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Priceline cervical cancer screening plan draws fierce criticism


Chelsea Heaney


17/10/2024 4:00:00 PM

A pilot program enabling patients to self-test inside the pharmacy giant’s stores has infuriated GPs who said it goes against the core values of the national screening program. 

A Priceline Pharmacy storefront.
The cervical screening program will operate in partnership with the InstantScripts telehealth service.

A Priceline Pharmacy plan to quietly rollout cervical cancer screening in a select number of stores has sparked fierce backlash from the general practice community, raising questions about how such a large-scale organisation can safely ensure patient risks are managed.
 
Priceline, which is owned by Wesfarmers, announced the initiative this month and plans to begin the pilot program in November – according to an article in Pharmacy Daily.
 
It will reportedly operate in partnership with the InstantScripts telehealth service, also owned by Wesfarmers, with women enabled to self-test in a private pharmacy consultation room.
 
Priceline was contacted by newsGP for further information, with a company spokesperson confirming ‘the pilot has been developed with reference to the National Cervical Screening Program [NCSP] Quality Framework and is overseen by doctors’.
 
The concept has been slammed by GP Dr Lara Roeske, who sits on the NCSP Self-collection Implementation Committee and has been integral in the advocacy for this option for patients for years.
 
Dr Roeske told newsGP this plan, and the lack of details around it, could endanger the world-class system Australia currently has.
 
‘They’ve chosen to focus on something that they believe they can offer, maybe in terms of convenience, but, in fact, they are completely unaligned with the intent of the NCSP itself,’ she said.
 
‘They’re taking a piece of the NCSP going, “oh, we’ll just do this little bit” and they’re taking it in isolation, out of all the other bits that are relevant which make it successful … that worries me, and I think that people need to be worried.
 
‘I’d hate to see this present any risk to the outcomes we’re trying to achieve through the way in which we support the NCSP.’
 
Due to her long list of concerns, Dr Roeske said there are far too many questions for the organisation to proceed with its pilot.
 
‘I can’t see that they have the ability or the capability to determine eligibility, and most importantly, I can’t see how what they’re proposing actually meets or aligns with the intent of the national program to, first and foremost, support informed choice,’ she said.
 
‘That means not just offering one test but offering the option of self-collection or clinician collection, so they’re not even doing that right, and then there’s a whole issue of timely follow up and the safety and the quality that goes with that.
 
‘I’m extraordinarily disappointed that they think this is okay and what I’d like to know is who have they consulted with or how they can offer a quality service that actually meets the standard requirements and aligns itself to our NCSP? Because that’s what we hold ourselves to in general practice.’
 
The pilot is the latest in a long list of recent pharmacy scope of practice expansions, with several states and territories handing over autonomous prescribing powers for a range of conditions.
 
The RACGP has spoken out strongly against this nationwide rollout, citing fears of patient safety and care fragmentation, and in the case of Priceline’s plan, Dr Roeske shot down assertions of it being an improvement to screening access.
 
‘A large amount of women may present with abnormal bleeding, vaginal discharge or painful sex, they’re not eligible for self-collection or clinician collective sampling and I’m also presuming they’re going to take the full responsibility that comes with ordering a test and determining that they actually are due for screening,’ she said.
 
‘There is a number of people we see who are unable to take their own samples, so there would be a whole cohort that would not be amenable at all to this model and, in fact, I don’t think this model is at all amenable for any Australian.
 
‘I don’t see it as safe, and I don’t see it as assisting with an equity issue.’
 
Finally, Dr Roeske said there are serious risks to women who have abnormal results or are symptomatic.
 
‘How on earth do they propose to follow up abnormal results? I fail to understand how they’re going to close that loop?’ she asked.
 
‘If they’ve had an abnormality in the past that hasn’t been determined at the visit, then that’s dangerous.
 
‘People are then being falsely reassured that they’ve had a screening test and they’re all fine, but in fact, there’s been an abnormality detected a couple of years ago that requires a completely different form of investigation and assessment.’
 
According to the story in Pharmacy Daily, Priceline has ‘plans for national expansion based on feedback’.
 
Associate Professor Joel Rhee, Chair of RACGP Specific Interests Cancer and Palliative Care, told newsGP the concept was ‘clearly an extremely bad idea’.
 
‘There is lot of issues, and, basically, meeting all of these challenges would mean that Priceline would have to essentially convert into some form of comprehensive primary care clinic,’ he said.
 
Key among his concerns, was the continual breaking down of preventive care.
 
‘We need to strengthen general practice as one place that does preventive care and not allowing all these different players, including pharmacies, to take a little bit here and there,’ he said.
 
‘That’s going to just result in serious risks, and it could lead to results being missed and other opportunities being lost.’
 
newsGP took the above concerns to Priceline, but no further details were provided.
 
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Dr Saluay Kidson   18/10/2024 9:57:50 AM

When I trained a cardinal rule of practice was that those who prescribed did not dispense drugs. We now see both Vets and Pharmacists doing this, with the blessing of multiple governments. The concept of screening tests is to both administer testing and to open a dialogue regarding general health and preventive care as part of holistic medical management. People are being lulled into convenience shopping for healthcare. Having failed to foresee the dire consequences of failing to understand the value and importance of independent General Practice as a primary care service delivery module, governments are now scrambling to plug holes in any way possible. I wonder whqt PI insurance the pharmacists and Vets carry? Lawyers PI insurance is 1-10% of doctors PI costs. If Governments are determined to follow this pathway to the lowest level of health service delivery then they can at least provide NZ style insurance for all so we do not end up in a lawyers' picnic like the USA.


Dr Steven Hambleton   18/10/2024 10:59:38 AM

I have said it before and I will say it again. These "profit driven" product lines are the major threat to GP lead comprehensive primary care. We are battling hard to preserve our world class system while State Governments and Commercial operators set "Rome on Fire". GP lead Primary Care teams are the future! We do not need disintegrated care. Professor Rhee and Dr Roeske are spot on. Short term or popular or profit driven policies will break what we are trying to fix. We all need to work together to fix this for the sake of our health system. Dr Steve Hambleton


Dr Michael Charles Rice   18/10/2024 5:59:46 PM

I wouldn’t get too excited.
These things will be going out in the post like FOBTs before long.

We’ll be having an annual CV risk package as well, I predict, with point-of-care lipids and BGLs.

Next, the Vectra machines!


Dr Matthew Piche   19/10/2024 8:56:36 AM

The moment self collected tests came available with clear criteria for their use it became an outsourceable entity, saving mostly female GP's from this dreaded burden.

Undoubtedly a benefit of self collected swabs is reducing the reluctance of people to have this test done, and implemented well, would increase rather than decrease the screening. Again we see the primary concern of the college's having little to do with patient access or outcomes, and everything to do with jurisdictional turf wars with those pesky pharmacies.

This is not a well constructed argument against the initiative. it's yet another "letter of our collective outrage" that fails to discuss merits and pitfalls.

I would think that the adaptive approach would be to treat these tests much like we do FOBT's (also available in pharmacies) and create a national mail-in screening.