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‘Significant overreach’: Queensland pilot ploughs ahead before national standards agreed


Jolyon Attwooll


21/03/2023 5:59:41 PM

The RACGP Queensland Chair finds little cause for comfort in documents inviting pharmacies to apply to the state’s pharmacy prescribing pilot.

Pharmacist
Concerns remain that there is little to address the conflict of interest involved in being both the prescriber and the dispenser.

With a deadline looming for North Queensland pharmacists looking to take part in Australia’s most far-reaching pharmacy prescribing project, the RACGP Queensland Chair has said there remains significant cause for concern.
 
Pharmacies and pharmacists must formally express an interest in the North Queensland Community Pharmacy Scope of Practice Pilot by the end of Wednesday (22 March).
 
However, Dr Bruce Willett, also the RACGP Vice President, highlights a lack of detail in the supervision standards in the documentation so far.
 
‘There’s no standards around training and what that means, which is a concern we’ve voiced before,’ he told newsGP.
 
The documents show participating pharmacists – who usually qualify after a four-year degree along with a year’s internship – are required to complete a Safe Prescribing and Quality Use of Medicines program, which includes 10 weekly hours of coursework over 13 weeks.
 
There are also 120 hours of supervised learning, and a six-month part-time ‘Extended Community Practice for Pharmacists program’ to be completed.
 
‘That’s the equivalent of 12 years of general practice training, supposedly,’ Dr Willett said.
 
‘That remains a significant concern.’
 
National pharmacist prescriber training program accreditation standards are currently in development, and while the RACGP declined a place in the stakeholder group due to concerns over transparency, the college has committed to being involved in the open consultation process.
 
However, the North Queensland pilot training program is due to be underway before pharmacy prescribing accreditation standards are finalised. Again, Dr Willett says there is a lack of information surrounding how the pilot will work in practice, with many of the pharmacies likely to be in isolated locations with little surrounding healthcare infrastructure.
 
‘There really is no clarity of how the supervision will be provided, what that will mean and how close that supervision will be,’ he said.
 
Queensland Health was approached by newsGP with inquiries about supervision, as well as the accreditation standards.
 
‘As advised previously, we will not be responding to newsGP,’ a Queensland Health spokesperson responded.
 
‘Your service is a media arm of RACGP, which is an advocacy and membership organisation.
 
‘Our team’s scope is to engage with traditional media outlets and journalists independent of these groups.’
 
Meanwhile, the publicly available expression of interest (EOI) documents do confirm the range of the conditions covered in the pilot, which were first detailed last October.
 
The scope includes autonomous prescribing for the following 17 different acute conditions:

  • Gastro-oesophageal reflux and gastro-oesophageal reflux disease
  • Acute nausea and vomiting
  • Allergic and nonallergic rhinitis
  • Impetigo
  • Herpes zoster (shingles)
  • Mild to moderate atopic dermatitis
  • Acute exacerbations of mild plaque psoriasis
  • Mild to moderate acne
  • Acute wound management
  • Acute diffuse otitis externa
  • Acute otitis media
  • Acute mild musculoskeletal pain and inflammation
  • Smoking cessation
  • Hormonal contraception
  • Oral health screening and fluoride application
  • Travel health
  • Management of overweight and obesity
 
Structured prescribing is also included as part of a chronic disease management program for the following:
  • cardiovascular disease risk reduction program for type 2 diabetes, hypertension and dyslipidaemia
  • improved asthma (and exercise induced bronchoconstriction) symptom program
  • Chronic Obstructive Pulmonary Disease (COPD) monitoring program
Asked whether he found anything reassuring about the latest Queensland Health documents, Dr Willett said he did not. 
 
‘It's a significant overreach,’ he said. ‘It is experimenting on North Queensland in a vulnerable population.
 
‘There is nothing in there that addresses the conflict of interest between the same person being a prescriber and the dispenser.
 
‘There seems to be a pretty reliable relationship that if the prescriber has a pecuniary interest, there is a significant increase in sales.’
 
Dr Willett also described the pilot as a diversion.
 
‘We know that this isn’t going to make any significant difference,’ he said.
 
‘It’s really about trying to attract a headline. I would urge the Queensland Government to really look at trying to fix the problems that are occurring within the Queensland hospital sector as a priority.’
 
The EOI documents include some further detail of the training organisations involved, the locations for the pilot, as well as costs for involvement.
 
While the cost of courses at Queensland University of Technology and James Cook University is $9995, scholarships are available through the Australasian College of Pharmacy for Pharmacy Guild pharmacists which would cut training costs to $995.
 
Again, Dr Willett has concerns for those that do take part.
 
‘It is really important to emphasise the fact that there is a shortage of pharmacists that’s at least equal to and probably more than the shortage of GPs,’ he said.
 
‘Worsening the plight of working pharmacists and increasing the stresses and strains on them for what’s essentially a band-aid solution is not going to be helpful.
 
‘It’s clear that there’s going to be enhanced profits for the pharmacy owners, but it’s not clear that there will be any significant benefits for working pharmacists.’
 
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BP   22/03/2023 10:28:15 AM

I for one will be reporting a Pharmacist to AHPRA if a major safety issue occurs. We know this is all pushed by the Guild and not by employee pharmacists. Perhaps it is time to let working pharmacists know that we won't let mistakes that harm patients or have potentially life-threatening outcomes just slip by.