Findings from PHN audit to remain confidential

The Department of Health (DoH) has confirmed a review into the North Queensland Primary Health Network (NQPHN) will scrutinise conflict of interest concerns raised by a grassroots network of GPs.
 
The performance and financial audit, first reported by The Medical Republic, will take place in the ‘coming months’. It follows accusations from the North Queensland Doctors Guild that the NQPHN has ‘consistently failed to engage with GPs’ while pursuing policies that would make ‘general practice increasingly untenable’ in the region.
 
The claims were made in a letter sent to Federal Health Minister Greg Hunt, which also alleged that the PHN had ‘failed to declare or manage significant conflicts of interest among board members and had not offered enough transparency around its decisions’.
 
Dr Lee Jason Jones, a Cairns-based GP and skin cancer specialist, is a founding member of the Doctors Guild and told newsGP the organisation was prompted by ‘deeply growing disrespect for general practice by multiple governments and special interest groups’.
 
‘We have felt as if we are essentially pushed to the background or ignored in favour of the pharmacists,’ Dr Jones said.
 
‘We would like from a local point of view to have a fair, equitable board on the North Queensland PHN if that is to continue.’
 
One of four founding members – along with Dr Aileen Traves, Dr Vinodh Rajeswaran and Dr Jason King – Dr Jones says the Doctors Guild has now grown to 237 members, despite only being established earlier this year.
 
Much of the controversy – and the reason behind the formation of the guild – surrounds the proposed Pharmacy Full Scope of Practice pilot in the region.
 
If the pilot proceeds, local government areas in the NQPHN will be the only places in Australia where pharmacists are allowed to diagnose and prescribe medication for 23 separate conditions, including type 2 diabetes, asthma, and hypertension.
 
The controversial pilot has generated widespread angst among doctors, many of whom hold fears over patient safety and the financial incentives pharmacies have to prescribe and sell medication.
 
The NQPHN’s former Chair, Nick Loukas, had been on a steering committee for the pilot scheme but stepped down after the ABC highlighted conflict of interest concerns related to his ownership of several pharmacies in the pilot area and his membership with the Queensland Pharmacy Guild.
 
Mr Loukas has also since been replaced as Chair of the NQPHN Board, but a press release announcing the restructure did not provide an explanation for the change nor did a spokesperson respond to a follow-up question.
 
It also followed the sudden resignation of the only two GPs on the NQPHN Board, as previously reported by newsGP. 
 
However, while the DoH review will investigate potential conflicts of interest within the PHN, a spokesperson said it would only form part of a wider audit that had been planned prior to the letter being received by Minister Hunt.
 
Instead, it will take place as part of a process to look into ‘around three’ of the 31 PHNs nationwide each year ‘to support continued improvement in the program’.
 
‘The audit will be conducted over coming months and is expected to report by mid-2022,’ the spokesperson told newsGP.
 
‘The reports of audits of this kind are normally confidential to the department and to the organisation [or] the subject of the audit.’
 
Regardless of the audit’s findings, Dr Jones says it is existing concerns related to the pharmacy prescribing pilot scheme that have led so many doctors to take action.
 
‘We are a group of passionate grassroot GPs [who] before this were more interested in just being good doctors and taking care of our patients,’ Dr Jones said.
 
‘But because the pilot was in our neck of the woods, we realised that sitting in our silos without calling out the dangers of the pharmacy pilot would potentially lead to second rate quality care to the patients of our region.’
 
He also said the group’s concerns about the NQPHN governance ‘were essentially ignored’ when they were raised and that he wants doctors from other specialties to join.  
 
Meanwhile, Pharmacy Guild of Australia President Professor Trent Twomey has said that ‘full scope of practice’ for pharmacists would involve them being able them to ‘prescribe, dispense, administer and review all medicines for all people’.
 
‘We are highly trained medicine experts who are restricted from performing the simplest of tasks, and it’s critical not only for the future of our profession but for the future of our healthcare system that we embrace full scope of our practice,’ he said in remarks made to the Australian Pharmacy Professional (APP) Conference last week and reported in the Australian Journal of Pharmacy.
 
‘This should be underpinned by compliance and adherence to national therapeutic guidelines and of course, where needed, additional appropriate training and skills.
 
‘The idea that someone who recommends an item can’t be paid to perform the service or deliver the item is truly an antiquated and ancient notion.’
 
In its response to newsGP, the DoH said the pharmacy prescribing pilot is ‘not consistent with Commonwealth medicines policy’.
 
‘For PBS medicines, only doctors, dentists, optometrists, midwives and nurse practitioners are approved to prescribe under the National Health Act 1953,’ their statement reads.
 
However, the DoH also said that ‘state and territory governments are responsible for determining who is authorised to prescribe medicines generally’.
 
The RACGP has consistently raised concerns about the pilot scheme and in February withdrew from a place on its steering committee, along with four other medical organisations.

Clarification: This article was updated at 12.20 pm on 29 March to clarify that The Medical Republic was the first publication to report on the Department of Health audit into the NQPHN, not Australian Doctor.
 
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