Victorian podiatrists are the latest group of allied health providers to be granted greater prescribing rights, adding to doctors’ concerns about patient safety and fragmentation of care.

I’m not just talking about topical creams and anti-inflammatory medications – Victorian podiatrists can now prescribe dangerous drugs of addiction and can initiate care for chronic conditions.

The Victorian Minister for Health, Daniel Andrews, has approved a list of scheduled drugs that may be used by endorsed podiatrists, which includes adrenaline, temazepam, lorazepam, Botox, codeine and methoxyflurane, a range of local anaesthetics, as well as a range of antimycotic, antibacterial, antihistamine and anti-inflammatory drugs. Topical, oral and injectable preparations are included.

I’m comfortable with podiatrists prescribing a limited range of medications where the risks are low and shared care arrangements are clearly defined – with the medical practitioner initiating treatment and a podiatrist following up.

But the breadth of drugs that podiatrists have been allowed to prescribe risks compromising the care of patients with complex conditions.

Many foot ailments have associated chronic health conditions. The population generally served by podiatrists consists of older people with a range of health issues and higher risk of poly-pharmacy harm.

Podiatrists have failed to demonstrate any cost savings or other efficiencies – rather, they have asserted that if patients see a podiatrist they will not have to see a doctor.

Unfortunately, the Victorian Health Minister has been driven by ideology rather than evidence, and has allowed podiatrists to prescribe a much greater range of drugs than fit any sensible criteria.

While podiatrists have zealously fought for the right to prescribe, they have successfully ducked many of the responsibilities that come with prescribing dangerous drugs.

The Podiatrists Registration Board of Victoria has issued guidelines for shared care that require podiatrists to notify a medical practitioner if they prescribe certain drugs under certain conditions.

However, the podiatry board has failed to provide legal advice on the liability assumed by a medical practitioner who receives such notification from an endorsed podiatrist. The board has not responded to any AMA Victoria communication on this issue over the past year.

The potential exposure of Victorian doctors under the new prescribing arrangements is concerning. AMA Victoria has prepared a template letter for Victorian doctors to refuse liability for any aspect of patient care arising from the prescription and associated notification.

Where scheduled medications are concerned, the medical profession reasonably expects the Government to ensure similar safeguards are in place for all prescribing practitioners. There is a range of regulatory bodies that govern access to pharmaceuticals for medical practitioners, including Medicare Australia, the Professional Services Review and others.

The podiatry profession is relying solely on its board to regulate medicines. The board has a total of three employees.

With podiatrists being allowed to prescribe drugs of addiction such as benzodiazepines and opioids in an under-regulated environment, there is increased scope for misuse, theft and threats against practitioners.

GPs are experienced in dealing with doctor shoppers and aggressive patients. Because of these threats, practice safety is taken very seriously and investment in security is substantial. Podiatrists’ capacity to deal with drug-seeking patients is questionable.

Doctors want what’s best for their patients, and this is proving to be team-based medical care, where practitioners work together.

Unfortunately, the Victorian Government has opted for a model of fragmented care that will allow podiatrists to operate outside of the team, with drugs that are dangerous to the community’s wellbeing. 

The saddest part is that the lack of accountability and oversight means that we may never see the harm being done, unless the harm is catastrophic. And guess who will have to clean up the mess then?

Dr Harry Hemley is president of AMA Victoria