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1 2 RURAL DOCTORS ASSOCIATION OF AUSTRALIA POSITION PAPER EXTENDING THE SCOPE OF PRACTICE OF PHARMACISTS IN RURAL AND REMOTE AREAS Policy decisions taken to expand the scope of practice of health professionals must always put patient safety first. Pharmacists are integral members of the health care team. Over time pharmacy p ractice has evolved from the provision of traditional dispensing and compounding services to include a broader range of activities including consumer education, information and training provision for other health professionals, drug imprest management, and input into treatment protocols, patient monitoring and medical reviews. In recent years, it has been suggested that the scope of practice of pharmacists be extended to address the unmet health care needs of people living in rural and remote areas caused by a shortfall of GPs. This expansion would see pharmacists undertaking independent prescribing, administering of vaccines, conducting health checks, and ordering and interpreting laboratory tests. A more practical, effective and sustainable solution to meeting the health care needs of people living in rural and remote areas is to invest in targeted, evidence-‐based supports for rural doctors and rural practices to help attract and retain doctors in rural and remote areas with the right qualifications, skills and experience to deliver integrated, team-‐based care to meet local health care needs. 1 People living in rural and remote areas deserve access to the same high quality health care as people living in the major cities. This includes access to primary care services delivered by appropriately credentialed rural GPs who have undertaken specialised vocational training, and who m ake a lifelong commitment to maintaining and updating their knowledge and skills, supported by a network of highly skilled allied health workers. In rural and remote communities collaborative models of health care practice are both necessary and desirable. Local circumstances may require flexible delegation of clinical tasks and supervision across a GP led health care team to meet needs. RDAA believes that within this framework there is the capacity for pharmacists to work at peak professional capacity including as experts in the Quality Use of Medicine. RDAA does not support measures which compromise the specialised and central role that GPs play in the diagnosis and management of care of patients, or the ability of the community to attract and retain GPs. A visit to a GP, even to renew a prescription or receive a vaccine, often provides an opportunity for the GP to assess the patient’s overall health and wellbeing. In rural and remote areas, where visits may be less frequent, incidental care is particularly important. This opportunity may be lost if pharmacists, w ho have limited training in diagnostic techniques, undertake these roles discretely. The possibility of overlapping scopes of practice and fragmented care are also of concern. Lines of responsibility and liability could become blurred, particularly in relation to patient follow-‐up and monitoring of outcomes. Allowing pharmacists to prescribe medications w ould merge the role of the prescriber and supplier, creating the potential for a conflict of interest and removing an important safeguard for patients. There is no robust evidence to support the use of pharmacists over GPs for preventative medicine. There is evidence that early intervention through regular health checks performed in a general practice setting can produce significant reductions in key risk factors.1 RDAA believes that the greatest value is realised by pharmacists working collaboratively with other health professionals to deliver team-‐based care within clearly articulated governance frameworks. Policy settings to support these arrangements would improve the delivery of coordinated, high quality patient care and should be explored. Moss JR, Sullivan TR, Newton SS, Stocks NP. Effectiveness of general practice-‐based health checks: a systematic review and m eta-‐analysis. British Journal of General Practice. 2014; 64(618): e47–e53. doi: 10.3399/bjgp14X676456.