The genesis of the National Prescribing Service (NPS) can be traced back to Australia’s National Medicinal Drug Policy, with a significant emphasis on the policy pillar of quality use of medicines.1 The groundwork laid by the Australian Pharmaceutical Advisory Council and the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee was instrumental in firmly establishing the quality use of medicines as a national health priority. Numerous projects received funding, and some effectively pinpointed interventions that positively shaped prescribing practices. However, a critical gap emerged: upon project completion, there was no established system to sustain these successful interventions. A cohesive national strategy was clearly needed to translate research benefits into tangible nationwide improvements in prescribing.
The concept of a dedicated national prescribing center to bolster healthcare providers had been floated on multiple occasions. Yet, these proposals remained in the realm of ideas until a pivotal moment arrived with the Federal Budget of the previous year. Approximately $22 million was specifically allocated to bring the national prescribing service to life. This financial commitment marked a turning point, signaling a concrete step towards realizing this long-discussed initiative.
A cornerstone of the quality use of medicines policy is its collaborative ethos. This approach actively encourages the participation of health professionals, consumers, government bodies, and the pharmaceutical industry in addressing shared challenges. For the national prescribing service to truly flourish, it was crucial that healthcare professionals and the public felt a sense of ownership. Furthermore, operational independence from direct governmental control was deemed essential. Consequently, the initial plan of having a select panel of experts solely design the service was reconsidered. Instead, a more inclusive advisory group was convened. This group comprised representatives from key organizations, including the Australian Medical Association (AMA), the Royal Australasian College of Physicians, the Royal Australian College of General Practitioners (RACGP), and the Consumers’ Health Forum. One of the advisory group’s initial key recommendations was a subtle yet significant name change, shifting from ‘prescriber’ to ‘prescribing‘ service. This alteration was deliberate, aiming to acknowledge the multifaceted nature of the prescribing process and the roles played by pharmacists, nurses, and consumers, in addition to doctors.
Consultations were initiated at the close of 1997, encompassing a broad spectrum of engagement methods. These ranged from formal written submissions to in-person meetings held in major cities, and finally, localized discussions facilitated by Divisions of General Practice. The diverse perspectives gathered through these consultations were carefully considered by the advisory group in their subsequent deliberations, ensuring a well-rounded understanding of stakeholder needs and expectations for the national prescribing service.
The advisory group determined that the NPS would be governed by a board consisting of up to ten directors. The selection process for board members involved nominations from clusters of relevant organizations. For instance, the three general practitioner positions on the board are filled by nominees from the AMA, the RACGP, the Australian Divisions of General Practice, and the Rural Doctors Association of Australia. Similarly, the single pharmacist representative is nominated jointly by the Pharmacy Guild, the Pharmaceutical Society of Australia, and the Society of Hospital Pharmacists of Australia. Crucially, these representatives, once appointed to the board, are expected to prioritize the best interests of the NPS as a whole, rather than solely advocating for their nominating organizations. Their remuneration reflects the significant responsibility they hold in deciding the financial allocations and strategic direction of the NPS. A portion of the current budget has already been utilized for initial setup costs and for funding the Health Insurance Commission to conduct the latest round of prescriber feedback reports. Looking ahead to the next financial year, the NPS is poised to implement several core strategies aimed at enhancing national prescribing practices.
The NPS is tasked with coordinating the various existing activities that impact prescribing habits. This includes fostering consistency in drug information disseminated from different sources. For any new initiatives designed to improve prescribing to be effectively developed and implemented, the NPS will need to ensure that appropriate research is undertaken. This research could encompass identifying both incentives and disincentives that influence optimal prescribing behaviors. A central function of the NPS is expected to be providing doctors with insightful data and feedback on their individual prescribing patterns.2 This feedback loop is intended to empower prescribers with data-driven insights to refine their practices.
Given its focus on prescribing information, close collaboration with Australian Prescriber is essential for the NPS. Prior to the announcement of the NPS, a thorough review of Australian Prescriber was commissioned. The purpose was to evaluate the journal’s current and potential role in promoting the quality use of medicines. Following a comprehensive readership survey and consultations with key peak bodies, the review unequivocally affirmed the continued need for Australian Prescriber. Healthcare professionals value access to reliable, independent information about the medications they utilize in their practice. Consequently, a key recommendation from the review was to increase the publication frequency of the journal. Australian Prescriber is to maintain its independent production and editorial control, which remains with the Executive Editorial Board comprised of practicing clinicians, ensuring its continued relevance and credibility within the healthcare community.
The NPS is also responsible for monitoring and evaluating its own impact on national prescribing practices. Its initial funding allocation was predicated on anticipated savings in the overall cost of prescribed medicines. However, it is acknowledged that optimal prescribing may sometimes involve higher drug costs in the short term, but can lead to significant cost savings elsewhere within the broader healthcare system, such as reduced hospitalizations or improved patient outcomes. The long-term sustainability and viability of the NPS will depend on its ability to demonstrate a positive effect on overall healthcare costs. Furthermore, if evaluations of the NPS after its first four years of operation reveal that the anticipated savings targets have been surpassed, the question arises: who should be the beneficiary of these realized savings?
A crucial element for the long-term success of the NPS may lie in decentralization and devolution of its principles. If the collaborative philosophy that underpins the NPS is extended and actively implemented at the local level, for example through Divisions of General Practice, the NPS is more likely to generate self-sustaining momentum. Instead of relying solely on a centralized national body, the vision is to foster a network of numerous local centers actively engaged in encouraging and supporting healthcare professionals and consumers in their efforts to enhance the quality use of medicines. The collective impact of these locally driven initiatives has the potential to surpass the effectiveness of top-down, centrally imposed interventions.
The NPS possesses significant potential to champion and advance quality prescribing practices across Australia. There is a wealth of existing research to inform its strategic planning, coupled with substantial resources to facilitate the implementation of these strategies. By effectively coordinating the various activities already underway that aim to promote good prescribing, the NPS will be well-positioned to contribute to achieving the required cost savings. Furthermore, by introducing its own targeted strategies, particularly those implemented at the community level, the NPS is poised to significantly increase its likelihood of achieving lasting success in improving national prescribing and ultimately, patient health outcomes.
