AMA Submission to PBAC – Restricted prescription of antipsychotics in residential aged care

Under the Royal Commission’s recommendation, by 1 November 2021, the Australian Government should amend the Pharmaceutical Benefits Scheme Schedule so that only a psychiatrist or a geriatrician can initially prescribe antipsychotics as a pharmaceutical benefit for people receiving residential aged care, and for those people who have received such an initial prescription from a psychiatrist or a geriatrician, general practitioners can issue repeat prescriptions of antipsychotics as a pharmaceutical benefit for up to a year after the date of the initial prescription.

The AMA submission to PBAC strongly opposes this recommendation. The AMA argues that there is a whole spectrum of other strategies that should be implemented before any prescribing is restricted to a small group of specialists. Those strategies include staff to resident ratios, registered nurse presence in RACFs 24/7, improved access to allied health professionals and better integration of aged care with healthcare in general, primarily through ensuring that greater numbers of GPs work in aged care and that GPs continue to care for their patients after they enter aged care, guaranteeing continuity of care. It is the AMA position that restraints in aged care should only be used as last resort - where any potential risk or harm caused by the restraint itself is less than the risk of the patient not being restrained. The prime purpose of restraint should be the safety, wellbeing and dignity of the patient, taking into consideration their previously expressed or known values and wishes. In the short term the welfare and protection of others (patients, carers, residents and staff) and the health and safety obligations on employers must also be considered.