan to allow practices to employ pharmacists on site, so that they can work alongside GPs and practice nurses in a primary care team led by the GP.

“This is a much safer and more practical primary health care model to serve the growing needs of rural Australians, he said.

According to the Grattan report, a shortage of GPs in many rural areas is imposing severe costs on individuals, doctors and the health system.

Author Dr Stephen Duckett said more than one million people were living in areas where there was a shortage of GPs, with barely half the GP services per person in very remote areas compared with the major cities.

Dr Duckett said the shortage was forcing many patients in rural and remote areas to defer or even avoid trying to see a doctor, with serious health consequences.

“People in rural areas with low access to GPs are more likely to have serious health risks,” he said. “If they can’t get care it will cost them, and the taxpayer, much more in the long run.”

Dr Duckett areas including Goulburn, Tamworth, Mount Isa, as well as the Northern Territory and most of Western Australia, were hit particularly hard by a shortage of GPs.

He suggested that pharmacists and physician assistants in under-served rural areas be allowed an expanded role in providing basic health services, freeing up GPs to handle more serious conditions and complaints.

“Pharmacists and physician assistants could take on some of the less complex tasks performed by GPs, without compromising quality and safety,” Dr Duckett said. “That would save money and free up GPs to do the more complex work they are trained for.

But Dr Hambleton it was a poor solution that was potentially dangerous and would consign rural Australians to poorer quality care.

He said there could be a greater role played by physician assistants, but only under tightly controlled circumstances, and the extra training involved would divert resources away from training the next generation of GPs.

“The AMA is not opposed to the use of physician assistants who would work strictly under the direction and direct supervision of GPs, but the reality is that there will be no extra training capacity for any new health professional in Australia until at least 2025,” Dr Hambleton said, adding that “the priority in medical training must remain with the medical students already in the training pipeline”.

“Providing prescriptions and vaccinations are key functions performed or directly supervised by GPs. It would be unwise to compromise the quality of health care by taking these functions away from general practice,” the AMA President said.

Rather than trying to get other health workers to take over some of the functions of GPs, Dr Hambleton said the AMA has proposed safer and more practical solutions to improve the access of rural Australians to GP services.

To achieve this, the AMA has called on the Abbott Government to provide a dedicated, quality training pathway, with the right skill mix to ensure GPs are adequately trained to work in rural areas, as well as more funding to support and encourage more generalist training.

To help address the imbalance in the distribution of GPs between rural and metropolitan areas, the AMA and the Rural Doctors Association of Australia have developed a Rural Rescue Package (node/4136) , which recommends financial incentives to ensure competitive remuneration for rural doctors.

In addition, the AMA has urged an extension of MBS video consultation items to include GP consultations for remote Indigenous patients, aged care residents, people with mobility problems and those who live some distance from the nearest GP.

The AMA has also urged the Government to replace the current flawed Australian Standard Geographical Classification and Districts of Workforce Shortage systems with a more comprehensive model that more accurately reflects the reality of on-the-ground workforce conditions.

Adrian Rollins