Romance of the Three Kingdoms is one of China’s four Great Classical Novels. The title of this blog post is more fully:
The empire, long divided, must unite; long united, must divide. Thus it has ever been.
PartridgeGP is based on a triple promise that we will be great for our patients and our community, GPs and our staff, and for the owners and the practice. Further, we will provide a comprehensive, professional, empowering, and sustainable service at all times.
Our friendly neighbourhood pharmacist sent this to me (see below). He was a little worried about the threat to his full service pharmacy and also to great General Practice.
Now different companies will have different service offerings at different levels of the market. Think Porsche and Hyundai. Both very acceptable to different groups. Maybe even acceptable to the same group at different times. I’m not sure they are competitors.
I put my thoughts down here:
So keep playing to your strengths, keep doing your best, and unite not divide.
Patients who require long-term treatment of chronic pain with opioids will still be able to access larger pack sizes and prescribers will be able to prescribe repeats where they meet the new restrictions requirements.
For chronic pain, increased quantities and/or repeats may be authorised by Services Australia where the patient meets the restriction requirements. Increased quantities to extend treatment up to one month may be requested via telephone/electronic authority request, and up to 3 months’ supply (up to 1-month quantity and up to 2 repeats) may be requested via an electronic/written authority request.
To be eligible for treatment with high strength opioids such as morphine, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, following maximum tolerated doses of other lower strength opioid treatments.
These new arrangements apply to all PBS listings for opioid medications and therefore there will also be amendments to the tramadol and paracetamol/codeine restriction requirements.
All new and amended restrictions will be updated on the PBS website (pbs.gov.au) from 1 June 2020.
What does this change mean for prescribers?
The new opioid listings for reduced pack sizes will provide a simplified way for prescribers to prescribe smaller quantities of immediate release opioids for acute, short-term treatment.
Prescribers must ensure that patients meet the relevant restriction criteria when prescribing opioids under Restricted Benefit and Authority Required (STREAMLINED) PBS listings. The ‘streamlined authority code’ is located on the relevant PBS listing on the PBS website. To prescribe an Authority Required (Telephone/Electronic) item, the prescriber is required to request authority approval from Services Australia through the Online PBS Authorities System or by calling 1800 888 333.
To ensure appropriate use of opioid medicines for the management of pain, patients must be referred to a pain specialist or alternative prescriber for clinical review if opioid use exceeds or is expected to exceed 12 months. The date of the review and name of the medical practitioner consulted must be provided for every authority application.
So from June 1:
If these addictive narcotic medications are required, your GP may prescribe smaller packs for your use
Please please please speak to your GP about any issues you are having – we have lots of options including counselling, physical therapy, diversional therapy, physiotherapy, non-drug therapy, other medications, and referrals to non-GP specialists for complex problems
We still care, we still want to help, we want to be safer and better for you
If you are on medications for 12 months or more, you will need to have a formal consult with another GP or specialist in addition to your usual GP to keep getting medication on a PBS (subsidised) prescription.