RACGP condemns pharmacist prescribing of the pill and certain antibiotics

Doug Hendrie

17/04/2019 4:10:02 PM

Questions raised over Queensland trial broadening pharmacists’ scope of practice.

Taking medicines from the shelf
RACGP President Dr Harry Nespolon is concerned pharmacists do not ‘have the medical training required to safely deliver these crucial healthcare services’.

Pharmacists in Queensland will be able to prescribe antibiotics for urinary tract infections (UTIs) and repeat scripts for the contraceptive pill, and expand their range of vaccinations as part of the trial.
RACGP President Dr Harry Nespolon has called on the Queensland Government to reconsider its decision before any patients potentially suffer.
‘It’s quite simple. Pharmacists don’t have the medical training required to safely deliver these crucial healthcare services,’ he said.
He warns that allowing pharmacists to prescribe antibiotics could drastically increase the risk of antibiotic resistance and the creation of superbugs.
‘Antimicrobial resistance is a real community risk, which has seen GPs become the stewards of antibiotic prescribing. Increasing the amount of professionals able to prescribe antibiotics will do nothing but exacerbate this issue,’ Dr Nespolon said.

‘The Queensland Government is thumbing its nose at antibiotic stewardship. Even the World Health Organization sees this as a major health problem. Governments should be trying to decrease the number of prescribers of antibiotics not flippantly increase them.’

The trial expansion of pharmacists’ scope of practice comes after the RACGP last year warned the Queensland inquiry that the proposed relaxation of rules risked increasing patient deaths and illness due to medication misuse, fragmentation of care and lack of training.
Dr Nespolon condemned the trial as a ‘misguided solution to a problem that doesn’t exist’.
‘Urinary tract infections can travel through the body and become very dangerous for the patient if not managed appropriately. Likewise, prescribing contraception is an invaluable opportunity to assess the overall health and sexual health of the patient,’ he said.
‘Only GPs can provide this comprehensive and holistic care.
‘While it may sound like a straightforward matter to prescribe medications for contraception and urinary tract infections, the Queensland Government clearly has not taken into account the complexities that can be involved in a patient visiting their GP for a script for antibiotics or the pill.
‘When you have a pharmacist dispensing and prescribing rights you remove all of the needed checks and balances on medications, leaving the system open for increased human error or worse, risk of manipulation for business purposes. Ultimately, it is the patient who suffers.’
Chair of RACGP Queensland Dr Bruce Willett described widening the pool of antibiotic prescribers as ‘borderline irresponsible’.
Dr Willett met with Queensland Health Minister Steven Miles yesterday, making the point that pharmacist prescribing of antibiotics is the wrong approach in a world heading towards a crisis in antibiotic resistance and with guidelines for antibiotic prescriptions tightened across many developed countries.
‘For us to go against the flow on antibiotics is borderline irresponsible,’ Dr Willett told newsGP.
Dr Willett said a key issue regarding the proposed pharmacist prescribing of the pill and UTI antibiotics is the fact the length of a repeat script remains undefined.
‘Is a repeat a year or a month? If it’s a year, that means the patient could go two years without being reviewed by a GP, which is unacceptable and potentially dangerous,’ he said. 
‘If the [Queensland] Government is hell-bent on going ahead with this terrible idea, at the very least restrict this to one-month prescriptions.
‘Multiple prescribers drastically increases the risks of medication error.’
In addition, Dr Willett said people seeking contraceptives at a pharmacy will not be able to access long acting reversible contraceptives.
‘Because pharmacies aren’t able to provide those, they won’t offer them. Patients will miss out on the best contraceptives available and they won’t be screened for STIs [sexually transmissible infections],’ he said.

Chair of RACGP Queensland believes pharmacist prescribing of antibiotics is the ‘wrong approach’.

Dr Willett also has concerns regarding the proposed methods of consultation.
The parliamentary inquiry’s report calls for pharmacists to consult the Queensland Government’s 13 HEALTH health service line or access the patient’s My Health Record as a way of minimising risk.
But Dr Willett said 13 HEALTH has no GPs who answer calls. In addition, he said, many patients do not have a My Health Record, and the Australian Digital Health Agency has stated that a My Health Record is specifically not to be used as a comprehensive patient record, but rather as a health summary.
‘The [Australian Digital Health Agency] has said we don’t want it used in exactly the way the Queensland Government wants to use it,’ Dr Willett said.  
State Health Minister Steven Miles this week told the Sydney Morning Herald that the Queensland Government had accepted all of the recommendations made by the pharmacy parliamentary inquiry.
However, the key recommendation on UTI antibiotic and repeat prescriptions for the contraceptive pill was only accepted ‘in principle’ and subject to the outcome of the state-wide trial, according to the official government response to the inquiry findings.
A spokesperson for Queensland Health said the Government will work with industry stakeholders to develop a trial to be rolled out at pharmacies across the state.
‘Recently we announced 16- and 17-year-olds can now receive vaccines for influenza, pertussis [whooping cough] and measles at a pharmacy – another recommendation from the inquiry,’ the spokesperson said.
In 2016, the Queensland Government permitted pharmacists to deliver several vaccines to adults, including measles, flu and mumps, following a trial.
The Government is expected to consult on how the new model would work.
The Australian Medical Association of Queensland (AMAQ) has also opposed the trial over concerns around the conflict of interest between the pharmacist’s role as both prescriber and retailer of medication.
The Queensland trial comes after a number of separate efforts to permit pharmacist prescribing, including the Pharmacy Board of Australia’s recent discussion paper suggesting three potential models for pharmacist prescribing, all of which were opposed by the RACGP.
The Federal Government recently moved to down-schedule medications by directing the Therapeutic Goods Administration to create a new group of medications between Schedule 3 and 4, able to be dispensed by pharmacists, which was also opposed by the RACGP.  
The moves come against a backdrop of declining profitability for many pharmacies in the face of growing retail competition.
A recent IBISWorld report states that community pharmacies have become ‘increasingly polarised between small, high-service pharmacies that offer allied preventative and primary healthcare services and large, high-volume, low-margin pharmacies that compete on price’.

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Dr Evan Wayne Ackermann   17/04/2019 10:04:06 PM

The government will lose all credibility with antimicrobial stewardship. Already chlorsig is prescribed/dispensed in increasing quantities without any audit capacity.

Dale van der Mescht   18/04/2019 6:28:17 AM

We believe you have the skill set required to prescribe medication but please call 13HEALTH before prescribing.... hahaha.

Arshad Merchant   18/04/2019 7:12:43 AM

Pharmacist have created the opioid addiction now antibiotics resistance on the way... why can’t GP open pharmacy when I can prescribe??

julian chin   18/04/2019 7:49:28 AM

No one is listening to the RACGP
Can you please get more political
Can you organise a Monday walk off the job please
That should get your voice heard

Sugan Appasamy   18/04/2019 8:53:47 AM

If we don't stop this then it becomes a free for all
They are taking away GP work and eventually general practice will suffer
As a group drs need to fight this or there will be the start of the end for general practice
Who gets sued if there are complications?
We should be allowed to dispense if they want to prescribe

Sugan Appasamy   18/04/2019 8:56:05 AM

We need to get more aggressive ,maybe form a union to protect GP s rights before the government and pharmacy groups destroy GP practice forever

emil djakic   18/04/2019 9:55:13 AM

The comments and objection to these changes are well meant . Can I encourage all RACGP members to look at the federal election advice from our President and take up the conversations with your local candidates . The RACGP wants us to advocate for General Practice and an election provides just that opportunity .
I know this appears to be a Qld state issue but be assured it is the thin edge of the wedge

Bruce Maybloom   18/04/2019 10:36:45 AM

It is pretty simple really. It's called political lobbying; aka buying politicians support. Something that the pharmacy industry is fabulous at and GP organisations don't do at all. Unless GP/GP organisations wakes up and act upon this point GP will be killed off. The next blow of course will be when referrals to specialists are not required.

Dr Leo Blanco   18/04/2019 1:01:18 PM

We should be allowed to dispense if they want to prescribe

joe   18/04/2019 1:05:31 PM

This is alarming. I have grave concerns regarding patient's safety. What if the UTI is resistant to antibiotic the pharmacist is prescribing. What if it is not UTI but interstitial cystitis or even a bladder tumor masquerading as a UTI. Are pharmacist really trained for that kind of stuff. Who will be responsible for patient's safety.

joe   18/04/2019 1:09:45 PM

Julian Chin, totally agree with you. Look at the nurses and teacher. They strike and all their demands are fulfilled. Here we are sitting on medicare freeze while the cost of living including exam fees, registration fee, mortgages are going up and up.
I think we should do the pen down strike. There is no benefit in playing the nice guy.

joe   18/04/2019 1:23:42 PM

Chair of RACGP Queensland believes pharmacist prescribing of antibiotics is the ‘wrong approach. That is a very good belief. What has he actually done to address the issue.

Dr Ting Kwok Wong   18/04/2019 3:56:17 PM

It appears to me that nowadays the politicians only need GP to write referrals, certificates, filling forms of various types, following guidelines.
GP has been downgraded to "medical clerk"status!
I am glad that I'm at the twilight of my career!

Brendan jones   18/04/2019 5:55:02 PM

What happens when someone with a rash or cellulitis attends a pharmacy and gets their “uti” diagnosis as a way to hand the system?

CB   18/04/2019 7:03:20 PM

RACGP condemns pharmacist prescribing ... Unfortunately that statement has about as much weight and gravity as Donald Trump’s hair in a blizzard. The pharmacist lobby is immensely powerful and that’s why more and more allowances are made for them. Our college is unfortunately extremely weak in comparison and that’s why we are continue to loose ground. One has to look only at how much pharmacy has gained in the last few years compared with GPs. They have not had to share one inch of their entitlements, rights or privileges. Unfortunately all of that boils down to the strength and lobbying power of the two colleges. And there clearly is a strong one and a weak one...

Anna   18/04/2019 7:13:33 PM

Pharmacists are already giving non ideal flu vaccines (under 65 yr vaccines to over 65 year people). Further expanding their prescribing role will further compound less than ideal practice.

Ahad KHAN   19/04/2019 12:17:53 AM

There is a Saying :
1. The One who knows not what he knows not - BEWARE of this Person.
2. The One who knows that he knows not - TEACH this Person.
3. The One who knows that he knows - follow him.

Guess which one of these 3 , are these Ambitious Pharmacists.

R S Gupta   20/04/2019 4:36:04 PM

We are putting the patient at high risk by letting the Pharmacist prescribe the Antibiotics & contraceptive , as a Pharmacyst is not a qualified to do this

TR   22/04/2019 9:37:29 AM

Perhaps now pharmacists have rights to prescribe, it is time to push for dispensing rights for GPs. That would really save the public a lot of time and money.

The report makes a lot of the 4 year pharmacy degree and internship which sounds a lot like the new 4 year post grad medical degree and internship. Maybe this does not help the RACGP argument that doctors have more training. Once upon a time in Australia it took 6 years to become a doctor, no matter if you had another degree or not.

ST   13/07/2019 7:17:50 PM

As someone who dispenses thousands of antibiotic scripts everyday from GPs for patients with the influenza virus, i find it hilarious that the antibiotic resistance is blamed on pharmacists. The amount of times in a day us pharmacists have to call doctors to rectify errors is a waste of precious time, if we can rectify it ourselves.

Also the day that doctors learn how to write a S8 script legally without pharmacists having to point out the errors, is the day they should be allowed to dispense.

Pharmie   4/09/2019 6:24:03 PM

Trimethoprim has been available as a pharmacist only medication in NZ for almost ten yrs. Because most drs are ignorant of how pharmacists work, il explain. It requires a consultation with substantantial recording and only for certain patients with no complications and simple symptomatic uti. Pharmacists take responsibility for the patient every time they dispense a Rx and this will be the same. Because of the MBS system in Aus and the powerful medical unions, govt has been slow to fully utilise other health professionals. Everything can't go through a dr all the time. If it does then you'll have to charge half rate lol. Pharmacy has seriously stagnated in Aus, in part bcos of the MBS system and in part due to discount retail pharmacies.