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Pharmacy Guild misrepresents government report to support own agenda


Anastasia Tsirtsakis


22/02/2022 6:17:30 PM

The peak body representing pharmacy owners has said a Queensland Health report recommends expanded pharmacy prescribing. But is that what it really says?

A pharmacist holding boxes of medication.
Dr Michael Clements says there is no evidence to link a possible reduction in ED presentations with expanded pharmacy prescribing.

Seventeen recommendations were included in a recently released Queensland Health report aimed at strengthening the state’s health system.
 
The recommendations range from ensuring the availability of essential clinical supplies, to optimising telehealth and virtual care to improve patient experience and outcomes.
 
However, it was one particular section – to ‘[expand] pharmacist-administered vaccinations and prescribing’ – that drew an especially strong endorsement from the Pharmacy Guild of Australia, which issued a media release to promote the excerpt.
 
Not only did the Guild welcome the report, it used the quoted section to justify calls for an expansion of primary healthcare services being offered by community pharmacists, under the guise of alleviating pressure on the state’s emergency departments.
 
‘We’ve all heard the stories of the long queues and pressure on our hospitals,’ Queensland Branch President Chris Owen said.
 
‘Many of the non-urgent presentations to emergency departments include supply of repeat prescriptions, vaccinations and common ailments like acne, sunburn and muscle cramps – all of which could easily be dealt with at a local community pharmacy.
 
‘This report goes a step beyond this by calling for an expansion of vaccinations and the ability to prescribe some medications within community pharmacy.’
 
But what the release and Mr Owen neglected to mention, was that the quoted paragraph was not actually one of the official recommendations put forward by the report’s authors.
 
Instead, it was taken from ‘Appendix F’, which summarised written submissions provided by 98 different external organisations seeking to contribute to the report – including the Guild itself.
 
Not only did the release not mention this fact, it actively mischaracterised the report’s findings by stating that expanded pharmacy prescribing was included in its ‘key recommendations’.
 
As a result, the strength of the Guild’s claims, and the extent to which the report can be relied on to support them, have been called into question.
 
According to Townsville-based RACGP Rural Chair, Dr Michael Clements, there is no evidence – in the report or anywhere else – to link a possible reduction in ED presentations with expanded pharmacy prescribing. 
 
‘I’d like to see the evidence for that [as] that’s not borne out by every other report we’ve seen from Queensland Health or any other state,’ he told newsGP.
 
‘There just isn’t a link between what they’re trying to propose and any benefit – there’s not even a tenuous link. What we see them doing is chasing shadows.’
 
newsGP asked both the Guild and Queensland Health for any available evidence to support the apparent benefits of expanded pharmacy prescribing practices.
 
Queensland Health did not respond to the question directly, but said ‘tapping into the expertise of all healthcare workers’ and enabling them to work to their ‘full scope of practice’ is key to ensuring health services remain ‘safe, effective, accessible, accountable, innovative, and capable of meeting future challenges’.
 
Meanwhile, the Guild said ‘potentially preventable hospitalisations data and reports are publicly available’, but did not provide any supporting evidence outside of a link to the Australian Institute of Health and Welfare (AIHW) homepage.
 
For Dr Clements, the Guild is exaggerating what the Queensland Health report findings mean in relation to pharmacy.
 
‘The reality is, pharmacists are only mentioned seven times in that 166-page report and none of the recommendations relate to pharmacy prescribing,’ he said.
 
‘The only time pharmacy prescribing was mentioned was by a stakeholder saying that they wanted it – and where the report talked about “full scope of practice” was for allied health.
 
‘There’s just no link.’
 
The release comes in the wake of a controversial Guild-driven proposal for an 18-month pharmacy prescribing ‘trial’ in North Queensland, which would allow pharmacists to diagnose and treat more than 20 conditions – provided they undertake an additional training course.
 
The full scope of the proposal led the RACGP and other medical groups to resign from its Steering Committee.
 
Despite the strong opposition from doctors, the Guild appears determined to push ahead with the proposal, arguing that people who live in regional and remote parts of the state ‘do not have access to a hospital or a GP, but do have access to a community pharmacy’.
 
However, even though areas in Queensland do have a GP shortage, Dr Clements said expanded pharmacy prescribing is ‘not a rural workforce solution’.
 
‘I work in remote communities, and I just haven’t seen a town that’s got a pharmacist sitting there waiting to do consults with no primary care services,’ he said.
 
‘The pharmacies only open where there’s a steady supply of scripts and so they generally only open up where there is already a reasonable primary care service in place. And the more remote you go, the closer the existing relationship between pharmacy and GPs.’
 
Instead, the Queensland GP believes the biggest threat to remote communities is a disjointed healthcare system, which points to the need for a collaborative approach ‘as per the RACGP’s model’.
 
Moreover, Dr Clements says one positive to emerge from the pandemic has been the advent of telehealth and electronic prescriptions, which has reduced the reliance on face-to-face services when providing ‘good GP-led care in collaboration with a pharmacist’.
 
‘We’ve always absolutely loved the idea of working with pharmacists,’ he said.
 
‘And there are models that do work and are working, but what the Pharmacy Guild is proposing is a new scope of practice, not a full scope of practice, and there’s just no evidence.’
 
The Queensland Health report was authored by the Reform Planning Group (RPG), and developed with input from health experts, patients and other stakeholders.
 
Queensland Health Minister Yvette D’Ath said she hopes it will serve as a roadmap to capitalise on successful initiatives undertaken during the COVID-19 pandemic to strengthen the state’s health system.
 
‘Throughout the pandemic we’ve seen increased use of virtual care, more collaboration to develop new models of care and greater uptake of flexible work arrangements,’ Minister D’Ath said.
 
‘More staff have been empowered to work to their full scope of practice and we have also seen a reduction in bureaucracy and an increase in access to and sharing of data.
 
‘We’re now in a unique position to further develop and embed these innovations to unleash more positive change in Queensland’s public health care system.’
 
Minister D’Ath said the government will consult stakeholders on the report’s recommendations, while a Queensland Health spokesperson told newsGP it will consider findings from the North Queensland Pharmacy Pilot when assessing which parts of the report to implement.
 
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Dr Ian   23/02/2022 2:13:53 PM

Rural and Remote Health cover is a problem area of scarcity in many highly developed medical countries especially large lands like the USA Canada Australia .
There are disparities based on regions socioeconomic group race particularly indigenous peoples and mental health .
If more could prescribe would Indigrnous health be better ?
You also need Competent and Compassionate Councelling and sadly but realistically Strong Security for Health Workers .
Better delivery of care has to instituted .
Either there have to be more doctors there or the demand for other health professionals to do more increases .
Pharmacies doing vaccinations for Covid indicated the problem as many General practices were overwhelmed .