Council News December 2023 

Council Message

Welcome to the final edition of the Pharmacy Council of NSW newsletter for 2023.

Challenges for community pharmacy

In this newsletter we include an article on the challenges that community pharmacy faces during the holiday season and the importance of extra vigilance during this busy time.

• A case study in relation to ‘Emergency supply and Continued Dispensing’.
• Advice in relation to ‘Dose administration aids (DAAs) and staged supply of dispensed medicines’, including advance packing.
• Advice in relation to access to pharmacies and scheduled medicines.

Pharmacy Ownership Applications

One of the responsibilities of the Pharmacy Council of NSW (the Council) is maintaining the register of pharmacies in NSW.

The register includes particulars of approved premises for the carrying on of a pharmacy business by a pharmacist and particulars of the registered holders of pecuniary interests in the pharmacy business. Pursuant to Health Practitioner Regulation National Law (NSW), a person cannot carry on a pharmacy business in NSW unless the premises have a current approval and all holders of a financial interest in the pharmacy business are registered in the National Register of Pharmacists. The National Register is maintained by the Australian Health Practitioner Regulation Agency.

With limited exceptions, only a registered pharmacist, a partnership of registered pharmacists and a pharmacist's body corporate (as defined in the National Law (NSW)) can hold a financial interest in a pharmacy business in NSW.

The Council would like to stress that we take this aspect of the National Law very seriously. We make an independent assessment of each application’s merits by referring to the terms of the National Law.

For any pharmacists considering ownership, we strongly recommend you review the publications and guidelines section of our website to ensure your application is complete at time of submission.

The Council strongly advises potential applicants to the Register of Pharmacies to closely read the relevant materials on our website and diligently examine documentation before submission to assessment by the Council. The Council can only assess complete and compliant applications. It is the applicant’s responsibility to ensure the application is accurate, complete and in accordance with the National Law.

NSW Pharmacy Quarterly Stakeholder Forum

The Council continues to interact with stakeholders, with the most recent Pharmacy Stakeholder Forum held on 17 November 2023 as an out-of-session meeting to provide members with information on the Exposure Draft Medicines Poisons and Therapeutic Goods Regulation 2023.

The next forum will be hosted by the Pharmacy Guild of Australia in December 2023.

Podcasts

If you have not yet listened to our podcasts, we encourage you to do so now. Please access the podcasts via our useful links section below. The latest podcast Episode 4: Managing pharmacy workloads is about managing pharmacy workloads and what pharmacists should be enquiring about when seeking new employment.

Office closure

We advise that the HPCA office will be closed from Monday 25 December 2023 to Friday 5 January 2023. HPCA will continue to process urgent complaints during this period. Ownership applications and less urgent complaint matters will be dealt with after the office reopens on Monday 8 January 2023. If you have any queries, please contact the Council secretariat prior to the office closure on 1300 197 177. Ownership queries may be sent via our application email address: hpca-cms-pharmacy-applications@health.nsw.gov.au 

We would like to take this opportunity to wish all pharmacists and their families and loved ones a safe and happy festive season.  

Veronica Murdoch
President, Pharmacy Council of NSW

Challenges during the holiday season

As the year nears its end, it is even more important for practitioners to be aware of additional time constraints and challenges faced in community pharmacy practice during the holiday season.

When the volume of work increases so, too, does the risk of error. It is critical that practitioners are vigilant and adhere to best practice dispensing guidelines.

Regular communication is a critical component of the relationship between practitioners and their non-professional staff. It is prudent to conduct staff meetings to review Standard Operating Procedures, ensure staff are aware of all policies and procedures, and confirm that there is agreement by staff on workplace policies.

Often, there is pressure during this time from patients to supply medication as an ‘emergency supply’. Please ensure you are aware of the policies and protocols to which all staff must adhere and ensure practitioners and staff abide by all legislative requirements.

During the holiday period, many patients are likely to seek early dispensing because of their travel arrangements. It is critical to abide by the legislation and guidelines applicable to dispensing prescriptions earlier than normal.

The Ahpra shared code of conduct refers to patient care is a pharmacist’s primary concern in clinical practice. Providing good care includes that pharmacists facilitate coordination and continuity of care.

A case study in relation to ‘Emergency supply and Continued Dispensing’

You are working in a small seaside town that gets very busy during the holidays with travellers from the city. A person presents to the pharmacy. They explain that they have been travelling, have had their car break down and that it requires servicing, resulting in them running out of their regular medications. They have not been able to get in contact with their usual GP to get another script, and they don’t leave their scripts on file with their usual pharmacy. You know the local GP surgery is closed this week, as the doctor is on holidays, and the nearest emergency hospital is two hours away.

The medications the patient is taking are metformin 1000mg MR, irbesartan 300mg, apixaban 5mg and Flutiform 250/10 inhaler. What do you do?

In NSW, a pharmacist may supply certain PBS medicines under the Continued Dispensing arrangements. In order to supply under this arrangement, you should ensure that:

• the person has an immediate need for the medicine before a prescription can be obtained
• the usual prescriber is unable to be contacted and/or is unable to provide an e-prescription or owing prescription
• the medicine is eligible for supply under the arrangements (including under relevant state/territory legislation)
• the person has been supplied the medicine in the last three months and their condition is stable
• the medicine has not been supplied under Continued Dispensing arrangements to the person by any pharmacy within the 12 months before the requested supply, and
• it is safe and appropriate for the person to obtain the medicine.

The Pharmaceutical Society of Australia (PSA) has developed a set of guidelines for supply via continued dispensing.

Advice in relation to "Dose administration aids (DAAs) and staged supply of dispensed medicines", including advance packing

The Pharmacy Board of Australia Guidelines on dose administration aids and staged supply of dispensed medicines were developed in recognition of the increased demand for dose administration aids (DAAs) and, where used in association with them, automated dose packaging systems. Also addressed is advice on dealing with the supply of medicines to be issued periodically.

Pharmacists may provide DAAs for selected patients to assist in the safe and effective administration of a patient’s medicines and to enhance adherence. In addition to the Board’s Guidelines for dispensing of medicines, the Board has regard to established practice and quality assurance standards, including the DAA service standards and guidelines issued by the Pharmaceutical Society of Australia (PSA). These standards should be considered as part of the process of determining whether the provision of a DAA to a patient is appropriate.

Particular reference is made to the PSA Guidelines for pharmacists providing dose administration aid services - advance packing. A DAA should be packed as close as possible to the date of use. Packing DAA in advance of expected use may be associated with increased risk where subsequent changes to the patient’s medication regimen are made. Pharmacists must have a system for ensuring all medication changes are incorporated into any DAA already packed. Pharmacists should note that 7CPA DAA Program rules require provision of a weekly DAA service.

Under section 41 of the National Law, these guidelines can be used in disciplinary proceedings under the National Law or law of a co-regulatory jurisdiction as evidence of what constitutes appropriate professional conduct or practice for pharmacists.

Advice in relation to access to pharmacies and scheduled medicines

With the Christmas and New Year break approaching, many of us are looking forward to some time off. However, pharmacies will continue to operate over this time, and thus you may have employed a locum pharmacist to cover for your holiday.

The Pharmacy Council would like to remind you of your obligations regarding access and supplying keys, access codes and safe access to locums.

The Health Practitioner Regulation National Law (NSW) Schedule 5F, clause 11(1) state that a pharmacist is to be in charge of every pharmacy business in NSW, where a pharmacy business carried on in approved premises must be in the charge of a pharmacist who must personally supervise the carrying on of the business.

In real terms, this means that whenever a pharmacy is open and operating as a business, regardless of whether dispensing is undertaken, the pharmacy must have a registered pharmacist on the premises at all times.

A message from the NSW Ministry of Health  

Updated pharmaceutical regulatory policy for prescribing or supplying psychostimulants in attention deficit hyperactivity disorder (ADHD)

From 13 November 2023 psychiatrists, paediatricians and neurologists are authorised under a class Authority to prescribe or supply psychostimulant medication for the treatment of ADHD in a non-drug dependent person. The class Authority can be used to prescribe up to a maximum daily dose of:

• dexamfetamine 50mg
• lisdexamfetamine 70mg
• methylphenidate 108mg

Destruction of Schedule 8 medicines at community pharmacies

As of 29 September 2023, the Poisons and Therapeutic Goods Regulation 2008 will allow a pharmacist who practises at a community pharmacy to destroy a drug of addiction (Schedule 8 medicine) at the pharmacy in the presence of an independent witness. For more information see Destruction of Schedule 8 medicines by community pharmacists.

The Ministry of Health is consulting on the Exposure Draft Medicines Poisons and Therapeutic Goods Regulation and its Regulatory Impact Statement

The NSW Ministry of Health is seeking your feedback on the Exposure Draft Medicines, Poisons and Therapeutic Goods Regulation (Draft Regulation) and its Regulatory Impact Statement.

The Medicines, Poisons and Therapeutic Goods Act 2022 (the Act) passed Parliament in November 2022. On commencement, the Act will replace the current Poisons and Therapeutic Goods Act 1966 (PTGA) which is the primary legislative framework governing the control of medicines, poisons, and therapeutic goods in NSW.

Recent Tribunal decisions 

Health Care Complaints Commission v Mai [2023] NSWCATOD 120

In its decision of 9 August 2023, the Tribunal found Mr Mai’s convictions rendered him unfit in the public interest to practise and that he was guilty of unsatisfactory professional conduct. The Tribunal cancelled Mr Mai’s registration as a pharmacist and imposed a non-review period of one year.

Health Care Complaints Commission v Lowe [2023] NSWCATOD 121

In its decision of 11 August 2023, the Tribunal found Mr Lowe’s convictions rendered him unfit in the public interest to practise and that he was guilty of unsatisfactory professional conduct. The Tribunal cancelled Mr Lowe’s registration as a pharmacist and imposed a non-review period of three years. 

Health Care Complaints Commission v Akawee [2023] NSWCATOD 115

In its decision of 3 August 2023, the Tribunal found Mr Akawee guilty of unsatisfactory professional conduct and professional misconduct. The Tribunal cancelled Ms Akawee’s registration with a non-review period of 12 months.

Health Care Complaints Commission v Grewal [2023] NSWCATOD 132

In its decision of 31 August 2023, the Tribunal found Ms Grewal’s conviction rendered her unfit in the public interest to practise and that she was guilty of unsatisfactory professional conduct. The Tribunal reprimanded Ms Grewal and cancelled her registration with a non-review period of 3 years. The Tribunal also imposed an order prohibiting her from providing a health service for the same period.

Health Care Complaints Commission v Osman [2023] NSWCATOD 177

In its decision of 4 December 2023, the Tribunal found Mr Osman guilty of unsatisfactory professional conduct and professional misconduct. The Tribunal cancelled Mr Osman’s registration with a non-review period of 6 months.

Useful links

Pharmacy Council podcasts:

Episode 1: Keeping the public safe - What pharmacists need to know

Episode 2: The dangers of high-risk medications

Episode 3: The importance of proprietor oversight

Episode 4: Managing pharmacy workloads