Pushback against Premier’s nationwide pharmacy prescribing call

Matt Woodley

2/02/2023 5:31:12 PM

Dominic Perrottet is set to raise the topic at National Cabinet, but the RACGP is urging leaders to prioritise patient safety ahead of pharmacy profits.

NSW Premier Dominic Perrottet
NSW Premier Dominic Perrottet is set to ask National Cabinet to support nationwide adoption of pharmacy prescribing for minor ailments. (Image: AAP)

Primary care reform is likely to be at the top of the next National Cabinet agenda, with Federal Health and Aged Care Minister Mark Butler set to table the Strengthening Medicare Taskforce report ahead of its release to the public.
But while general practice reform is expected to feature heavily in the report, NSW Premier Dominic Perrottet has flagged his own desire to promote independent pharmacy prescribing at the meeting, as a way of easing the strain on under-pressure state healthcare systems.
Independent pharmacy prescribing has long been opposed by the RACGP due to fears it would endanger patients and compromise care, and President Dr Nicole Higgins responded to the news by warning against replacing GPs with less qualified substitutes.
‘GPs train for well over 10 years in diagnostics, as well as doing ongoing training for the rest of our working life, in order to be able to diagnose patients,’ she said.
‘There is no substitute for GP care. This road leads to bad health outcomes and more pressure on our already overburdened hospitals.
‘Band-aid solutions will not solve Australia’s health crisis. It might be a cheaper option at first, but who wants cheaper if it means a serious illness is missed?’
Premier Perrottet’s call came shortly after the Pharmacy Guild of Australia sent a letter to all state and territory leaders promoting pharmacists’ ability to independently prescribe, claiming it would prevent 6.5 million trips to the doctor annually.
The estimate is reportedly based on a Guild-commissioned Ernst and Young (EY) economic analysis of the supposed financial and time-saving benefits should pharmacist prescribing be adopted nationwide. A Guild spokesperson told newsGP the report’s public release has been blocked by EY due to copyright.
It also came a day after Australian Electoral Commission records revealed that the Guild had given more than $577,000 to political parties in 2021–22, including $50,950 to the NSW Liberal Party.
Late last year the NSW Government announced separate pharmacy prescribing trials to allow pharmacists to independently diagnose and prescribe medications for several conditions, including UTIs, skin ailments and ear infections, but outcomes for these trials are also not yet available as they are either only in their infancy or have not yet started.
However, in expressing her opposition to the move, Dr Higgins cited adverse clinical outcomes stemming from a similar pilot program instituted in Queensland, which were picked up even without appropriate safeguards in place.
‘The pharmacy prescribing trial in Queensland was not a proper research trial. It did not evaluate health outcomes, and it cannot be used as evidence that such trials should be expanded,’ she said.
‘The RACGP and other medical bodies have long been warning about risky moves to allow retail pharmacists to prescribe antibiotics and other medications in Australia.
‘In Queensland, pharmacists prescribed antibiotics to 96.3% of patients with UTI-like symptoms, without taking urine samples to confirm if they actually had the infection. And there were reports of patients being given antibiotics who in fact had other serious health issues, including a woman with a 15-centimetre pelvic mass.’
Instead of pharmacy prescribing, the RACGP has urged the Government to overhaul Australia’s pharmacy ownership and location laws, which it says limit competition and make it harder for people to access discounted pharmacy services.
‘Australia’s pharmacy ownership laws are anti-competitive, and this inflates the cost to consumers, makes it harder for people to access medicines and reduces choice,’ Dr Higgins said.
‘There have been numerous reviews and reports on pharmacy ownership and location rules, and none of the recommendations to break up the monopoly or allow longer dispensing intervals have ever been actioned.
‘Supermarket pharmacies are widespread in most western nations, including the United States, the United Kingdom, and all over Europe. Why not here? It makes no sense, particularly in a country where we have so many rural and remote communities that don’t have a pharmacy nearby.’
The college has also said that patients would benefit ‘significantly’ if they could access a larger supply of medicines in one visit to the pharmacy via longer dispensing intervals and larger medicine pack sizes.
‘The Medicare Taskforce Review is about improving access to care for patients,’ Dr Higgins said.
‘We need to consider everything as part of this, including Australia’s anti-competitive pharmacy rules which have put Australia so far behind other countries when it comes to access to care and convenience for patients.
‘We [also] need serious investment in general practice care and long-term reforms that ensure all Australians have access to high-quality care, no matter their postcode or income.’
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Dr Aditya Reddy Vitta   3/02/2023 5:24:37 AM

Why cant we GP's just stop being a push over and go on a strike untill our voices are heard??RACGP will find immense support it organises it.

Dr J   3/02/2023 6:07:40 AM

Why stop with deregulation?

Why not adopt a UK model to free up pharmacist time in such a stressed health system and introduce dispensing of let's say 3 months of medicines at a time. It would save the government 2 dispensing fees per dispensing.

Why not allow doctors to dispense medications under the pbs for common things such as antibiotics? My local pharmacy closes well before we do and is extremely inconvenient for patients to get medicines. What about small areas with very limited access to pharmacies, and also after hours medications.

I see no reason at all why doctors can't dispense first line evidence based antibiotics under the pbs.

Why haven't these 2 things been argued by the racgp?

Dr Gardiyawasam Lindamulage Chaminda De Silva   3/02/2023 8:55:56 AM

RACGP should lobby to government that doctors should be able stock medicine and dispatch patients. If pharmacist can stock medicine and prescribe. Why cant we prescribe and stock medicine. We should stand united for our rights .We work hard get paid 50% less than what we should get . I think we are the only profession that is working on a 50% discounted rate. The whole issues is we are not united .

Dr Tatiana Cimpoesu   3/02/2023 12:49:15 PM

Why not study medicine if they want so much to do clinical work?
There is a reason why pharmacists are trained differently and there will be consequences if we ignore the risks of having little clinical knowledge and experience! We should work together, not trying to "cherry-pick" tasks without the legal headache!
Maybe pharmacy prescribing "would prevent 6.5 million trips to the doctor" (i.e. GPs) but would increase the more expensive hospital presentations!
Someone asked, would you hire a plumber to fix your wiring?

Dr Mahalingum Naidoo   3/02/2023 12:55:34 PM

We need the Government to respect the opinion of the RACGP and their members.Supporting political parties as the Pharmacy Guild do is a n obvious conflict of interest.
There was a case where a young girl was treated for a painful red eye with Chromycetin ointment and 3 days later a foreign body was removed by myself.This was missed as it did not involve an eye examination by the pharmacist.All due credit to the Pharmacist who wanted to treat with good intentions but it was missed .
Recurrent UTI could have sinister Pathology which can be missed with consequences.
GP should stand together with RACGP support and question our leadership in health.

Dr Qi Rong Huang   3/02/2023 11:39:15 PM

So far, I haven't seen any powerful criticism against the idea of pharmacist' prescribing. It is a conflict of interest if medication sellers were given right to prescribe medication. The general public would be placed in a great risk, ie, taking wrong or unnecessary medication. The UTI trial has proven this.
Reduced bilk-bulling rate is not because it is too hard to see GPs, it is because of increased cost to provide services. It is an absolute exploitation of doctors' service when Medicare rebate is frozen for 5 years. GPs had suffered the worst stress to provide sharply increased demand and vaccination task during COVID pandemic, It is surely GPs are able to do the same after the pandemic. It is the rising inflation and cost that force bulk-billing to drop.
A practical solution to reducing burden on hospital ED is starting afterhour from 6pm and increasing incentives for afterhour service. In short, increasing funding to GPs is the key to succes of Medicare reform.

Dr Sumathy Mahendravarman   4/02/2023 9:16:00 AM

Why can't the pharmacy to start filling the center link papers and housing commission papers first. It will free up doctor's valuable time.

A.Prof Christopher David Hogan   4/02/2023 2:00:47 PM

This whole project hinges on the public's appetite for risk.
Most people will not come to harm but some will, more than if a GP were involved in a patient's care.
The greatest risk in such issues is unconscious ignorance- people do not know what they don't know.
To demonstrate this to students I ask them to list at least 4 causes of throat pain that are potentially fatal.
About 30-50% of medical practice is defensive medicine- the undertaking of activities, investigations or treatments not because they are clinically indicated but because practitioners do not want to be prosecuted for making a mistake.
Support doctors to cease defensive medicine & their productivity , well being & performance almost doubles

Dr Rifaat Roshdy Salama Girgis   4/02/2023 11:51:54 PM

Very absurd. Politicians have no idea about how medicine is practised. I am horrified with what they are doing. The mistakes the pharmacists will make will lead to horrific jump in law suits and will lead to increased burden to the hospital casualty department and wards to clean up the mess.
Wow, what a shame , what a shame.
The politicians are destroying the health system and destroying the lives of people.
The health ministers should be doctors to direct the
Government to the right path.
I am amazed and appalled at the same time.

Winston Smith   5/02/2023 9:40:12 AM

Let’s be clear here:
1. The Guild’s sole function is to perpetuate the profits of their shopkeeper members. Historically, this is what a guild does.
2. They have an anachronistic, anti-competitive business model that keeps their profits fat, and also keeps medication prices high.
3. They are aggressive lobbyists - spending large amounts of money defending their outdated businesses.
4. They are aware that retail pharmacies could be replaced by a giant vending machine with a ChatGPT interface in a large supermarket.
5. Their latest push to both prescribe and dispense far beyond their expertise is an accident waiting to happen.
6. Watch the AHPRA complaints roll in and the inevitable deaths and additional strain in our already stretched hospital system if this I’ll-advised idea gets off the ground.

Dr Abdul Ahad Khan   5/02/2023 1:19:42 PM

There is a Saying :
The One who knows that he knows not - Teach him
The One who knows that he knows - follow him
The One who knows not that he knows not - BEWARE of him

Dr. Ahad Khan

Dr Ali Tanko Kidmas   6/02/2023 6:33:08 AM

The current coverage of General Practice in the media and the government determination to ‘fix’ the challenges facing primary health care has been encouraging. It prompted me to reflect on my personal experience as a General Practitioner in Australia.

I started work in Tasmania 15 years ago, stationed in a rural general practice. I was given a dispensing license when in Zeehan General Practice. Patients would drop their script at the reception staff. A designated staff would take the script into the medicine room, dispense the medication and lay them all out - scripts and labelled medicine on a table in the room. At lunch I would go through each to confirm they were appropriately done, and patient would return to pick up their scripts in the afternoon. What a patient-centred idea? I thought.
To be continued

Dr Ali Tanko Kidmas   6/02/2023 6:35:28 AM

When I moved to a larger community, where there was a pharmacy, I understood that a medical centre was not allowed to have a pharmacy on the premises. The reason given to me was to avoid conflict of interest. Not bad I thought. But I could not understand why a medical practice could not have a pharmacy on site and recruit a pharmacist to run it.
A colleague of mine moved to a major city to work. When I visited, I noticed the medical practice was located within the same complex with a pharmacy. You walked through the pharmacy to the medical centre located at the rear. My colleague informed me the medical practice was owned by the pharmacist who owns the pharmacy in the complex. Then I WONDERED HOW THAT IS NOT A CONFLICT OF INTEREST. How is it that a medical doctor can work for a pharmacist-owned medical centre but not a pharmacist for a doctor-owned pharmacy? How is it that a pharmacist can own a medical practice in her pharmacy….

Dr Ali Tanko Kidmas   6/02/2023 6:39:06 AM

Very early in my experience in Australia, I realised some medications require prescriptions and still others require special authorisation, unlike in some of the countries I had worked where you could buy practically any medicine over-the-counter besides anticancer drugs. I thought what a great idea considering all the medication mishap and antibiotics resistance that exist in some of these countries. I remember having an interaction with a patient who hesitated accepting a prescription for a common antibiotic because, according to him “in my country this does not work” demanding only the strongest of antibiotics be given to him. My patient would return later, to report “it actually worked” These safeguards are important albeit inconvenient, I thought.

Dr Ali Tanko Kidmas   6/02/2023 6:40:16 AM

Over the years, I have had the privilege of tutoring medical students at the rural clinical school and taking on medical students on General Practice rotation in our Surgery. Besides guiding them in clinical practice in Primary Health context; I have actively promoted General Practice and its central role in ensuring that our health indexes are better than major western nations who spend more on health but achieve less because of fragmentation of care. I have had a student ask me if I honestly believed he should consider General Practice. My response? Of course, I believe you should. He went on to highlight his difficulty with General Practice as a career option. His arguments centred around financial challenges, community perception of GPs versus Specialist and the lack of political support for General Practice.

Dr Ali Tanko Kidmas   6/02/2023 6:41:34 AM

It is only reasonable to conclude that the current shortage of GPs and the declining number of medical graduates choosing General Practice in Australia is the expected outcome of years of chiselling away the value and role of General Practice in the medical ecosystem.
Ali Kidmas, GP, Launceston

Dr Louise Elizabeth Sparrow   8/02/2023 4:10:57 AM

If pharmacists are allowed to diagnose prescribe and dispense GPs should be allowed the same rights. It is in my opinion completely unethical for pharmacists which operate in a highly commercial environment to be dispensing S4 and above medications, especially when they profit financially from doing so. GPs have been educated (esp in last few years) to avoid prescribing antibiotics empirically without good clinical evidence of infection and they have time to take Hx, examine, exclude high temp, do a UA or send a sample and may welll know the patient well enough to know that previous ‘uti’ symptoms have shown negative culture results and indicate bladder irritability or another problem and have comprehensive notes and past history to aid dx and mx. It is frustrating when the NP in the pharmacy does blood work for a patient and fails to send on to the GP which can result in needless repeating of tests or beneficial tests being missed when care is so fragmented.