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GPs pulling back from palliative care over opioid crackdown fears
GPs are reducing palliative care services due to fears their opioid prescription rate will trigger a Department of Health investigation.
Scrutiny of palliative care medications is causing concerns for GPs.
A number of GPs have written to Palliative Care Australia stating they will no longer risk prescribing opioids for palliative care patients.
One of those GPs, Adelaide’s Dr Peter Ford, told newsGP he had reduced his palliative care work in aged care facilities after receiving a letter from the Department of Health (DoH) earlier this year stating his rates of opioid prescribing were very high.
‘I’m an older doctor now and my cohort of patients is old, with multiple morbidities,’ he said. ‘I’ve reduced the nursing home work.
‘It’s all very well for people in bureaucratic positions to take a superficial view, but when you’re face to face with patients in pain and distress, those who require palliative care require palliative care.’
‘Extricating yourself from an onerous investigation of you is quite intimidating, time consuming, and expensive. No one wants to go into it lightly.
‘I’m sure there are many doctors who would rethink their position on palliative care.’
The news underlines the RACGP’s early concerns about a letter the DoH sent to almost 5000 GPs around the country in June, warning them that their rates of opioid prescription were in the top 20% of all GPs in Australia.
The letter stated that the DoH would monitor their opioid prescriptions over the following 12 months.
A DoH spokeswoman previously told newsGP that a small number of GPs with very high rates could be asked for an interview as part of the Practitioner Review Program to understand the reasons for their prescribing.
Immediate Past RACGP President Dr Bastian Seidel warned the DoH that while the campaign may be well intentioned, the college has significant concerns for GPs who work in palliative care, aged care or rural hospitals, all of whom have legitimate reasons for high rates of opioid prescribing.
‘These GPs are therefore more likely to be identified in this campaign as problematic prescribers, when they are in fact providing suitable care,’ Dr Seidel wrote to the DoH.
Palliative Care Australia nurse practitioner clinical adviser, Kate Reed, told newsGP her organisation is encouraging concerned GPs to contact Australia’s Chief Medical Officer Dr Brendan Murphy.
She said DoH officials had moved to reassure her that GPs will not be in trouble if they are within the guidelines for palliative care patients.
‘We’re trying to feed back to [concerned GPs] that this prescribing for palliative care is not going to be of concern,’ Ms Reed said.
According to Ms Reed, a key factor in the issue is that oxycodone hydrochloride – a potent opioid – is not listed as a palliative care item on the Pharmaceutical Benefits Scheme (PBS). That could mean GPs working in palliative care have been sent the letters unnecessarily.
‘[Oxycodone] is a commonly used opioid in palliative care and may not be being captured properly in the data around palliative care prescribing,’ Ms Reed said.
‘We will be asking for a review of PBS items for palliative care. They have agreed to have further discussions as to what is classified on the PBS as palliative.’
The DoH did not respond to requests for comment.
department of health opioids palliative care
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