Queensland makes pharmacy prescribing permanent

The Queensland Government has made the controversial decision to make two community pharmacy prescribing pilots a permanent fixture of the healthcare system.
 
Queensland’s Health Minister Tim Nicholls announced the change last week, which sees specially trained pharmacists across Queensland permanently able to diagnose and prescribe medication for several health conditions.
 
‘Queenslanders will be able to visit their community pharmacy to receive safe care and treatment for everyday health conditions,’ he said.
 
‘This opens up another avenue for the community to receive the right care at the right time safely and effectively, which is at the core of our Easier Access to Health Services Plan.’
 
The RACGP has been a vocal opponent of expanding pharmacists’ scope of practice, citing both safety and ethical concerns for patients.
 
RACGP Rural Chair Associate Professor Michael Clements told newsGP he is concerned that politics is taking precedence over evidence.
 
‘We would always argue that any kind of health intervention needs to be assessed for what it improves, and balances out the risks and harms,’ he said.
 
‘This particular announcement just shows that they have never been interested in whether this is actually good for the community, or beneficial and safe.’
 
The Queensland Government launched its Community Pharmacy Scope of Practice Pilot in April 2024 and established a separate training pathway for pharmacists to prescribe hormonal contraception in August that year.
 
Since then, people have been able to access treatments for conditions such as ear infections, acne, school sores, eczema and mild psoriasis, nausea and vomiting, as well as contraception. 
 
More than 135 community pharmacists are currently taking part in the pilots. 
 
Minister Nicholls has declared both pilots as ‘successful’ and claims there have been ‘no safety concerns’ among more than 1700 services delivered so far.
 
However, neither of the pilot programs have reached their official completion dates, when they would be independently evaluated.
 
It comes at a time when similar pilot programs are gaining momentum across Australia, with patients in every state and territory now able to bypass a GP and have their suspected urinary tract infection (UTI) diagnosed and treated by a pharmacist.
 
Associate Professor Clements says the proof is certainly lacking as to whether pharmacies are appropriate settings for people to receive this kind of healthcare.
 
‘There’s nobody looking anymore to make sure that this is something that the communities should be needing expanded,’ he said.
 
For pharmacists to participate in the program, they must have completed additional training, this includes completion of prescribing training and clinical practice training.
 
But the Townsville-based GP has also questioned whether the training offered to pharmacists is adequate.
 
‘The problem is when you only teach people five different skin rashes or one cause of pelvic symptoms in females, they are absolutely going to be over diagnosing those cases,’ Associate Professor Clements said.
 
‘It’s the old adage: “If all you’ve been given is a hammer, everything’s going to look like a nail” – and this is absolutely true.’
 
He added that GPs’ concerns are also backed by feedback from patients who have sought medical care through the pilot programs.
 
‘They go to the pharmacy and they say, “I’ve got these pelvic symptoms, I think that it might be a UTI” and the pharmacist says “well, I can’t do a urine test and I can’t examine you. I might as well just give you some antibiotics to see if that helps”,’ Associate Professor Clements said.
 
‘Now, that’s not a diagnosis; that’s not good evidence; and that’s not good science.
 
‘If we only give pharmacists 10 things that they think that they might learn more about, it’s the other 20 or 30 conditions that are dangerous where the patient harm comes from.’
 
Meanwhile, Associate Professor Clements says what particularly frightens him is the lack of accountability and opportunity for feedback for dispensing pharmacists when something goes wrong.
 
‘I’ve had patients come to me who had treatment initiated by a pharmacist, often incorrectly, but they don’t remember which pharmacist it was,’ he said.
 
‘In medical education, our registrars have an apprentice-like program where they see patients and then they see them for follow up.
 
‘If they miss a diagnosis or they try a course of treatment that doesn’t work, they actually get to see the patient again to learn and see what works and what doesn’t.’
 
Minister Nicholls said that feedback on the pilot programs has confirmed the services are ‘increasing access for patients who otherwise might not have received the care they needed’.
 
However, Associate Professor Clements says ‘pharmacies do not open up where there aren’t script writers’.
 
‘In all the rural communities that I’ve been to, there are far more rural towns with a GP and a doctor and no pharmacy than there are places with a pharmacist and no doctors,’ he said.
 
‘I’ve had pharmacies right next to me, when we’ve got walk-in appointments and we bulk bill children and pensioners, trying to compete.
 
‘So, it’s a myth to say that we need to give access to pharmacy prescribing because people can’t get in with a GP.
 
‘The reality is that we’re turning the corner when it comes to GPs and GP workforce.’
 
Now the concern is that the Queensland Government has set a new precedent, and that lobby groups will leverage the move to make similar changes nationally.
 
‘Again, we caution that any kind of health intervention, without being backed by evidence – that this is something that’s needed and safe – is going to be dangerous,’ Associate Professor Clements said.
 
‘Patients deserve the best care, and the best treatment that can be offered.’
 
The Queensland Government has confirmed that management programs included in the Community Pharmacy Scope of Practice Pilot for conditions such as cardiovascular disease, asthma symptom control and obstructive pulmonary disease will continue to be trialled until 2026, as originally planned.
 
It says this will allow for ‘further evaluation and consultation’.
 
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