Abstract
New Zealanders are living longer (over 65 years), which means that social and health services will have to adapt, and it challenges the health system to find ways of providing services that are still affordable. An increasing population - New Zealand population’s annual growth rate in 2021 was 1.36% increase from 2020 (population increase of 68,594), in 2022 was 1.08% increase from 2021 (population increase of 55,561), and in 2023 was 1.06% increase from 2022 (population increase of 42,812). This surge in population and health needs is not just a statistic, it's a looming challenge that will significantly strain our healthcare system and workforce. Currently, the bulk of healthcare is managed by general practitioners (GPs) in primary care. However, the impending retirement of a significant portion of GPs, with 47% planning to retire in the next decade and 27% in the next five years, will exacerbate New Zealand's GP shortage. This is a problem that needs immediate attention. To ensure optimal health outcomes and continued access to medicines for all New Zealanders we need to refine the primary care model. Prescribing of medicines by health professionals other than general practitioners (non-medical prescribing; NMP) is growing throughout New Zealand in response to legislative changes to address this need. NMP was initiated in the USA and Canada in the 1960s, followed by other countries such as the UK, Australia, and New Zealand. It reached 54% of the world's countries in 2020. NMP was proven to enhance patients’ access to healthcare services, improve clinical outcomes and continuity of care, and consequently increase patients’ satisfaction. NMP provides more professional autonomy to non-medical prescribers, more integration of the latter into the primary healthcare iv system, and better use of their skills. Additionally, NMP decreases GPs’ workload, freeing up their time for more complex cases and reducing long wait times for patients to access GPs. In New Zealand, a Ministerial Review Group recommended that New Zealand needed to change the approach of healthcare services delivery. Changing the conventional way of healthcare services provision and rigidly defined jobs to a more patient-centred, inclusive, integrated model with a flexible workforce would achieve better access to healthcare services in New Zealand. In response to healthcare system challenges, Health Workforce New Zealand funded demonstration sites (including diabetes nurse prescribers and pharmacist prescribers) to investigate whether new roles and extended scopes of practice can improve service delivery. Whilst most professions have a growing number of prescribers (e.g. approximately 200 nurse practitioners in NZ), pharmacy is yet to see this same success. New Zealand has just 46 pharmacists trained to be prescribers in a clinical setting. Training requirements for pharmacists in New Zealand are much longer and more expensive than the nursing pathways. Little is known about the barriers, facilitators and preferences for current pharmacists to train. There has been a lack of evaluation around the current prescribing course and whether it is fit for purpose. In Australia and the UK, there has been the development of a standardised prescribing competency frameworks however this has yet to be adopted in a wide-spread fashion in New Zealand. There is also a paucity of information about stakeholder’s values and ideas around training pharmacist prescribers in their local areas, the funding for this and the model for delivery of services.