Another state flags pharmacy prescribing for UTI

Unperturbed by evidence of compromised patient safety, lingering conflict of interest concerns, and the risk of fuelling antimicrobial resistance, New South Wales Health Minister Brad Hazzard has come out in support of independent pharmacy prescribing for suspected UTIs.
 
Minister Hazzard told Nine Newspapers he has asked his department to investigate a similar pilot to the one carried out in Queensland – which was itself confirmed as a permanent feature of that state’s healthcare system earlier in the week – ostensibly to ease the pressure on GPs.
 
‘There’s a very clear message from COVID … that pharmacists have been able to step up where needed to fill gaps,’ he said.
 
‘There are parts of the state where it is extremely tough to get in to see a GP and there are some conditions, like UTIs, that I think lend themselves to the possibility of pharmacists having an expanded scope of practice.’
 
But while pharmacy owners have welcomed the news out of Queensland and lobbied extensively for the establishment of UTI prescribing pilots in other states, doctors remain steadfast in their opposition to the move.
 
NSW GP and RACGP Expert Committee – Quality Care (REC–QC) member Dr Michael Tam told newsGP Minister Hazzard’s decision to pursue independent pharmacy prescribing is disappointing and poses significant risks to the community.
 
He also said framing it as a ‘prescribing’ trial is problematic.
 
‘People don’t present with a diagnosis of a UTI. They present with symptoms that might be due to a simple UTI, but it may well be due to another diagnosis that will need treatment,’ Dr Tam said.
 
‘One wonders, for instance, how many STIs have been missed in the Queensland trial.
 
‘This transactional and unintegrated approach to primary care worsens care quality. Specifically in this situation, it seems to throw out the principle of antimicrobial stewardship.’
 
RACGP Vice President and Queensland Chair Dr Bruce Willett is similarly opposed, telling newsGP that the trial used to justify the scheme in his state was ‘totally insufficient’ and never received ethics approval.
 
‘Only around a third of patients provided any type of response to queries about outcomes and even then it was only to the prescribing pharmacist – so there was no true evaluation,’ he said.
 
Dr Willett also referenced a 2019 paper that assessed a similar trial in Canada and found that pharmacists had prescribed seven times more antibiotics than doctors had for patients presenting with a suspected UTI – raising questions about conflicts of interest and antibiotic stewardship.
 
‘This gap shows that profit-driven prescribing is not in people’s best interest and that people are getting unnecessary medications just to generate more profits for the pharmacy,’ he said.
 
‘We should make no mistake that that’s what this is about.
 
‘It also means that six of those seven patients were probably misdiagnosed and I have grave concerns for patient safety, in that, potentially six out of seven patients are going to be inappropriately treated.’
 
In addition to independent prescribing for suspected UTI, Pharmacy Guild President Professor Trent Twomey – who recently defended joining 21 colleagues on a London trip partly-funded by pharmaceutical company Arrotex that included complementary centre court tickets to the Wimbledon quarter finals and a stay at a $1160 per night ‘super boutique’ hotel – would like to see pharmacists provide prescriptions for the contraceptive pill, blood pressure and cholesterol tablets.
 
Professor Twomey is also a supporter of the proposed ‘scope of practice’ pilot in North Queensland – where he is a partner in a group of pharmacies – that would allow pharmacists to diagnose and treat more than 20 complex conditions.
 
The pilot has been strongly criticised by RACGP leadership, the Queensland AMA, and the Professional Services Review, due to concerns over patient safety, lack of oversight, fragmentation of care, and conflicts of interest.
 
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Pharmacy Guild pharmacy prescribing UTI