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RACGP condemns pharmacist prescribing of the pill and certain antibiotics
Questions raised over Queensland trial broadening pharmacists’ scope of practice.
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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