Regulation of prescribing of medicines
The discussion paper set out the current legislative framework that regulates the prescribing of medicines by registered practitioners. At present medical practitioners, nurse practitioners, dentists, optometrists and Chinese medicine practitioners have prescribing rights, but the nature and scope of these rights varies (chapter 20).
Views were polarised on whether approval processes for new drugs or lists of drugs should be streamlined, and whether additional professions such as podiatrists should have limited prescribing rights. Medical stakeholders generally opposed any extensions to prescribing rights or streamlining of approval processes for new drugs. Respondents from those professions with prescribing rights (or with aspirations for prescribing rights) supported more streamlined processes for approving lists of drugs.
The Department is of the view that:
Extensions to the scope of practice of various professions to include prescribing rights should be supported, where these professions can demonstrate sufficient training and adequate mechanisms to support safe and competent prescribing practices.
There is a net public benefit in supporting an expanded scope of practice for suitably trained podiatrists to prescribe from an approved list of drugs, and that legislative changes to support this extension should proceed.
There are adequate safeguards in the Nurses Act to ensure accountability and transparency in the way lists of drugs are approved for each category of nurse practitioner, without the need for the categories of nurse practitioner and lists of drugs to be prescribed in regulation.
There must be a transparent and accountable system in place for approving the drugs available for prescribing by practitioners from those professions with limited prescribing rights.
The system must ensure that the lists of approved drugs or classes of drugs become official and known/available, for example, to those with statutory responsibilities under the Drugs, Poisons and Controlled Substances (DPCS) Act such as pharmacists and wholesalers.
Once an initial list or class of drugs has been approved by the Minister (following advice provided by the Poisons Advisory Committee), administrative arrangements for approving changes/additions to the list should be streamlined and responsibility should reside with the respective boards.
Reform proposals
35. That the legislation make provision to retain limited prescribing rights for optometrists (drugs for the treatment of anterior eye disease), nurse practitioners (various drug formularies depending on category of nurse practitioner) and Chinese medicine practitioners (Schedule 1 herbs).
36. That the legislation make provision for limited prescribing rights for podiatrists appropriate to their scope of practice.
37. That the legislation make provision for the following in relation to limited prescribing rights:
* A board responsible for overseeing limited prescribing rights for a profession be empowered to endorse suitably qualified practitioners to be authorised under the DPCS Act to prescribe drugs.
* The board be required to have in place a statutory committee with a membership and functions similar to those set out in sections 79(3) and 80(2) of the Nurses Act.
* The Minister have statutory power to receive applications from a board for approval of endorsed practitioners to prescribe a drug, type or class of drugs, including, where relevant, type of preparation and route of administration, and to approve this application for the purposes of authorisation of endorsed practitioners under the DPCS Act.
* The Minister have the power to determine matters to be addressed in an application for approval of prescribing rights, including:
o The scope of the approval sought.
o The consultation undertaken by the board to determine the need for and scope of the limited prescribing rights, including what expertise it has accessed.
o The arrangements the Board has made to ensure that existing and newly endorsed practitioners have adequate skills and knowledge to prescribe the drugs.
o The safeguards in place to ensure safe prescribing, including any clinical practice guidelines, CPD requirements etc.
* The Minister have statutory power to amend, vary or withdraw an approval at any time.
* The DPCS Act be amended to authorise endorsed practitioners to obtain possess, use sell or supply any Schedule 2,3, or 4 poison as long as it is consistent with the terms of the Ministerial approval and the endorsement granted by the registration board.
* That once the Minister has granted an approval, the registration board be empowered to issue and clinical practice guidelines for endorsed practitioners, and to amend from time to time any associated drug formulary, as long as such changes are within the scope of the approval granted by the Minister and the requirements of the DPCS Act.
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