GP resignations leave PHN without general practice voice

Jolyon Attwooll

16/03/2022 4:58:04 PM

The moves come in the wake of controversy surrounding the proposed North Queensland pharmacy prescribing pilot.

Map of Northern Queensland
The pharmacy prescribing pilot for North Queensland has caused significant controversy.

Two GPs have stepped down as board directors of the North Queensland Primary Health Network (NQPHN), a move which will leave governance of the organisation without a general practice voice.
Dr Nicole Higgins and Dr Toni Weller have confirmed they have resigned from the PHN, which is based in an area where a controversial pharmacy prescribing pilot is being proposed.
Mackay GP Dr Higgins told newsGP that she resigned as a director from the board earlier this week, following the prior resignation of Townsville GP Dr Toni Weller from the same governance body.
Dr Higgins, who is also a member of the RACGP Queensland Faculty Council, said she is unable to give any further comment about the reasons for her departure apart from to confirm that their resignations will leave the PHN without any general practice representation.
Their departure from the health network follows extensive controversy surrounding a proposed pharmacy prescribing scheme for the area. It has seen several high-profile medical groups, including the RACGP, withdraw from any involvement in a steering committee, with the college expressing serious concerns about the impact on patient care.
The Chair of the NQPHN board is Nick Loukas, who owns a number of pharmacies in the region and is a member of the Pharmacy Guild of Australia.
Under the terms of the proposed Queensland State Government pilot scheme, pharmacists would be able to diagnose 23 conditions as well as prescribe treatment medications without the involvement of a GP. These include asthma, type 2 diabetes, and heart failure.
The North Queensland Pharmacy Scope of Practice Pilot, proposed for 37 different local government areas in the state, could also allow pharmacies to charge up to $55 for consultations, the ABC has reported.
The RACGP resigned from a steering committee last month. Several other peak bodies have also withdrawn their representatives, including the Australian Medical Association (AMA) and the Australian College of Rural and Remote Medicine (ACRRM).
An RACGP letter addressed to Queensland’s Chief Allied Health Officer said the pilot scheme ‘compromises quality care’.
‘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,’ it read.
While newsGP has been unable to establish the exact details of remaining steering committee members, a Pharmacy Guild of Australia press release issued last month cited a number of participating organisations.
Five have since withdrawn their support, leaving PDL – a not-for-profit organisation that provides indemnity insurance for pharmacists – and Health Consumers Queensland remaining from that list.
A total of around 15 representatives were originally understood to be on the steering committee, the details of which were not made public until a leak to Australian Doctor earlier this year.
Last month, the ABC reported that Mr Loukas had also resigned from the steering committee for the pilot scheme to avoid the perception of a conflict in interest.

More than 200 GPs in the region have now reportedly banded together to form the North Queensland Doctors’ Guild to protest against the pilot scheme’s implementation.
RACGP Vice President and Queensland Faculty Chair Dr Bruce Willett said he welcomes the withdrawal of the NQPHN.
‘We know that the North Queensland PHN has removed its representation from the steering committee, and we are glad to see that has happened,’ Dr Willett told newsGP.
‘All GPs have real concerns about this, about the fragmentation of care and additional costs for patients and the conflict of interest that pharmacists have about generating profits from prescribing.’
He also said the RACGP had been seeking for some time to be PHN members, including for the NQPHN.
‘It is difficult for us to see how a primary care organisation can not include the RACGP as a member,’ he told newsGP.
‘We are disappointed that we haven’t heard back yet because GP involvement is really important.’
The NQPHN is an area with a high Aboriginal population who would be particularly affected by the proposed pilot scheme.
However, Aboriginal Community Controlled Health Organisations (ACCHOs) in Queensland have also stated their opposition.
Dr Jason King, the director of Clinical Services at Gurriny Yealamucka Health Services Aboriginal Corporation, has been involved in the formation of the North Queensland Doctors’ Guild.
‘Our communities deserve the highest quality care,’ Dr King previously told newsGP.
‘The pilot project fragments healthcare for some of the most vulnerable [and] it undermines the decades of work the ACCHO sector has done to bring us closer to closing the gap.’
The Guild has stated that the pilot scheme could help to address primary care shortages in the area, and that pharmacists would undergo extensive training before becoming involved.
The Queensland Health Minister Yvette D’Ath told the ABC last month that she expected the scope of the trial to be finalised in the near future.
Dr Willett says he would like to see the Queensland Government review its involvement.
‘I think it does show the depth of concern there is,’ he said. ‘We would like to see the government to have a big re-think about this trial.’
A Queensland Health spokesperson said the exact timeframe for the pilot is under review and that further information on its scope would be made available as soon it is finalised.
The NQPHN was also approached for comment but did not respond in time for publication.
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Dr SD   17/03/2022 12:29:05 PM

I think If the pharmacists want to prescribe then there should be assessments to pass at the level of doctors so as to not putting people’s lives at risk. It should not be few hour modules for each condition which will make a mockery of other health professionals treating same conditions. It should at least be of 2 years and run by RACGP or equivalent with rigorous examinations.
Secondly, The treating and dispensing pharmacist should not be working in same building or organisation. That’s an undeniable conflict of interest.
Thirdly, the treating pharmacist is independently liable for medico-legal obligations and litigations resulting from it. It cannot be passed on to GP after complicating the cases.
Fourthly, as a treating professional should be answerable to AHPRA from management perspective.
There should not be an ego battle that can ensue when GP changes a medication prescribed by pharmacist.

Dr Peter James Strickland   17/03/2022 1:32:31 PM

My first question is --who is paying any pharmacist $55 for a consultation --is it the Qld Govt? If so, this is an insult to medically trained doctors with respect to what they are paid by Medicare.
My next question is how are the pharmacists going to diagnose the difference between allergic-type asthma and left heart failure (cardiac asthma), and thus treat these two totally different conditions in their pharmacies, OR are they going to send everyone with any sign of wheeze etc to a hospital after charging $55?
If the Qld Health Minister wants proper medical management of anything at all, then get it managed properly and ethically by qualified people, and pay the GPs etc properly. NIDDM is a complex disease, and often needs inpatient monitoring to control BSL fluctuations and insulin dosages, BP, peripheral circulation, visionary and renal problems etc ---how the hell can a pharmacist properly manage anything but very basic requirements of any NIDDM patient including oral medicines.

Dr LS   17/03/2022 8:10:43 PM

Really! Go back to Uni.
I respect my pharmacist colleagues and they have an important role in healthcare in any community, however diagnosis, treatment and management of acute or chronic health conditions is not in their skill repertoire. I don't care how much training they get. Diagnosis and Management skills are learnt over thousands of hours in a supervised environment .
Sorry but this will cost lives if it goes ahead, not to mention the extra strain on ED and GPS who will take up the slack when things go wrong.

Dr Cynthia Filipcic   24/03/2022 8:41:49 PM

Absolutely agree! The politicians may be able to give pharmacists the ‘power’ to prescribe, but they cannot give the necessary knowledge and skills to diagnose and manage medical conditions. Medicine is not just about prescribing! What about appropriate lifestyle management, investigation and specialist input? I can just see that every single patient with an HbA1c >6.5 will be commenced on metformin, if not dual therapy, without any opportunity for lifestyle changes which are important firstline management.

Dr Kannan Ramanathan   14/10/2022 7:21:21 AM

The lab technician who had worked many years in pathology, has much knowledge, now wants to be paid as pathologist and give opinions on tests. Government of QLD should consider this too.
Radiographers , who knows more about fractures ,now should be allowed to give diagnosis, as radiologists are not available on saturdays and sundays. will QLd government consider this too.? what a sham!!!