Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023

By John Berger

03 AUGUST 2023

I rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Authorising Pharmacists) Bill 2023. This bill will introduce minor yet important changes to the Drugs, Poisons and Controlled Substances Act 1981 which will allow community pharmacists a far better platform to provide health care. The bill will act as a 12-month pilot with three principal areas of focus: continued supply of oral contraception, treatment of some skin conditions and antibiotics for certain urinary tract infections (UTIs). It also includes an expansion of the vaccines that pharmacists are authorised to administer. This bill is an important step in reducing the strain on our GPs by allowing pharmacists to prescribe medications for simple diseases, which can reduce the total stress on our healthcare system and free up GPs for more serious matters.

The community pharmacist statewide pilot will ensure that health care and medication are more accessible to Victorians who truly need them. This bill is also a way that we, the Andrews Labor government, are honouring the promise that we brought to Victoria in the 2022 election: the promise that we would back pharmacists. Much like the Andrews Labor government, community pharmacists do what matters. I will explain more specifically how the bill goes about achieving this by acquitting pharmacists with the necessary means to deliver uncomplicated but essential procedures. This will be achieved by establishing a strong regulatory body for pharmacists to ensure that they are legally authorised to administer these services, which include pharmacists writing prescriptions, administering vaccines and even treating mild, uncomplicated medical conditions. This is all about ensuring that primary health care is as strong as it possibly can be, especially in lower risk cases and for conditions that have the potential to become complicated. It is essential that these be treated as soon as possible, not only for the individuals suffering from the condition but also for the health system. If it is easily avoidable, then we do not want the resources to be focused on a condition that could have been simply treated earlier.

Under these amendments pharmacists will be able to directly prescribe medications like antibiotics for uncomplicated UTIs or oral contraceptive pills, both very common medications. This will decrease the number of individuals requiring doctors appointments. Due to this, the bill will expand the accessibility of certain medicines and make the process of receiving treatment less stressful for Victorians who tend to already be in extremely stressful circumstances. Navigating the health system is always a stressful situation, which is why it is essential that we have a government that recognises this and does everything in its legislative power to mitigate the negative aspects of those experiences safely and sensibly.

The fact of the matter is that backing pharmacists boosts our healthcare system, which is exactly what this bill does. Health is one of those bread-and-butter issues that a Labor government will always deliver on. We are after all the party that on a federal level brought in Australia’s Medicare. The Andrews Labor government is no exception to this rule. We have done extensive work in supporting and improving the Victorian health system by introducing innovative new approaches to the way Victorians receive health care. We are making treatment more accessible and alleviating pressures on our existing hospitals and clinics.

By allowing pharmacists the power to deliver more medications, two things will happen. Patients seeking prescriptions will no longer have to go through the hoops of renewing prescriptions when they require medication. This will be particularly impactful on Victorians who are not in a position to seek private health care and must go to the bulk-billing clinics, which often have much longer wait lists.

This leads on to the second effect that this pilot will have on the health system. This pilot will have a positive impact on the strain that health services are experiencing right now. Our frontline workers are the backbone of our community, and for this reason every effort should be made to decrease the size of their workload.

Additionally, community pharmacists will be authorised to complete other services that previously in Victoria only GPs were able to deliver. This includes several different services. Wider access to these services through pharmacists will greatly ease the strain on our health care providers at this time. For example, community pharmacists with general registration qualifications will now be able to administer a wide range of vaccines, including both health and travel vaccines. This is technically an expansion of the already successful pharmacist-administered vaccination program. The amendments made by this bill will allow community pharmacists to deliver travel vaccines in addition to the core health vaccines such as COVID-19 and influenza vaccines that they already are authorised to administer. This is another measure in the bill that eases the strain on GPs to promote accessibility for patients. This will also lead to several other beneficial outcomes for Victorians – cheaper health care for a start – by eliminating the steps that the individual must take before purchasing their actual medication. Safeguards are put in place to ensure that the new method of acquiring a prescription is not more expensive than a normal bulk-billed GP visit. Additionally, overlapping medications that are affected by this authorisation of pharmacists and those affected by the pharmaceutical benefits scheme are in fact still covered by the Commonwealth government scheme. This is about improving accessibility for those seeking medications, not locking them out through pricing.

‘Community pharmacist’ is a very appropriate way to label this new role, as they are able to support the community and the members of the community medically when doctors are unable to do so at the same rate of efficiency. The existence of such pharmacists will greatly decrease the financial squeeze that families can feel when they seek medical care.

The pilot program absolutely does not mean that the price of medicines will go up. Victorians will not be spending more than they would be when going to their GP. As of May this year there were 1453 community pharmacies across Victoria. This means that there are over 8300 pharmacists in Victoria with a general registration. That is all these pharmacists need – general registration and an untapped workforce of competent professionals. There are similar pilot programs that have been implemented in other jurisdictions, and they all show promising results for a solution to many of the problems that face many health systems.

We know there are similar programs implemented in domestic jurisdictions and internationally. Both Queensland and New South Wales have given pharmacists the power to treat less complicated cases or certain conditions, like UTIs, which, left untreated, may develop dangerously and in a manner that poses a serious threat to a patient, and difficult conditions to navigate the health system with. Queensland established the two-year trial in 2020 of a structured pilot program allowing pharmacists to prescribe medications to address UTIs which, since its conclusion and success, has been adopted as a permanent policy. It continues to produce results for people in Queensland needing treatment. Similarly, New South Wales is in the process of implementing a similar policy with similar structural regulations to provide specific trained pharmacists the power to prescribe certain medications for specific conditions. The Andrews Labor government hopes to learn from these examples by introducing the successful practice of prescribing pharmacists, taking notes from the strict regulation of those two northern states so that the rollout of our own pilot program will be as safe as possible whilst ensuring the flexibility inherent in the making of an effective program.

Prescribing pharmacists are not a new concept by any means. They have been a common fixture in the health system in New Zealand, the United Kingdom and Canada for over a decade and have proved to be very effective in decreasing the strain on their hospitals, clinics and other places of healthcare delivery. Additionally, in implementing the Victorian iteration of prescribing community pharmacists, in-house prescriptions will be subsidised by the Victorian government, meaning that all affected medications will be the same price as they are under the pharmaceutical benefits scheme. This is because we believe that it is essential that a government ensure that all its constituents are able to access necessary health care. This is achieved by removing barriers for people seeking health care and making it more accessible.

On the topic of accessibility, one of the bigger problems that health systems face is the very literal question of space. Geography can often determine your health and your health care that you are able to receive. This bill addresses that by making a concerted effort to implement community pharmacists in rural, regional and remote areas. Whilst it is an issue that not many of my constituents face, I understand, and I am sure everyone on the other side of the chamber does too, that seeking health care when you are an hour’s drive from the nearest GP or hospital can be incredibly difficult and sometimes dangerous. This is addressed by ensuring that regional pharmacists will have the same ability to prescribe as those in metropolitan areas. This will be a huge win for regional Victorians and improve their wellbeing and health.

The pilot has been designed and will continue to take on the recommendations from several expert groups and stakeholder representatives. This is to ensure that, through the extensive expert and stakeholder engagement, the pilot will in fact be the best possible version it can be before being rolled out. The design has been informed by the community pharmacist statewide pilot clinical reference group. The pilot’s clinical reference group has contributed greatly to the design of the pilot, ensuring that clinicians who are experts in their respective fields of medicine may contribute critiques and improvements to the model to ensure that we seek the best possible designed version of pharmacist-delivered prescriptions for the Victorian people.

The pilot clinical reference group is chaired by Safer Care Victoria, which comprises professionals who come from a range of backgrounds and fields of expertise. The reference group received input from veterans of fields like community pharmacy, microbiology, pharmacology, general practice, women’s health, infectious diseases, antimicrobial stewardship, therapeutic guidelines, clinical safety and so on. These contributors were experienced clinicians, pharmacists, educators and safety experts alike and all accomplished in their fields to ensure that the design was also informed by direct stakeholders external to the clinical reference group by way of an advisory group. The advisory group is comprised of pharmacists, doctors, community members and other stakeholders. This ensures that those who will interact with the pilot on a day-to-day basis as part of their job or medical treatment have had a hand in suggesting what they believe is the design to deliver the best outcome for the health system and those who interact with it.

In cooperating with clinicians the Andrews Labor government has ensured that all medicines that pharmacists will be able to prescribe are in line with the current clinical regulations. This is to ensure that the pilot is delivered as safely as possible. In addition to this, other measures to promote include a mandatory training program that all participating pharmacists will have to complete. There are other conditions determined by the clinical reference group that participating pharmacists and community pharmacists will have to meet. Guidelines and protocols on who and what can be prescribed will be carefully and thoroughly explained to participating pharmacists during their training in their new roles. They will also be easily accessible to ensure that there is no breach of community pharmacist privileges if they are genuinely unaware of the regulation. The department has also consulted directly with the Pharmacy Board of Australia and the Australian Pharmacy Council.

So in summary, although to many it may seem like a small change in the grand scheme of health regulation, this will forever change the Victorian health system and will change how Victorians interact with their health care. Seeking treatment should be easy and accessible. You should not be locked out of seeking care because of how much money is in your bank account or where you live. Every Victorian deserves a health system that can do what matters. One of the key aspects of that is having a government that backs pharmacists. The Andrews Labor government is that government. We will support anybody that does what matters, and pharmacists and GPs – they do.

This bill also highlights one of the key parts of this year’s budget: backing women’s health. Many of the conditions that participating community pharmacists will now be able to treat and prescribe medications for overwhelmingly affect women and girls – conditions for too long that have been ignored or not believed. This will remove the barriers that women experience in the health sector and ultimately will create a fairer, more equal and healthier Victoria. Improvement in women’s health is also one of the key areas that will be assessed at the end of the 12-month pilot. I look forward to seeing the results of the 12-month pilot, and I commend the bill to the house.