North Queensland doctors urged to keep airing concerns

Jolyon Attwooll

17/10/2022 4:49:23 PM

A united front is key to countering potential damage, says RACGP president-elect, who has closely tracked the pilot’s controversial evolution.

Anonymous pharmacist
The pilot will allow participating pharmacists to prescribe for a range of conditions.

Dr Nicole Higgins, the RACGP’s president-elect, is a great believer in the collective power of GPs.

With a general practice in Mackay, and as a former director on the North Queensland Primary Health Network Board, Dr Higgins has tracked the evolution of the North Queensland Pharmacy Full Scope of Practice Pilot and the surrounding controversy very closely.
‘I have lived and breathed the pharmacy pilot,’ she told newsGP.

Queensland Health finalised the pilot last week, albeit with a reduced scope than originally planned – but Dr Higgins is determined to keep voicing her concerns. She hopes other doctors will do the same.
‘The thing local GPs can do is educate their communities, which means talking to their patients, talking to their local members of parliament, about how this is going to impact patient safety and care,’ she said.
Dr Higgins points to the North Queensland Doctors’ Guild, which was formed as a result of deep unease surrounding the impact of the state’s policy on general practice, as an example of effective grassroots advocacy.
‘It’s brought our profession together,’ she said. ‘It’s not just GPs, there are non-GP specialist colleagues also involved – and we’ve been really effective in highlighting it as a state issue and a national issue.’
Dr Higgins was the RACGP Queensland Faculty Council representative when the college resigned from the pilot scheme’s steering committee. The AMA, Australian College of Rural and remote Medicine (ACRRM) and Aboriginal Community Controlled Health Organisations all took the same action.
She remains unequivocal in her views on the potential damage the pilot could cause.
As a long-time GP supervisor in the region, Dr Higgins says one of her most significant worries is about the suitability of the training for pharmacists who take part, and the impact on patient care.
A Queensland Health document including details of the pilot says participating pharmacists will need to undertake a prescribing education and training program with 120 hours of in-practice learning. A clinical program covering assessment, diagnosis and management of the conditions will also be carried out, the document states.  
‘My primary concern is inadequate training,’ Dr Higgins said. ‘This is very complex work, which takes GPs 10–12 years to learn.’
Under the terms of the pilot, autonomous prescribing would be allowed for 17 separate conditions, compared to 23 listed in earlier documents that were leaked to the media – but for the Mackay GP, this does not go nearly far enough.
‘The pilot is not significantly watered down and the conditions where we have the biggest amount of concern, like acute otitis media, or asthma, or COPD, or cardiovascular disease – they’re really complex illnesses that take a long time for GPs to be able to diagnose and treat,’ Dr Higgins said.
She also cannot see how the pilot will help ease systemic strains in her home town.
‘We’ve got such a shortage of pharmacists and pharmacists in training, I don’t think they’ve got the capacity to do this in Mackay,’ Dr Higgins said.
‘I’m concerned for the pharmacists themselves and the impost that it’s going to have on their usual dispensing work.
‘There’s a shortage of pharmacists, both in North Queensland and Australia as a whole. How are they going to be able to manage to do this and dispense? It may reduce access for patients.’
And while the Pharmacy Guild of Australia said the pilot will bring pharmacists in the region ‘in line’ with other countries including ‘parts of Canada, the United Kingdom and New Zealand’, Dr Higgins points to the detrimental impact on primary care elsewhere.
‘If you have a look at what happened in Alberta, Canada, when they devalued and defunded the general practice system and increased the pharmacies’ scope of practice, they’re now in crisis,’ Dr Higgins said.  
‘They’ve lost significant numbers of GPs or primary care doctors.
‘They’ve got people who don’t want to train in the area and they’ve got people who don’t want to stay. We don’t want North Queensland to become like Alberta.’
Dr Lee Jones, one of the founding members of the North Queensland Doctors’ Guild, echoes those concerns and is critical of the Guild’s international comparisons.
‘It’s disingenuous to say that this sort of pilot is done overseas,’ he told newsGP. ‘It is not the same.’
He shares the view about the likely workforce impact and cites an AMA Queensland survey that suggests half of all doctors could be put off working in the area.
‘I am also very concerned about the effect of this on GP morale considering the workforce issues,’ he said.
‘It may lead to worsening GP numbers. The [Queensland] Government should focus on getting more doctors to live and train in North Queensland.’
Among GPs, there has been almost universal concern expressed over the impact on patients, with those using the proposed pilot service to be charged from $20–55 for a consultation, as well as for resulting scripts.
‘The RACGP has deep concerns about the retail pharmacy sector pushing through policy changes that put financial gains ahead of patient care and safety,’ RACGP President Adjunct Professor Karen Price said.
‘This pilot should be stopped, because patient safety and wellbeing must always come first, and nobody deserves second rate care.
‘This pilot will result in poor health outcomes for patients and much higher healthcare costs.’
For Dr Higgins, the work goes on.
‘[The pilot] isn’t about what’s best for the community. This is just the Queensland Government delivering on an election promise,’ she said.
‘In North Queensland, we don’t want to be known as a place where general practice has been watered down, where our work is so poorly valued.’
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