‘Insult to general practice’: GP advisor for pharmacist trial quits

New South Wales is the latest state to announce further expansion of pharmacist prescribing, as the number of conditions that can be diagnosed and treated without seeing a GP are growing, much to the concern of many.
 
One of those is Rural Generalist and educator Dr David Leaf, who recently resigned ‘in disgust’ from his role on the NSW Health Expert Advisory Group for Expanded Scope Community Pharmacy Services.
 
Speaking to ABC Radio on Friday, Dr Leaf said as a member of the advisory group for the past year, he repeatedly raised concerns around lack of safety evidence behind the pharmacist program, but believes medical advice is not being prioritised.
 
‘There was no medical benefit – when our evidence-based opinions were put forward, they were dismissed, they were not recorded,’ he said.
 
‘It felt like the assembled experts in these meetings were there to be ticked off as attended, but when you form an expert advisory group, you listen to the experts and you incorporate them into your recommendations. That was not happening.’
 
Speaking to newsGP, Dr Leaf doubts his departure from the advisory group will prompt NSW Health to consider the risks raised and to change processes.
 
‘I have no confidence that they will do so. In fact, I saw that the Premier had doubled down on their commitment to the Pharmacy Guild by attending their conference and promising ongoing commitment and further expansion,’ he said.
 
‘It’s an insult to general practice as a whole. It’s dishonest to the public.’
 
Dr Leaf says there are some conditions that pharmacists are ‘simply not trained to do’, but in the advisory group’s meetings they ‘completely overrepresented’ the type of training they have.
 
‘I was asked as an educator by [NSW Chief Health Officer] Kerry Chant how many ears it takes before you know what you’re looking at for ear infections,’ he said.
 
‘And I scratched my chin and said, “hundreds probably, and they need to be verified by another doctor”, and the Pharmacy Guild said, “we’re not trained in that, but we’ve got a training program where people can look at up to 30”.
 
‘There was no gold standard, no one was looking over the person’s shoulder – which is wholly inadequate.’
 
Dr Leaf also points to pharmacists trialled to prescribe UTI antibiotics for women, saying they were not equipped, trained, or were able to test for those conditions, and never were.
 
He describes the trial as ‘deeply flawed’, with the conclusions drawn from it ‘completely unreasonable’.
 
‘We represented this to the Chief Health Officer in writing and in the meetings, and it was clear that they simply weren’t interested in the experts gathered there from various specialty colleges.’  
 
The RACGP continues to warn of politics being prioritised over patient safety, and any expansion of pharmacy prescribing needs appropriate safeguards in place when diagnosing and treating patients.
 
RACGP NSW&ACT Chair Dr Rebekah Hoffman said Dr Leaf walking away is a clear red flag that backs what the college has been saying.
 
‘This is a good example of how the New South Wales Government isn’t listening to the experts in the room,’ she told newsGP.
 
‘And that’s a really clear example with the representative GP from the working party getting to the point where they didn’t think it was safe enough for them to continue representing general practice – that’s an absolute red flag.
 
‘It’s something the Government should have been aware of, the NSW Ministry of Health should have been aware of, and really should have been assigned to slow down rather than to speed up.
 
‘As a college, we’re definitely happy to continue working with them, but only if we’ve got a seat at the table and only if we’re being constructively listened to.’

Included in the NSW Expanded Scope Community Pharmacy Service proposals is an expansion to treat chronic and complex conditions, including hypertension, wound care, ear infections and lung disorders.
 
This is in addition to an already announced expansion of access to pharmacist-prescribed contraceptives and treatment for uncomplicated UTIs, a move which prompted the RACGP to urge for stronger evaluation to ensure it improves care for women.
 
Dr Hoffman, who has described the latest expansion of pharmacist prescribing powers as a ‘reckless gamble’, is deeply disappointed.
 
‘We’re disappointed it wasn’t flagged with us that this announcement has happened,’ she said.
 
‘We’re disappointed that there’s been some really significant clear evidence from independent bodies like the Sax Report and the Grattan Report saying that this really isn’t safe, and irrespective of all of that, the Government continued to plow forward.
 
‘We’re really worried about patient safety, we’re really worried about boundaries and we’re really worried that the people who are at the advisory committees and are flagging these concerns haven’t been listened to.’  
 
And as pharmacy prescribing continues to gain momentum, Dr Leaf’s frustrations are clear.
 
‘All the GPs from the Expert Advisory Group thought it was a bad idea,’ he said.
 
‘So, at that point I felt it was a reputational risk for me to be part of this group, and that we were there simply to be seen as being consulted but not actually listened to – and that’s when I left.

‘I don’t mind if people disagree with me on an intellectual basis, but if you compile an expert group and you ignore and don’t incorporate anything that’s said, then you can only conclude that you’re being ignored.

‘It’s professionally flawed.’
 
newsGP contacted NSW Health for comment.
 
Log in below to join the conversation. 

NSW Health pharmacist prescribing pharmacy prescribing trial scope of practice