Cultural safety and responsiveness


A patient, who identi­fies as an Aboriginal person, presents to the pharmacy for her monthly prescriptions. Her prescriptions are not annotated as ‘CTG – Closing The Gap PBS Co-payment Measure’. She queries why she has to pay for her medicines as they are usually free.

How should you respond?

Questioning the patient’s eligibility for CTG is not appropriate

A pharmacist should seek to promote cultural safety, responsiveness and equity in service delivery and the practice environment (Professional Practice Standards [PPS] criterion 1.4.4). Culturally safe and responsive care requires that pharmacists ensure all individuals are treated with respect and consideration of their beliefs, culture and practices.

Annotating the script as CTG may not be appropriate

Pharmacists are required to ensure that all dispensed and supplied therapeutic goods and associated pharmacy services re­flect the prescriber’s intentions, and are consistent with the quality use of medicines and the patient’s health goals and values. Pharmacists should comply with legislation specific to particular supply arrangements (PPS criterion 3.7.4).

The prescriber is responsible for determining the patient’s eligibility for the CTG scheme, and for arranging registration for the patient. Pharmacists should recognise that annotating the prescription as CTG without confirmation may appear to be in the patient’s best interests, but may not be consistent with the prescriber’s intention and may not comply with legislative requirements.

Con­firming the patient’s needs with the prescriber is the most appropriate option

Patient-centred care requires that pharmacists ensure patient health needs, including cultural needs, are foremost in the delivery of care. A pharmacist should determine the specific health needs, including cultural needs, of the patient and ensure that the dispensing service is adapted accordingly (PPS criterion 1.1.1).

A pharmacist should communicate and collaborate effectively with other healthcare professionals to ensure that the patient has appropriate and ongoing access to healthcare services (PPS criterion 1.9.7). The pharmacist should contact the prescriber to confirm the patient’s CTG status.

If the prescriber confirms the patient’s participation in the scheme, the pharmacist should liaise with the prescriber to obtain a correctly annotated script (i.e. by fax then follow-up with original script), or refer the patient back to the prescriber. Pharmacists are not able to annotate CTG scripts even after confirming patient participation with the prescriber.

The pharmacist should complete appropriate documentation i.e. include in the dispensing history or healthcare plan all communication with the prescriber about prescriptions, medicines and patient health issues (PPS criterion 3.12.2).

Pharmacists are also required to instigate any follow-up arrangements, and identify and act to address the needs of the patient to ensure meaningful and quality engagement with them and members of their healthcare team (PPS criterion 3.10).

If the prescriber confirms the patient is not currently registered for CTG, the pharmacist should consider referring the patient to a general practice participating in the Indigenous Health Incentive or to an Indigenous Health Service for a comprehensive review.

Relevant Professional Practice Standards

  • Standard 1 – Fundamental Pharmacy Practice
  • Standard 3 – Dispensing and Other Supply Arrangements

Further resources

  • PSA Guide to providing pharmacy services to Aboriginal and Torres Strait Islander people

PSA gratefully acknowledges the Australian Government Department of Health for providing funding for the original development of this case study as part of the PBS Access and Sustainability Package, including the Sixth Community Pharmacy Agreement.