Controversial pharmacy prescribing pilot finalised

RACGP Vice President and Queensland Chair Dr Bruce Willett is ‘very disappointed and concerned for patients’ after it was revealed that the North Queensland Pharmacy Scope of Practice Pilot has been ‘finalised’ and is due to start next year.
 
According to the state’s Health Minister, Yvette D’Ath, the pilot will begin in the second half of 2023 and allow participating pharmacists to prescribe ‘for a range of common conditions’ – albeit fewer than were originally slated when news of the scheme first broke.
 
‘Now that the scope has been finalised, work has started on implementing appropriate structures to ensure the pilot is safe and effective,’ Minister D’Ath said.

Confirmation of the pilot was announced at a Pharmacy Guild of Australia event on Wednesday night. 
 
The Queensland Health said pharmacists will be able to offer more vaccines and prescribe for conditions including nausea and vomiting, reflux, rhinitis, mild skin conditions, and acute mild musculoskeletal pain.
 
‘Pharmacists will also be able to prescribe – as part of structured chronic disease management – programs for cardiovascular disease risk reduction, asthma, and chronic obstructive pulmonary disease [COPD],’ the press release states.

An earlier draft of the plan, leaked to media in January, proposed allowing pharmacists to diagnose and prescribe for 23 medical conditions, including hypertension and type 2 diabetes.
 
The exact detail of what S4 medications can be prescribed under the terms of the pilot is expected to be published shortly on the Queensland Health website.
 
Dr Willett says the move will expose North Queenslanders to ‘second class treatment’. In particular he is concerned about the capacity of participating pharmacists to carry out differential diagnosis.
 
‘Patients deserve to be diagnosed and treated by medically trained doctors,’ he told newsGP.
 
‘As we saw in the UTI pilot, pharmacists do not have the medical training required for differential diagnosis.’
 
AMA Queensland reported ‘alarming complications’ from the UTI pilot, including 73 apparent examples of misdiagnosing, and 67 claimed instances of problematic prescribing recorded in a survey it distributed. The figures were rejected by the Pharmacy Guild as ‘hearsay allegations’.
 
The UTI pharmacy prescribing began in June 2020 and has now been confirmed as permanent.
 
‘These decisions are disappointing particularly after we saw common sense prevail when the RACGP successfully advocated on behalf of patients for COVID anti-viral agents to remain a prescription-only item,’ Dr Willett said.
 
In this week’s press release, Minister D’Ath said pharmacists participating in the pilot ‘will undergo additional training to ensure they are able to safely manage the included conditions and responsibilities’.
 
A Pharmacy Guild of Australia press release, which was sent to media one minute after Queensland Health announced the pilot, stated that training will consist of ‘12 months of post-graduate level education’.
 
Pharmacies will also require ‘suitable consulting spaces that provide patient privacy’, Queensland Health stated.
 
Dr Willett noted the announcement referenced the Queensland Government delivering an election commitment, which he believes is more oriented towards the Pharmacy Guild than to community wellbeing.
 
‘This is an obvious conflict of interest to boost drug sales,’ he said.
 
‘It is completely against the aims of the Commonwealth Government’s medicines policy, which is supposed to protect patients by separating prescribing and dispensing.’
 
He also highlighted widespread workforce issues in pharmacy, and said GPs are more widely distributed in Queensland than pharmacists, especially in rural area.
 
‘Over-worked pharmacists and patients will bear the brunt of this,’ he said.
 
‘The Queensland Government should be dealing with the issues in its own hospital systems that impact ambulance ramping, instead of investing time and money in band-aid solutions like this – which will ultimately worsen ramping.
 
‘We should be addressing this by improving access to doctors.’
 
Doubts have also been raised about the charges patients will incur and the potential impact on access to treatments.
 
Patients will reportedly pay $20 for consultations lasting less than 15 minutes, $30 for those taking up to 30 minutes and $55 for anything longer.
 
‘The only people accessing the service are those that have got deep pockets,’ RACGP Rural Chair and Townsville GP Dr Michael Clements told the ABC.
 
‘Our most vulnerable patients are the ones that are having the most difficult access to general practitioners, so this does nothing to solve access to GPs.’
 
Deputy Director-General, Clinical Excellence Queensland, Dr Helen Brown said the pilot will be ‘closely monitored to ensure it is safe and effective’.
 
The project was originally due to begin in June this year and run for 18 months.
 
Earlier this year, the college withdrew from a steering advisory committee for the pilot, citing ‘serious concerns’ about patient safety.
 
The AMA and Australian College of Rural and Remote Medicine (ACRRM) also took the same action. 

In a letter addressed to Queensland’s Chief Allied Health Officer, the RACGP Queensland Faculty said the pilot ‘compromises quality care’ and runs ‘in direct opposition’ to clinical and prescribing arrangements.
 
‘The proposed model requires a pharmacist to make complex diagnostic decisions, including using skills for which they are not trained, and manage complex chronic illnesses such as diabetes and chronic obstructive pulmonary disease,’ the letter stated.
 
The fallout later extended to the local North Queensland Primary Health Network (NQPHN), whose then chair Nick Loukas withdrew from the pilot scheme steering committee after an ABC article raised conflict of interest concerns linked to his ownership of several pharmacies in the area.
 
Two GPs, including RACGP President-Elect Dr Nicole Higgins, subsequently resigned from the NQPHN’s board, leaving the organisation without any general practice representation for a number of months.
 
The Department of Health and Aged Care confirmed an audit had been established to look into potential conflicts of interest among the board, but said the findings would remain confidential.
 
The North Queensland PHN covers around 693,000 people.

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