GPs say politics and money behind NSW pharmacy prescribing push

Matt Woodley

14/11/2022 5:46:30 PM

The controversial move was announced a week after a new report showed pharmacy profits have soared on the back of increased service delivery.

NSW Premier Dominic Perrottet
NSW Premier Dominic Perrottet has said the proposed reforms are aimed at relieving pressure on emergency departments. (Image: AAP)

GPs have accused the NSW Government of shifting the cost of healthcare directly onto patients, after it announced plans that will allow pharmacists to independently diagnose and prescribe medications for several conditions, including UTIs, skin ailments and ear infections.
Details of the schemes remain unclear, but it is likely that participating pharmacists will be able to prescribe antibiotics for suspected UTIs from early next year, while the expanded scope of practice trial would not begin until 2024.
Unlike Medicare-subsidised consultations that occur in general practice, patients will likely need to pay between $30–50 per consultation, while dispensed medicines will not be subsidised by the Pharmaceutical Benefits Scheme.
At a press conference promoting the new trials, Premier Dominic Perrottet has said the proposed reforms are aimed at relieving pressure on emergency departments and general practice waiting lists, but GPs medical groups are not convinced.
RACGP NSW&ACT Chair Associate Professor Charlotte Hespe has come out strongly against the move, describing it as a ‘Band Aid’ solution that will result in a ‘festering wound’.
‘I think this is a very political manoeuvre to try to get wins for the current New South Wales Government with an election looming in March, because they can see that GP access has been a key issue for marginal seats in rural and remote parts of the state,’ she said.
‘For me, it’s very disrespectful.
‘They’re launching a program that is ostensibly supposed to solve general practice access issues with no input at all from GPs or the AMA, on the back of Pharmacy Guild promises that they can provide these services in a safe manner, which from my perspective, is a false premise.’
When asked to comment on Monday, Federal Minister for Health and Aged Care Mark Butler also said he was not consulted prior to the weekend announcement.
‘The New South Wales Government hasn’t chosen to reach out and have a discussion with us about this, so I’m going off media reports,’ he said.
‘All we’ve seen is a media announcement from the Premier, I’m not sure you could call that a plan. They have not chosen to talk to us about that.
‘I’ve been talking about this issue with representatives of health, nursing and other groups at the Strengthening Medicare Taskforce. I obviously talk very regularly with the pharmacist associations including the Guild and the Pharmacists’ Society.
‘We are stepping through these issues carefully. But my starting point is that all Australia’s healthcare professionals … should be working as close to the top of their scope of practice as possible.’ 
While much of the programs are still yet to be finalised, Health Minister Brad Hazzard has said they will likely follow similar – equally criticised – Queensland programs that have already taken place or are due to begin next year.
Doctors say those pilot programs, the development and assessment of which were long shrouded in secrecy, raised multiple red flags, including, but not limited to:

Given patients will more than likely be expected to pay for each consultation and prescription, Associate Professor Hespe is sceptical about any pharmacy prescribing scheme being able to alleviate pressure on emergency department­­s, as much of this traffic is driven by patients seeking free healthcare.
She also questioned statements made in support of the program by Minister Hazzard that patients have to wait ‘possibly six weeks’ to be seen for a UTI at a general practice.
‘I’m sorry, that’s a total falsehood,’ she said.
‘I don’t think there’s any patients out there who are not being seen for a urinary tract infection six weeks down the track, and there are plenty of ways that even rural and remote people can access medical care in that timeframe.
‘I’m well aware that there are difficulties accessing general practice, and I’m not going to deny that at all. But let’s use correct data not over-inflated figures.’
Meanwhile, RACGP Vice President Dr Bruce Willett believes the latest Guild Digest – produced by the Pharmacy Guild of Australia – shows pharmacy owners have a strong financial incentive to continue their push for expanded practice.
While the Guild only makes the document freely available to members, AJP reports that community pharmacy registered $1.39 billion in net profit in 2020–21 (up from $998 million in 2019–20), despite a reduction in total prescription volume.
At the same time, there has also been a decrease in the share of prescription sales as a proportion of the total sales, from 63% in 2019–20 to 59% in 2020–21.
However, this shortfall was more than compensated by growth in average revenue from other income, which increased from $71,000 in 2019–20 to $100,000 in 2020–21.
‘This highlights the need for pharmacies to diversify into services beyond dispensing prescriptions to maintain growth in their businesses,’ the report stated.
‘Many successful community pharmacies [are] responding to the changing business landscape by moving to a greater services orientation through, for instance, incorporating dedicated consultation rooms for the provision of professional health programs and services.’
The protected nature of the Guild Digest makes it difficult to track whether or not these figures represent record profits – a point the Guild declined to clarify prior to publication – but prior reporting shows average pharmacy sales have increased by $800,000 since 2014–15.
In that same period, average net profits have more than doubled, from $107,000 in 2014–15 to $236,827, while the percentage of revenue generated by prescription sales has dropped from 66% to 59%.
Dr Willett told newsGP the results suggest that pharmacy’s continued push to provide greater services is more related to profits than it is good patient care.
‘We’re seeing increasing investment into pharmacies at the expense of general practice – not just at the federal level, but at the state level,’ he said.
‘From a Queensland point of view, we’re seeing potentially millions being invested into a pharmacy prescribing program that ultimately will mean that patients will be paying up to $55 for a consultation and receiving un-subsidised prescriptions to drive profits higher for pharmacies.
‘It would be interesting to know what percentage of these profits are generated through the sale of non-evidence-based medications.
‘It’s unfortunate that these [potentially] record profits are not being translated into fair payments for working pharmacists.’
While expressions of interest for NSW’s UTI pharmacy prescribing program have already opened, NSW Health did not respond to requests for details on either of the pilots, nor did it answer questions related to training requirements, clinical oversight or trial design prior to publication.
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Dr Suresh Gareth Khirwadkar   15/11/2022 5:47:53 AM

This is a clear money grab at patients’ expense and will result in terrible care. So much will be missed and directly feeds in to worsening health by completely ignoring all aspects of healthcare other than ‘here’s another drug’.

Thankfully much of the public get this and don’t just want to be rattling with pills as they walk around and are seeking out doctors who don’t just rush to prescribe drugs, and hopefully these ventures will fall flat on their face as they should.

Dr George Al-Horani   15/11/2022 6:00:04 AM

The pharmacy Guild lobby needs serious action and we are asking for a Royal Enquiries in this matter .
The alleged donations from pharmacy Guild to any government needs to reviewed and investigated further with a Royal enquiry .
We all know and pharmacist know very well that starting prescribing medications over the counter especially antibiotics will only creat a huge antibiotic resistant, which will harm us all and will harm our children more .
There is something about pharmacy Guild that they are trying to take our role as GPs , we study 12 years to be a GP , they study 4 years to be pharmacist, if they really want to do our job ( vaccination , travel vaccines , prescribing PPI , antibiotics over the counter ) and God knows what else they are planning for . Then they should go and study medicine and do the exams we have done .
Our college unfortunately is weak in comparison with pharmacy Guild , that’s why they get what they ask for . This has to stop NOW .

Dr Christopher Adrian Murcott   15/11/2022 6:35:18 AM

A recent government proposal to allow pharmacies to dispense 3 or 6 months of medication ( such as anti hypertensives) at a time was blocked by the pharmacy guild as it would harm members profits, even though both patients and the government would save money. Perhaps we should make that idea part of the deal , now that the pharmacies net profit has increased by 40% in a year according to the article?

Dr Mary-Louise Graham   15/11/2022 6:49:02 AM

This would effectively be downscheduling these medications. I wonder what the TGA make of this. Does this change fit within the poison’s schedule?

Dr Abdul Ahad Khan   15/11/2022 10:32:15 AM

Without a MBBS Degree & without the Gruelling Hospital Training, & without a Thorough Clinical Examination of the Patient, a Pharmacist is being allowed to make a Clinical Diagnosis & Prescribe & Dispense from their own Pharmacy, MEDICATIONS - WOW !!!
There is a Saying by a Philosopher in Urdu Language :
" Neem Hakeem - Khatre-Jahan " - Translated it means " Half a Physician is a Danger to the World "
RACGP & ACRRM need to come out of their Slumber & let the INNOCENT POPULACE know their Views on the Matter - use the Press & the TV to WARN the INNOCENT Populace of the lurking Dangers .
Dr. Ahad Khan

Dr Bruce Phillip Maybloom   15/11/2022 11:43:18 AM

We all (should) know that pharmacy organisations make year-on-year political donations to both major political parties, including all governments (state, territorial and Federal) in this country. Declared political donations are all published and available for the public to look up. All major political parties in the country are essentially owned by the pharmacy industry. Quid pro Quo! It is well known that the prescribing pilot in QLD was an election promise irrespective of all the safety and quality issues. I love how in QLD they call it a pilot. As we all know, pilot studies have a start and stop time, followed by an evaluation which may or may not need to full implementation of a program. GPs will not win against the pharmacist unless we force them to be tied up in bureaucracy around standards, such as making detailed notes on every patient they prescribe to. Where GPs can win is marketing to the public re why going to somebody 'playing 'doctor is dangerous!

Dr Irandani Anandi Ranasinghe-Markus   15/11/2022 11:57:54 AM

The only sensible element in this whole hare-brained scheme is that tax payers are not subsidising this!! User beware - patients will soon work out what a ridiculous proposal this is. It is downright dangerous and a disaster waiting to happen.

Dr Simon Mark Holliday   15/11/2022 1:33:33 PM

Who needs GPs anyway?
It's easy to smooth the dying pillow for GPs.
Any specific diseases to Single organ specialists
Acute care to Emergency Departments or pharmacies (dressings or medications)
Pregnancy to antenatal clinics
Infant vaccinations to Early Childhood clinics or pharmacies
Skin cancers to Skin cancer clinics
Contraception and CSTs to Family Planning /Women's Health Clinics (+ pills to pharmacies)
Dying? Call your palliative care team.
Anything else to Clinical Nurse Practitioners.
While we're on a roll to make the Health Industry more Efficient, lets have a go at General Physicians and General Surgeons.
How good is Australia?

Dr Abdul Ahad Khan   15/11/2022 7:31:14 PM

In Praise of GPs :
GPs are ' Jack of all Trades ' .
GPs are well-versed in all aspects of Primary Health Care.
GPs appropriately refer to all Consultant Specialists, as & when needed.
GPs manage each Patient in a Wholistic manner.
GPs manage the Effects of Family / Occupational / Social Dynamics on our Patients.
GPs are aware of the inter-relationship of the Psyche & the Human Body.
GPs look after each Patient from the Cradle to the Grave.
GPs are the most important Cog in the wheel of Primary Care.
There you go : I have written an Epitaph for the Graves of us GPs

Dr Prashanta Kumer Saha   20/11/2022 1:28:09 PM

Dear RACGP chair - Dr Karen Price & RACGP executive committee members,

We r following ongoing news after news
about GPs in Australia how they r subject
to bulluing, intimidation, devalue, disrespect etc etc in some major public news channel as well as news paper. It is
understood after allege investigation when it proves wrong - a statement made by minister/agent but by that time damage
is already done. Now the major concern is
non-clinical political people ambition to marginalize doctors - first step to prescribe
UTI abx & now another 20-30 medicines
in the card to approve. I feel that RACGP must stand for what it believes to be right
& must do all possibly can be done against
wining the wrong. As railway/trasnport
is a union & can do industrial action for their rights why not doctors? We like strong
action from RACGP with immediate effect.

Dr Aline Suan Lin Smith   25/11/2022 10:08:59 AM


Dr Philip Ian Dawson   4/03/2023 11:33:17 AM

If this is just a push for more profits than benefitting the patient, and the reasonbehind not allowing 3 or 6 months of medication for long term conditions is purely for pharmacy profits, perhaps we shoult fight back? I reegularly hear from elderly patients on miltiple medications for eg Hypertension Diabetes and Heart Disease that at the end of each month they have to visit the pharmacist multiple times in the week their months script runs out. If they go a day or two early they are told to come back as they still have two days medications, and the packets variously contain 28 days or 30 days of pills and or were written on different dates. Strategy 1 would be to mark all long term scripts for elderly poorly mobile patients with long term conditions, especially rural ones, as Regulation 49 ) formerly 24) Strategy 2 would be to word up th local bakery (s) that pharmacist be told no you cant have a fresh loaf of bread, you still have 2 slices left come tomorrow.