RACGP resigns from pharmacy trial steering committee

Anastasia Tsirtsakis

11/02/2022 4:36:35 PM

The college has said a ‘truly inappropriate’ trial that would allow pharmacists to diagnose and treat more than 20 complex conditions must end.

A pharmacist doing a diabetes sugar test.
If the pilot program were to go ahead, patients would be facing out pocket costs of up to $55 for an ‘inferior treatment’, says Dr Bruce Willett.

‘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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Dr George Al-Horani   12/02/2022 7:51:17 AM

UTI treated by pharmacist has to be stopped immediately, otherwise there will be a time they will regret they even started that , when we start to see E-Coli UTI resistant to all antibiotics we have in Australia ….. if pharmacist are really so keen to take over our job … then guys simply just go and study medicine … then do the training program to become a GP , it’s a fact 5 yrs study doesn’t equal 10 years to become a GP !

Dr Skinner   12/02/2022 10:11:39 AM

I applaud the college for backing out of this fiasco. It seems all about money and increasing profit margins and power for pharmacies. Why is a doctor not allowed to own a pharmacy, but a pharmacist can own a medical centre? Protection from conflict of interests should work both ways. A friend of mine who is an academic and a responsible pharmacist wants nothing to do with the sort of diagnosing and prescribing this trial is proposing, or even with administering vaccines, as she knows pharmacists are not trained for this, and don’t have the infrastructure to provide a safe service for patients should something go wrong.

Dr Lynette Dorothy Allen   12/02/2022 2:22:14 PM

I wonder how much the Pharmacy Guild and the Pharmaceutical Society have donated to the Queensland Government? And then to slip it through in a sparsely populated ,vulnerable, and poorly serviced area it is like a rehash of the old drug trials that used to happen in Africa.

Dr Francois Johannes Jacobs   13/02/2022 10:01:36 AM

This will make a mockery of the whole GP training curriculum. Why train GP's when the pharmacy guild can unilaterally decide what to treat and when.
Would they allow GP's to dispense medications from our premises?
May be they can do the antibiotics and we can dispense the more expensive

Good on the College for taking a stand

Dr Abdul Ahad Khan   13/02/2022 11:53:32 AM

There is a Saying : ‘ Half a Physician is a DANGER to the Public.’
What Crime has the Innocent Populace done to deserve this ?

Lurking behind ‘ Simple ‘ Clinical Presentations, are many a Sinister Diagnoses.
Pharmacists will never know what they do not know.

Dr Simon Holliday   13/02/2022 2:46:10 PM

This is an example of exactly why we need a Federal Corruption Commission and better transparency laws around political party donations. The Pharmacy Guild of Australia donated nearly $300,000 in donations during the 2020-21 financial year. Clearly this was an astute investment by the Guild and typical of the focused economic management that the Coalition self-report.

Dr Robert William Micallef   13/02/2022 9:38:31 PM

You only need to see the large number of donations for the Australian pharmacy guild to Queensland ALP to know why this is being entertained.

Dr Bahman Ranjbar   14/02/2022 10:07:58 AM

What is happening is not a safe way for community health. Chemists should do their job and GPs the same. Looks like all the GP's clinics could sell medication to patients and make financial benefit. Therefore, patients does not need to go chemist which will save the time and travelling. In addition, they do not need to pay the cost of dispensing medications.
So many times patient comes with symptoms of UTI and we diagnose other communications.
Are chemists trained to do the same things?

Dr Slavko Doslo   14/02/2022 5:03:15 PM

finally RACGP stand for us GP
Thank you

Dr K   28/03/2022 4:27:20 PM

Here is an idea, how about Doctors start prescribing medicines to save people the hassle and money of being charged for a label in a pharmacy where counseling and quality pharmacy seems to have left for entertaining higher profit margins.