GPs slam ‘worrying’, ‘opportunistic’ pharmacy COVID testing trial

Anastasia Tsirtsakis

1/02/2021 4:49:24 PM

Queensland Health is pushing ahead with the planned trial despite concerns for the safety of pharmacists and the wider community.

Healthcare worker in PPE preparing a COVID test.
An AJP poll conducted last year found an overwhelming lack of support for pharmacy COVID testing.

After months of debate over the suitability of pharmacy settings for COVID testing, the Queensland Government has confirmed it will oversee a pilot trial in the coming months, with staggered commencement dates across five pharmacies.
But RACGP Vice-President and Chair of RACGP Queensland Dr Bruce Willett, who has been outspoken against the trial, has grave concerns.
‘It makes no sense at all,’ he told newsGP. ‘A pharmacy is not a safe place to be doing COVID tests; they’re retail settings. Many – in fact, most of them – are in shopping centres.
‘So you’re asking people who are potentially infected to walk through crowded shopping areas and have their tests in a retail space.
‘Obviously there is some benefit to the pharmacist in that they’re hoping people will buy things as they walk past the shelves on the way in and out. But from a public health point of view, it’s certainly not worth it.’
Queensland Health has said it is ‘working with each pharmacy individually to adapt the service model to their workflows’.
‘This is to ensure that the service is conducted in a way that maximises staff and patient safety without disrupting the pharmacy’s service delivery,’ a Queensland Health spokesperson told newsGP.
‘Pharmacies will not commence offering the service until all the pilot requirements are met.’
According to News Corp, the participating pharmacies will be located in the Townsville, Cairns, West Moreton and Metro North health regions.
However, the exact locations will not be revealed as the proposed testing model does not permit pharmacies to advertise the service, nor will customers be able to request a test.
Rather, pharmacists will be able to offer a test to customers requesting to purchase products for cold and flu symptoms.
Dr Kat McLean, who has extensive experience with COVID testing in general practice and as a clinical lead of a respiratory clinic on the Gold Coast, says the trial’s lack of transparency is ‘worrying’ and has the potential to undermine public health messaging.
‘We have a lot of really vulnerable patients attending pharmacies that, I think, if they were asked to comment would express considerable concern. So it should be a transparent process,’ she told newsGP.
‘Also, we really want to be particularly cautious of not having patients who are symptomatic spending time within a retail pharmacy with other community members.
‘Even if it’s not promoted, word will start to get around and you will potentially have people that may specifically start attending pharmacies thinking that this is a place they should go to get routine COVID testing.’
According to Queensland Health, participating pharmacies will be required to meet strict criteria, including having a safe area to carry out the test, appropriate pharmacist training, and access to full personal protective equipment (PPE). 
Dr McLean says this will likely be a logistical challenge.
‘The set-up in the respiratory clinics for infection control is very vast. I just cannot see how you can provide the appropriate cleaning and environment within a community pharmacy setting,’ she said.
‘It is exceedingly difficult to actually don PPE, assess a patient within a practice setting, and the time that that takes, as well as the logistics around actually having the appropriate PPE and the appropriate cleaning. Also, where are people waiting and where is the testing being undertaken?
‘This whole process within a normal general practice would take me 30 minutes. So it is challenging, and certainly not ideal, and it really is the reason why we have places like the GP respiratory clinics.
‘I worry if you’re doing this opportunistically that, potentially, mistakes can be made. I am also concerned in terms of the safety of the pharmacy team and the staff with that process.’
Which raises the question, are pharmacists themselves on board?

Kat-Mclean-hero-2.jpgDr Kat McLean, who has worked as a clinical lead in a Queensland respiratory clinics, says the trial’s lack of transparency is cause for concern. 
A poll run by the Australian Journal of Pharmacy (AJP) in September found that just 4% of  respondents agreed that ‘pharmacies are appropriate centres for testing’.  
Meanwhile, 69% said they thought it was a ‘bad idea and puts staff and the public at risk’, and 30% said they did not think pharmacists are appropriately trained.
The findings are in line with the feedback Dr Willett and Dr McLean have received from local pharmacists.
‘The majority of pharmacists that I’ve talked to – in fact, all the pharmacists that I’ve talked to who aren’t pharmacy owners – are against this and not keen for this to happen at all,’ Dr Willett said.
‘This seems to be an initiative at the behest of the Pharmacy Guild, who represent only pharmacy owners, [and] see this as a business opportunity while transmission is low. But, of course, we’ve seen with outbreaks in the Northern Beaches, Queensland, and Melbourne that that can change in a heartbeat.
‘So it does still have the risk of bringing COVID carriers into busy retail spaces and that is a concern.’
Dr McLean says the risk is sure to outweigh any benefit.
While some Queenslanders had to queue for up to six hours last month amid a testing blitz related to an outbreak in Victoria, Dr McLean says there is no evidence to suggest locals are now struggling to get tested.
‘Access to testing in Queensland is now easily accessible in the community. There is no waiting time at present [and] we’re getting results through within 24 hours,’ she said.
‘So I struggle to see the benefits for the patients or for the pharmacists of doing it on-site within a community pharmacy. There is certainly not a need at present, and in terms of if we did surge, we’ve got the existing infrastructure already there within dedicated sites – that expertise and experience is there.’
Dr Willett agrees and says time would be better spent in raising awareness among the community of where to get tested.
‘One of the issues we had in Queensland was with the outbreak where there were lines outside of some of the public hospitals,’ he said.
‘But in my local area, at the very same time as there was an hour wait at the hospital 2 km away you could walk into the pathology collecting service next to my practice and get your COVID test done with literally no waiting.
‘Respiratory clinics are accessible, and there’s a private pathology company collection place on almost every street corner and people can go in and have a COVID test if they have symptoms now without a referral. So they’re incredibly accessible and safe.
‘There’s really no need to do this, and one wonders why the Government’s even considering it.’
The Pharmacy Guild, Pharmaceutical Society of Australia and Professional Pharmacists Australia were contacted for comment.
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Dr James Courts (GP and COVID-19 testing centre staff member)   2/02/2021 7:57:30 AM

"‘Respiratory clinics are accessible, and there’s a private pathology company collection place on almost every street corner and people can go in and have a COVID test if they have symptoms now without a referral. So they’re incredibly accessible and safe."

Please be aware that not all pathology providers take COVID samples, also most need GP referrals - there are some exceptions including surge management.

"From time to time, Queensland Health may authorise exceptions to the need for a GP referral to manage surges in demand for COVID-19 testing. However, a GP referral is still preferred."

Rural GP   2/02/2021 5:24:10 PM

There has to be a 4 corners report in this somewhere.
That QLD Health is so swayed by a lobby group to go against common sense.
What are the real motives behind this sinister move?
Fails the whiff test. Thank You Bruce Willett for calling them out, on behalf of General Practice.