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Non-medical prescribing no cure for workforce ills

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On 8 November, Australia’s Health Ministers approved a framework for non-medical health practitioners to prescribe medicines without any oversight from a medical practitioner.
You may have seen the AMA response – which labelled the decision as “a green light to fragmented care” – but not quite understood what all the fuss is about. Here’s some more information.
The Health Workforce Australia (HWA) framework – known as the Health Professionals Prescribing Pathway – aims to provide a national approach to the training, accreditation and endorsement of non-medical health professionals to prescribe medicines. In this context ‘non-medical’ covers only health practitioners registered under the National Registration and Accreditation Scheme (and expressly excludes medical practitioners and dentists).
Development of the framework was largely prompted by the assumption that medical practice workforce shortages and maldistribution have created barriers to health care access, and that access will become increasingly difficult as the population ages and demand increases.
HWA also assumed that broadening prescribing eligibility to non-medical health professionals would address access problems without affecting safety. No cost-benefit analyses were undertaken to test these assumptions.
The AMA recognises that ad hoc practices and approaches to education, practitioner competence and prescribing practices are a risk to patient safety.
We acknowledge that the Health Professionals Prescribing Pathway will go some way to reducing the hazards associated with prescribing by non-medical health professionals.
The AMA also supports the way the pathway provides a framework for health professional national boards and accreditation councils to make their education requirements, competency standards and assessment processes nationally consistent, and meet the high standards set by the NPS Prescribing Competencies Framework.
However, we strongly oppose the autonomous model of prescribing that is described in the HWA framework.
We maintain that in the interest of patient safety, any prescribing by non-medical professionals must be carried out within collaborative care arrangements, with the relevant medical professional groups working with the relevant non-medical groups.
The AMA argued long and hard against the autonomous model of prescribing throughout a year-long consultation process with HWA, which involved an advisory group comprising a range of health professionals. Associate Professor John Gullotta ably represented the AMA on this advisory group.
Despite this, HWA decided to retain autonomous prescribing as one of three models it recommended to the Health Ministers.
The Health Ministers’ decision will have implications for quality use of medicines. HWA has now been tasked with working with jurisdictions to develop a strategy for implementing the pathway. We don’t know how quickly non-medical health practitioner boards will pursue the HWA pathway.
The risk is currently contained, as State and Territory legislation limits non-medical health practitioners to prescribe only certain medications, and generally only covers dentists, optometrists, nurse practitioners, midwives and podiatrists. Similarly, PBS restrictions confine these practitioners in defined circumstances to non-PBS prescriptions, with a cost that may be a deterrent for their patients.
However, the framework theoretically supports national health practitioner boards to endorse practitioners to autonomously prescribe scheduled medicines, which in turn gives the practitioners a reason to lobby State and Territory governments to change the legislation.
The AMA and all other medical practitioner organisations will need to lobby hard to convince governments not to relax current prescribing restrictions, and we will be meeting with the organisations working in the areas of medical care that are most likely to be affected.
If you’d like further information about the AMA’s rationale for opposing autonomous prescribing by non-medical health professionals, read our initial submission to HWA at [node/7989]. The framework and pathway approved by Health Ministers is available on the HWA website at [http://www.hwa.gov.au/hppp].