Prescribing Rights For Allied Health Practitioners – Opportunities For Reform
The release of the Strengthening Medicare Taskforce Report signals the Australian Government’s intention to consider new approaches to funding, regulating and organizing the delivery of primary care services.
The vision to strengthen Medicare includes ‘coordinated multi-disciplinary teams of health care professionals work to their full scope of practice to provide quality person-centred continuity of care, including prevention and early intervention’. (Australian Government 2022: 4). Some of the report’s recommendations, if implemented, may bring opportunities for the allied health professions to expand their remit.
But what does it mean for allied health practitioners to ‘work to their full scope of practice’? This article addresses this question with particular reference to the use of restricted (scheduled) medicines.
The division of labour in Australian health care is highly contested. Turf wars abound both within and between professions, over who does what, when, where and how. While scopes of practice are constantly evolving in response to shifts in technology, training and population health needs, legislation can present barriers to scope of practice change – laws that authorise only certain classes of health practitioner to do certain things. The legal authority to prescribe scheduled medicines is one example where scope of practice change often requires changes to legislation.
Organised medicine has a long history of actively opposing regulatory changes that extend the right to prescribe medicines to ‘non-medical’ health professions.
Some scholars have argued that organised medicine’s efforts to maintain its monopoly over the prescribing of medicines for patients has been key to maintaining the power of the medical profession to control and direct the work of other health occupations (Collins 1990a: 20). However, despite continuing resistance from organised medicine, in the last two decades a range of health professions, such as optometry, podiatry, pharmacy, nursing and midwifery have achieved prescribing rights, albeit limited in scope (Health Workforce Australia, 2013; Carlton, 2017). Many of these professions now have an extensive track record of safe prescribing practice.
The legislative framework under which health practitioners are authorised to use (administer, supply or prescribe) scheduled medicines is complex – a mix of Commonwealth legislation that sets nationally agreed standards, and state and territory laws that authorise members of specific professions (or classes of practitioner within a profession) to administer, supply or prescribe medicines.
While state and territory governments use various mechanisms to authorise classes of health practitioner to administer scheduled medicines, currently, the authority to autonomously prescribe scheduled medicines is available only to practitioners from professions that are regulated under the National Registration and Accreditation Scheme (NRAS).
Under the NRAS, a regulatory mechanism known as an ‘endorsement for scheduled medicines’ is used to identify registered practitioners who are considered qualified and competent to prescribe scheduled medicines. A registered practitioner may apply to their National Board for the endorsement. State and territory scheduled medicines laws then authorise endorsed registrants to prescribe restricted medicines, generally in accordance with the terms of their endorsement. To date, only the National Boards for optometrists, nurse practitioners, nurses, midwives and podiatrists have been approved by the Ministerial Council to grant scheduled medicines endorsements to their registrants.
National Boards require an applicant for an endorsement of registration to demonstrate the necessary competencies for safe prescribing practice and they also assess and accredit the training programs. In 2021, NPS MedicineWise published an updated version of its Prescribing Competencies Framework. The Framework describes prescribing expectations for all prescribers regardless of profession, and the curriculum design for medical, pharmacy and allied health prescribing courses.
The trend to extend or expand prescribing rights to allied health and other professions is evident in many countries around the world. A recent study commissioned by the World Health Organization reviewed the global literature on health practitioner regulation (Leslie et al., 2022). The study examined the literature on different approaches to regulating practitioner scopes of practice and the impacts on health workforce capability, flexibility and access for patients to safe, high-quality services.
The researchers made several findings with respect to the way practitioner scopes of practice are regulated. They point to extensive evidence that restrictive and unresponsive scope of practice regulation is stifling innovation, inhibiting workforce reform and having adverse impacts on healthcare access and quality (Leslie et al., 2022: 8). This literature on scope of practice reform shows the complexities of a dynamic and evolving division of labour in the health sector, the modern context of team-based and collaborative practice, and the urgency of workforce reform to improve access to care.
The researchers conclude that expanding health care worker scopes of practice to encompass prescribing and administering restricted medicines improves access to and quality of care, particularly for rural or other underserved populations (Leslie et al., 8). The role of regulators is considered important – to set the necessary competencies, accredit training programs, monitor compliance with standards for safe use of medicines and deal with registrants who breach accepted practice standards (Leslie et al., 8).
In Australia, progress in expanding allied health scopes of practice to incorporate prescribing rights has been slower than necessary to meet population health needs. Of course, workforce reform must be informed by the best available evidence and carefully designed and implemented. We are hopeful that implementation of the Strengthening Medicare Taskforce Report will provide opportunities to accelerate the pace of workforce reform – to expand in a measured and responsible way the authorities of allied health professions to prescribe, supply and administer scheduled medicines, for the benefit of all health consumers.
Dr Anne-Louise Carlton is Senior Policy Advisor at HealthWork Solutions. View some of Anne-Louise Carlton’s published research here. | Connect with Anne-Louise on LinkedIn.
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References
Australian Government (2022). Strengthening Medicare Taskforce Report. December 2022.
Collins, R. (1990a). Changing conceptions in the sociology of the professions. In R. Torstendahl, & M. Burrage (Eds.), The formation of professions: Knowledge, state and strategy (pp. 11–23). London: Sage Publications.
Health Workforce Australia (2013). The Health Professionals Prescribing Pathway.
Leslie, K., Bourgeault I.L., Carlton, A.L., Madhan Balasubramanian, M., Mirshahi, R., Short, S., Cometto, G., Lin, V.K. (2022). Design, operation and strengthening of health practitioner regulation systems: A rapid integrative review. (kleslie@athabascau.ca).
