RACGP resigns from pharmacy trial steering committee

‘Serious concerns’ regarding patient safety have led the RACGP to withdraw its representative from the steering advisory committee of a proposed pharmacy prescribing pilot program in North Queensland.
 
In a letter addressed to Chief Allied Health Officer, Liza-Jane McBride, RACGP Queensland Faculty Council representative Dr Nicole Higgins said the college cannot provide representation for a pilot that ‘compromises quality care’ and is in ‘direct opposition’ to current clinical and prescribing arrangements.
 
‘The proposed model requires a pharmacist to make complex diagnostic decisions, including using skills for which they are not trained, and manage complex chronic illnesses such as diabetes and chronic obstructive pulmonary disease,’ the letter reads.
 
The AMA and Australian College of Rural and Remote Medicine (ACRRM) also withdrew their representatives from the trial’s steering committee in a joint protest.
 
While Queensland pharmacists are already able to prescribe antibiotics to women between the ages of 18–65 whom they diagnose as having an uncomplicated UTI under a trial program, a proposed expansion in North Queensland would dramatically increase the number of conditions that they are able to diagnose and prescribe medications for.
 
Plans for the North Queensland Pharmacy Scope of Practice Trial, originally leaked to Australian Doctor, show it is currently slated to commence in June and run for 18-months are part of a deal signed by the Queensland Government, Pharmacy Guild of Australia and Pharmaceutical Society of Australia to allow pharmacists to practise at their ‘full scope’.
 
RACGP Vice President and Queensland Faculty Chair, Dr Bruce Willett told newsGP the college had concerns from the moment they were advised of the trial and hoped having a representative on the committee would contribute to a reasonable outcome.
 
But he says new insights into its full scope have made any kind of RACGP involvement untenable.
 
‘We are all collectively shocked by the degree and the scope of what the Pharmacy Guild are trying to do here,’ Dr Willett said.
 
‘Given the extent to which this is going … it really is too dangerous for patients’ wellbeing to risk being involved in it at all.’
 
Under the trial, pharmacists across almost 180 pharmacies would undergo some additional training before being permitted to diagnose and treat more than 20 conditions, ranging from asthma and type 2 diabetes, to heart failure and middle ear infections, without consulting a GP.
 
Dr Willett said while pharmacists are experts in medicines, the pilot is clearly a bid from the Pharmacy Guild to move into areas that they are ‘absolutely not trained for’, raising fears over misdiagnosis and fragmented care.  
 
‘It will take GPs an average of at least 12 years to become a GP, with four or five of those years working under direct supervision,’ he said.
 
‘We’re talking about a three week course and then being let loose on the public here.’
 
Particular concerns have also been raised for the location of the proposed pilot in North Queensland, where there is a high population of Aboriginal and Torres Strait Islander people, many of whom have comorbidities and complex healthcare needs.
 
During a state parliamentary inquiry in Queensland’s public health system on Friday, the Guild’s Queensland Branch President Chris Owen vehemently backed the trial, citing ‘significant shortages’ of primary healthcare practitioners.
 
‘Times are changing,’ he said.
 
‘The community wants and deserves access to convenient, safe and accessible healthcare, which community pharmacists can provide without an appointment, during extending trading hours, and via convenient locations.’
 
While Dr Willett acknowledged the GP shortage in North Queensland, he said increasing the scope of pharmacists is not the answer.
 
‘People in these communities, who on average actually have more chronic disease and more ill health, actually need a higher standard of care than other communities,’ he said.
 
‘Rather than foist a second class, makeshift treatment on them, the obvious solution is to train more GPs, encourage them to work in these areas and better reward them.’
 
Meanwhile, the program would also entail private costs for patients, posing a major obstacle to access. While just under 90% of general practice attendances are bulk-billed, under the pilot patients would be required to pay up to $55 per consultation, for what Dr Willett says is certain to be an ‘inferior treatment’.
 
‘It’s really very difficult to justify that,’ he said.
 
RACGP President Dr Karen Price, who is also Chair of the National Council of Primary Care Doctors (NCPCD), agrees, and says the pilot clearly appears to be driven by a ‘desire to increase profit for pharmacies’ rather than increase access to care.
 
‘There are also serious conflicts of interests involved, with pharmacists encouraged to not only diagnose conditions, but also sell patients medications based on this diagnosis,’ she said.
 
‘The Pharmacy Guild has long held strong views in relation to the separation of prescribing and dispensing when it comes to doctors, who are unable to sell the medications they prescribe, yet under this model it seems that it is considered appropriate for pharmacists to do exactly that.
 
‘Clearly there are financial implications that extend past just the price for a pharmacist consultation, but also into the profit margins on the medications prescribed.’
 
If the trial goes ahead, it will also allow pharmacists to prescribe a number of Schedule 4 (S4) medicines, which are currently only indicated to be prescribed under the guidance of a doctor.
 
Dr Willett said this is ‘an obvious attempt’ by the Pharmacy Guild to get around existing legislation.
 
‘The S4s have been deemed by the regulatory authorities as not being appropriate to be pharmacy only, whereas this is shown to use alternative backdoor legislation to enable pharmacists to do it,’ he said.
 
‘It’s clearly putting patients at risk in that way.’
 
The RACGP has issued the committee with a detailed response outlining the college’s full concerns surrounding the trial, and intends to take the matter up with the TGA and other relevant authorities.
 
The NCPCD has also written to the Queensland and Federal Health Ministers recommending that the pilot be ceased immediately.
 
It comes just weeks after the Queensland Government announced its decision to extend its urinary tract infection pharmacy prescribing trial, with the college having raised concerns over antimicrobial resistance.
 
Reflecting on this, Dr Willett said if prior trials are anything to go by, he holds dire concerns.
 
‘The UTI one was just a simple online training module – and we’ve got no reason to expect that this will be any different,’ he said.
 
‘A three-week online course and then you get act like a doctor.
 
‘It’s truly inappropriate [and] clear the trial should be ceased immediately.’
 
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