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Minutes

15 March 2006 | 21 June 2005 | 17 June 2002 | 12 March 2002 | 30 October 2001 | 31 July 2001

Confirmed Minutes of the New Prescribers Advisory Committee (NPAC) Sub-committee

Meeting held on 15 March 2006
133 Molesworth St, Wellington
10am – 12pm

Present:

NPAC Sub-Committee:
Margaret Horsburgh (Chair)
Beryl Anderson
John Shaw
Barnett Bond

Ministry of Health:
Ryan McLean (NPAC Secretariat)
Judy Glackin (Manager – Health of Older People & Workforce)

Podiatrist Board:
Trevor Tillotson (Board Chair)
Annabel Whinam (Board Registrar)
Greg Coyle (Board member and representative of School of Podiatry)

Apologies:

John Simpson (the Royal Australasian College of Surgeons)

In Attendance:

Ros Gellatly (Royal New Zealand College of General Practitioners)
Mark Jones (Australasian Society for Infectious Disease and College of Pathologists of Australasia)

ITEM 1 Welcome and Introduction

Margaret outlined the way the meeting would proceed and identified the key issues the New Prescribers Advisory Committee (NPAC) had seen as important to clarify before proceeding with recommendations. These were:

  1. how the podiatrists see collaboration and cooperation and how a prescribing podiatrist fits within the inter-disciplinary team;
  2. expanding on the training approach that would be adopted at an undergraduate and postgraduate level to ensure podiatrists were competent to prescribe, and have knowledge of the systemic effects of medications;
  3. clarification of the clinical content of the training podiatrists received including the supervision of prescribing practice by current prescribers;
  4. the list of medications podiatrists wish to prescribe;
  5. monitoring of podiatrist prescribers.

ITEM 2 Presentations by Judy Glackin

The presentation outlined the:

  • legislative requirements – particularly for consultation,
  • role of NPAC,
  • process for making a proposal to extend prescribing rights,
  • nature of prescribing, i.e the collaborative nature of prescribing,
  • health workforce environment, i.e the ageing population and increase in chronic illness such as diabetes, and
  • workforce implications, i.e continuum of care and information sharing between practitioners.

ITEM 3 Presentation by Greg Coyle

Issues highlighted included:

  • Only appropriately trained and competent podiatrists would be endorsed to prescribe; requirement will be for 3 years post-basic experience together with a postgraduate diploma completed on a part-time basis over 3 years;
  • It will be several years, once the right to prescribe has been extended, before New Zealand trained podiatrists begin to prescribe. The relevant training programme offered by the Auckland University of Technology (AUT) while developed in a generic format, appropriate for nurses seeking to become Nurse Practitioner Prescribers, will be revised where this is relevant for podiatrists seeking to acquire competencies to prescribe;
  • Only a limited range of prescription-only medicines was being sought for podiatrist prescribers to have access to;
  • Podiatrists with prescribing rights would maintain interdisciplinary practice; and
  • The Podiatrist Board would develop an appropriate Scope of Practice, ensure appropriate qualifications would be developed and monitor and audit, annually, those podiatrists who gained a prescribing endorsement.

The presentation noted that complaints about the practices of podiatrists are uncommon, also that podiatrists commonly work collaboratively with other health practitioners and that this is envisaged to continue where prescribing is concerned.

It was also suggested that where a podiatrist and medical practitioner worked collaboratively to provide patient care, the podiatrist would defer to the medical practitioner if a prescription was necessary.

ITEM 4 Discussion

Access to services and training

Some time was spent discussing patient access to services and the responsibilities of the medical practitioner within the inter-disciplinary team and with respect to the training/supervision of podiatrist prescribers

The Board stated it envisaged medical practitioners taking a mentoring, rather than oversight, role during the initial development of a podiatrist prescribers skills.

It was noted that the programme a podiatrist would have to complete to develop competence to prescribe would only be offered from Auckland. It was suggested that the Board might like to investigate distance learning so that those podiatrists not in Auckland or in rural areas might have easier access to training as it is patients in rural areas who may not have easy access to medical practitioners, who will benefit most from podiatrist prescribing.

It was clarified that unless the undergraduate training of podiatrists was increased from 3 years to 4 years that the completion of training to be eligible to prescribe would only be part of post-graduate training.

Limiting over prescribing and anti-biotic resistance

A point was raised regarding the incidence of over prescribing which has become prevalent in some areas of medical practice. An assurance was sought that podiatrists would, where possible, be encouraged to use a narrow spectrum range of antibiotics and focus on the micro-organism causing the infection

The Board made an undertaking to talk with the College of Pathologists so that both parties might work to develop best-practice guidelines for ensuring appropriate lab/culture testing.

An issue raised by the Board was the lack of funding subsidy to podiatrists around lab/culture testing. The Board undertook to raise this issue with the Ministry of Health.

Podiatrist understanding of prescribing

Some errors had been identified, specifically in the Boards case-studies which had been included in their submission to NPAC. This highlighted an issue around podiatrist’s knowledge of prescribing being of an acceptable standard. It was suggested that the School of Podiatry work with medical practitioners and pharmacists around developing an appropriate framework or model for case studies which highlight diagnostic and prescribing decisions.

The Board agreed that the ‘case studies’ submitted with their submission would be removed.

List of medicines

Some errors were identified in the list of medicines podiatrists are seeking to gain access to. The Board agreed to work with an experienced pharmacist to clarify and ensure accuracy of the list of medications podiatrist may wish to prescribe.

Monitoring

The Board will be establishing a Prescribing & Audit Committee to undertake annual audits of podiatrist prescribers. These audits will be based on the submission of a portfolio of prescribing activity, which will include a self-assessment by the podiatrist prescriber. The audits will be undertaken as part of the Annual Practising Certificate round. The Board gave an assurance that podiatrists are provided with training to self-assess from the commencement of their under-graduate training.

It was suggested that the Board employ a more robust system of monitoring podiatrist prescribers. This might include the use of Best Practice Advocacy Centre (BPAC) data collection services. The use of duplicate script analysis was also suggested as this would allow the Boards Prescribing & Audit Committee to provide feedback to podiatrist prescribers.

General comments

It was noted that there are currently 252 registered podiatrists in New Zealand and that of this number it was expected that 10-15 would want to undertake the additional training required to apply for podiatrist prescribing. This number would increase as graduates from the current undergraduate programme entered the workforce.

It was identified during the implementation of optometrist and nurse practitioner prescribing that early communication with pharmacists is essential. The Board made an undertaking to increase its communications with the Pharmacy Council, Society and Guild to endeavour to ensure podiatrist prescribing could be implemented smoothly and that pharmacists would be able to identify appropriately qualified podiatrist prescribers.

Representatives of the medical colleges confirmed that they had no ongoing issues with the consultation process to develop podiatrist prescribing.

Recommendations

The Sub-Committee of NPAC recommend to the full NPAC that the Podiatrist Board will:

  1. remove the case-studies from the submission to NPAC and work with medical and pharmacist practitioners to develop a model for case study presentation for educational purposes which highlights diagnostic and prescribing decisions;
  2. increase communication with the pharmacy sector to endeavour to ensure a smooth implementation of podiatrist prescribing;
  3. work with an experienced pharmacist and medical practitioner to clarify and ensure accuracy of the list of medicines podiatrists wish to gain access to; and
  4. provide the NPAC with an updated list of medicines before the NPAC makes recommendations to the Minister to proceed with the making of regulations.

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