In Australia, medications are traditionally prescribed by medical practitioners such as general practitioners, dermatologists and paediatricians, as well as dentists. More recently, suitably qualified health professionals including nurse practitioners, optometrists and podiatrists have taken on the role of prescribing medications. In the past it has been up to the professional bodies to lobby for prescribing rights in a profession, and as the laws can vary in each state, prescribing rights may have been in place in some states but not others in the same profession throughout Australia.
A nationally consistent approach
A nationally consistent approach to prescribing my non-medical health professionals has been on the agenda for about 4 years, with a final report called Non-Medical Prescribing being released in June 2010. Health Workforce Australia undertook the Health Professionals Prescribing Pathway (HPPP). The HPPP final report was released in November 2013. The HPPP was conducted in 3 phases:
- Consultation on key issues and principles for a prescribing pathway
- Design of a prescribing pathway
- Testing and feedback on a draft Health Professionals Prescribing Pathway
In November 2013 Health Workforce Australia set out five steps to ensure the safe and competent prescribing of medications by health professionals other than doctors:
- Complete education and training
- Obtain recognition from the national Board of competence to prescribe
- Ensure authorisation to prescribe
- Prescribe medicines within the scope of practice
- Maintain and enhance competence to prescribe
Professions for and against the HPPP
The Australian Medical Association (AMA) made its opposition clear when the Health Workforce Australia consultation was underway, with articles such as this being published by the Medical Observer. In the AMA’s consultation response, they quoted the 2010 non-medical prescribing report which says that “without a team approach, patient care can easily fragment reducing quality of care and patient outcomes.” The AMA’s concerns about non-medical prescribing are also around the quality use of medicines, safety, medico-legal issues and education of non-medical prescribers.
By November 2013, the Australian Physiotherapy Association(APA) was applauding Health Workforce Australia’s HPPP and shift towards non-medical prescribing. The APA national president Marcus Dripps was quoted “A carefully designed and implemented non-medical health prescribing framework in Australia will allow patients to receive improved care from physiotherapists, reduce the burden on doctors, and decrease existing inefficiencies in the health system.”The APA believes that physiotherapists are “highly skilled, qualified and experienced primary contact health professionals, and experts at diagnosing, managing and treating musculoskeletal conditions and injuries, often providing recommendations for management including advising on the need to prescribe.”
While the APA was applauding Australia’s Health Ministers for progressing down the path towards non-medical prescribing, AMA president Steve Hambleton said that the new prescribing pathways could harm patients, and that the decision should be reversed before there were any risks to patient safety. Dr Hambleton said that “We support prescribing by non-medical professionals that is carried out within strict collaborative care arrangements in partnership with doctors. Most prescribing by non-medical health practitioners currently occurs in public hospitals under strict protocols. The AMA supports the prescribing competency framework developed by the National Prescribing Service (NPS). This framework sets high standards for prescribing that are currently only met by medical practitioners.”
The NPS “Competencies Required to Prescribe Medicines” framework can be viewed here.
Another issue that has been raised around the topic of non-medical prescribing is that of relationships of practitioners with drug company representatives. Professor Philip Darbyshire from the School of Nursing and Midwifery at Flinders University has said that non-physician clinicians such as nurse practitioners were naïve about how drug representatives could influence their prescribing habits. He stated that health care professionals including nurse practitioners need to be able to spot biased information that may be coming from pharmaceutical companies, and ensure that they stick to evidence-based practice guidelines.
Where to from here?
At this stage it looks like the AMA will continue to oppose non-medical prescribing where it is carried out autonomously by non-medical health practitioners. Allied health professional bodies will most likely continue to welcome the changes. It will be interesting to see if the AMA takes on a government body in a similar way to The Australian Society of Ophthalmologists (ASO) and The Royal Australian and New Zealand College of Ophthalmologists’ (RANZCO) courtroom battle with the Australian Health Practitioner Regulation Agency (AHPRA). In fact, the outcome of this will most likely set precedence for non-medical prescribing in Australia.