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- Issue 81: April 2009
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Prescribing Pharmacists Have Arrived in Australia

Lesley Gregory
From a Prescribing Pharmacist Perspective

Issue 79: February 2009
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version
I migrated to Perth in January this year from the UK. Prior to that I was a UK Pharmacist Prescriber, a position I held and developed over 4 years.
I qualified as a Supplementary Prescriber in August 2004 and was amongst the first cohort of pharmacists to receive this accolade in the UK.
Prior to that I was a Prescribing Adviser and Medicines Information Pharmacist for a Primary Care Trust (PCT) – an NHS body with responsibility amongst other things, for ensuring quality and cost-effective prescribing.
I was affiliated to an organization called the National Prescribing Centre which is virtually the same as the Australian National Prescribing Services.
At the time, as you are now experiencing in Australia, there was a problem of a shortage of GPs and the Primary Care Trust began to look at other models for provision of prescribing services in particular.

Nurses had been the first to receive prescribing rights 10 years previously.
At the time I qualified as a Prescriber there were approximately 27000 nurses who had a prescribing qualification in the UK, but less than 10% of them used it on a regular basis.
My fellow pharmacists prescribers and I enthusiastically faced the challenge.

I simply changed tack from advising GPs on what they should be prescribing to actually seeing patients and making prescribing decisions myself.
Don’t get me wrong I’ll never forget the first time I put pen to pad to write my first prescription.
It was for Aspirin 75mg dispersible tablets- one a day.
Considering I’d conscientiously sold Aspirin 300mg to treat headaches over the counter in my community pharmacist days, I didn’t half inwardly make a big fuss, checking and rechecking that there were no contraindications or interactions and that I’d given the patient adequate information about the adverse effects and how best to avoid them.

Initially the area I chose to prescribe in was Cardiovascular diseases mainly in hypertension, dyslipidaemias and general management of cardiovascular risk as I had been the PCT ‘lead’ for advice in this area.
I was commissioned to work in three different surgeries and had once weekly pharmacist led Cardiovascular Clinics in each of them.
My appointments were for 20 minutes which was sufficient for me to provide an additional general medication review with the patients.
I felt like the new kid on the block but to my relief everyone including doctors, nurses and the patients were extremely accepting of me from the start.
Before treating patients I had to obtain their formal consent and to my amazement in those four years not a single patient declined to let me treat them.
I guess patients in the UK are now very used to multidisciplinary teams and they actually enjoyed the longer appointments I could offer as this enabled them to relax and air concerns that they might not have felt able to do in a 10 minute appointment with a GP.

Perhaps the biggest endorsement of my skills came when the Senior GP partner of one of the surgeries I worked in asked me to work solely for them.
Prior to that my services had been ‘free of charge’ from the PCT but presumably the GP partners could see that my clinics were well attended, well run and that I was fastidious about treating patients safely, cost-effectively and ‘to target’.
In fact the GPs often referred hypertensive patients to me that they admitted they couldn’t cope with themselves!

Despite my confidence today at the time I started the prescribing course the very same concerns and objections that you have raised were running through my mind.
But of course I was a Pharmacist and by nature we are a very cautious and pedantic breed. We do everything by the book.
We play by the rules.
Medicines can be lethal and should be treated with the utmost respect.
I still play by the rules and have never lost that respect which is another reason, perhaps, that makes us good prescribers.

My main worries at the start of the course were the big E and D – Examination and Diagnosis!
When I first qualified as a pharmacist back in 1990 I was a bit squeamish and used to look on the fact that Pharmacists never had to actually touch patients as being one of the perks of the job!
I soon got over this aversion and the Supplemetary Prescriber course did provide formal training in clinical examination and we had to pass some quite rigorous OSCEs.
I actually quite enjoyed that part of the course but to be honest despite prescribing in quite a broad variety of areas, I have still yet to actually physically examine a patient.
I didn’t need to.
The vast majority of patients I saw had an existing diagnosis.
As a prescriber I simply adopted these patients from GPs and took on the responsibility of prescribing for their long term conditions.
I did however train as a phlebotomist mainly to enable me to improve the service I offered to patients I visited at home.

As my role developed I began to find the Supplementary Prescribing restrictions were a burden upon both me and my GP Independent Prescriber colleagues.
I subsequently did an Independent Prescriber course and qualified as an Independent Pharmacist Prescriber.

Pharmacist prescribing can take many forms from Pharmacist led Anti-coagulant clinics in hospitals where Pharmacists simply prescribe warfarin in response to INR results, to more complex scenarios such as in hospices where pharmacist supplementary prescribers can prescribe controlled drugs to treat cancer related pain and other palliative treatments.

In the UK pharmacist prescribers are making a valid and respected contribution to the National Health Service.
In recognition of this The Royal Pharmaceutical Society have bestowed upon us the honor of some more Post Nomial letters!

I hope my brief insight has put to rest some of your concerns.
I obviously have a vested interest in encouraging Pharmacist Prescribing in Australia and I look forward to perhaps helping to develop this role with you.

Pharmacists are highly educated and capable healthcare professionals.
I would encourage you to promote this and the benefits we can provide to the Australian Government.
We are definitely the next best placed professionals to adopt prescribing responsibilities.
Pharmacist Prescribing has been shown to work well in the UK and it can of course work just as well here in Australia?


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