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GPs say politics and money behind NSW pharmacy prescribing push
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 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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