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Pharmacy prescribing expansion a ‘race to the bottom’ of healthcare
An extension of Queensland’s controversial contraception prescribing pilot has left GPs seething, saying it is ‘tokenistic’.
Consultations will range in price from $18.85 to $68.10 depending on length.
Eligible Queensland patients can now bypass their GP and head straight to a pharmacist to begin hormonal contraception, as a controversial pilot program officially expands across the state.
The Community Pharmacy Hormonal Contraception Pilot was extended on Thursday, bringing about a new wave of concern from GPs, who say the program is risking patient safety and further fragmenting care.
The trial was announced by the Queensland Government earlier this year to allow greater access to contraception amid ‘ongoing challenges around access to primary healthcare services’.
Community pharmacists participating in the pilot can now consult with patients about their contraception needs, determine a management plan, and prescribe treatments, all without involving a GP.
Contraceptives which can be accessed as part of the pilot include the combined oral contraceptive pill, depot medroxyprogesterone acetate, and the combined hormonal contraceptive vaginal ring.
This can be done after pharmacists have completed a six-hour course and added consulting rooms to their premises.
Consultations will range in price from $18.85 to $68.10 depending on length, and are not eligible for Medicare rebates, with prescriptions not subsidised by the Pharmaceutical Benefits Scheme.
RACGP Queensland Chair Dr Cathryn Hester told newsGP the expansion has left her highly disappointed, describing it as ‘a missed opportunity’ to meaningfully support the provision of quality healthcare.
‘The expansion of this pilot deteriorates healthcare standards in Queensland even further in terms of quality, whole-person care,’ she said.
‘We see this as a tokenistic approach to “improve access”, which really is only going to benefit pharmacy owners.
‘A pharmacist is simply not capable or trained to provide whole-of-person women’s healthcare, and we should never confuse the act of selling a box of oral contraceptive pills for actually providing women’s healthcare – as a woman and a GP, I would find that highly insulting.’
The pilot is open to women aged 16 and older who meet other eligibility requirements, while eligible pharmacists must complete a compulsory training course to participate.
It is the latest in a long list of similar pilot programs to be launched by the Queensland Government, with eligible pharmacists now able to prescribe for, among others, shingles, acne, smoking cessation, and structured prescribing as part of a chronic disease management program.
The pilots have drawn significant concerns from GPs, with past criticism saying they ‘make no sense‘ and are a ‘significant overreach‘.
They come after the Therapeutic Goods Administration was previously asked to consider down-scheduling oral contraceptives, but decided against the idea as ‘consultation with a pharmacist is not sufficient to ensure safety, particularly over extended periods of time’.
Dr Hester said she has significant concerns about the pilot’s care fragmentation, and what will be missed when ‘women’s healthcare is conflated with selling a script’.
‘I’m worried that sexually transmitted infections will go undiagnosed, that cervical cancer screening will be foregone, that episodes of domestic abuse will never have a chance to be addressed,’ Dr Hester said.
‘These are the types of consults I have every day when my patients book in for “just an oral contraceptive pill script” that would have zero chance of being appropriately addressed in a retail pharmacy environment.
‘My patient cohort much prefers to see their usual GP in a quiet, safe and private location than to see a random prescribing pharmacist in a retail environment.’
Adding to growing concerns, last month researchers revealed serious discrepancies in urinary tract infection (UTI) prescribing protocols, finding a ‘deficiency in the quality of most clinical management protocols governing pharmacist-led UTI management’.
Several other states have now followed Queensland’s lead with the introduction of pharmacy pilots covering a range of treatments.
And Dr Hester now fears this is just the beginning of pharmacy prescribing.
‘There is an element of contagion to the other states – it seems like a race to the bottom of healthcare for Australia at the moment,’ she said.
‘We will continue to fight this; GPs and our communities deserve better.’
More Queensland community pharmacists are expected to start offering the service later this year, with the pilot to continue until 30 June 2025.
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