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Supervisor recruitment issues contradict Guild claims about NQ Pilot


Michelle Wisbey


19/09/2023 6:08:28 PM

Recent comments that local GPs are ‘very supportive’ of pharmacy prescribing do not appear to match the reality on the ground.

Pharmacist prescribing medication.
The North Queensland Community Pharmacy Scope of Practice Pilot is due to start before the end of the year.

Earlier this month, Pharmacy Guild of Australia President Professor Trent Twomey spoke of a ‘massive disconnect’ between leadership at the RACGP and AMA and their members.
 
While both organisations have long raised concerns about the upcoming North Queensland Community Pharmacy Scope of Practice Pilot, Professor Twomey said local GPs are in fact ‘very supportive’ and ‘signing up to be our supervisors’.
 
However, a recent Designated Prescriber Information Evening webinar aimed at ‘doctors seeking information on the requirements’ to take on the mentoring role appears to tell a different story.
 
In the hour-long information session, the Guild’s Senior Project Manager, Sara Kemp, discussed training progress being made by participating pharmacists, who need to complete 120 hours of learning in practice, reviewed with a licenced prescriber mentor, as part of the program.
 
She said the second cohort of pharmacists is in the process of completing its coursework, but also noted issues related to supervision, with participating pharmacists ‘struggling to find designate prescribers that can act as mentors and preceptors to them’.
 
It means with time running out in 2023 for the pilot to get off the ground, organisers – including Australian Health Practitioners Advisory Solutions (AHPAS), which hosted the webinar – have had to cast their net wider in order to recruit practitioners willing to be preceptors.
 
It also appears unlikely that supervision and mentoring will occur face-to-face.
 
‘Ideally, in a perfect world, they would be preceptors that are in a medical clinic nearby so that you can start to develop those really close bonds and relationships and that trusting nature, that collaborative type of relationship,’ Ms Kemp said.
 
‘Unfortunately, the pharmacists haven’t been able to secure designated prescribers in that North Queensland footprint, so that’s why we’ve had to do this.’
 
According to AHPAS, all of the positions have since been filled, but it remains unclear who received them and what their specialities are, as the organisation would not confirm the number of GPs involved, nor the qualifications of those already selected.
 
Dr Mark Raines, a GP based in Mackay who originally trained as a pharmacist, said the situation – and discussions he’s had with colleagues in the area – suggest that the Guild is ‘dreaming’ about the program having widespread support from local GPs.
 
‘This pilot program will fragment primary care, confuse patients, separate the safety net between prescriber and dispenser and just deliver profits for community pharmacies at a cost to patient care,’ he told newsGP.

‘A more sensible approach is to have pharmacists embedded in general practices where the pharmacist will work not unlike the ward clinical pharmacists who were a valuable resource to the collaborative hospital healthcare team.’
 
Once it commences, the pilot program will enable participating pharmacists to autonomously prescribe medication for a host of specified acute common conditions, including psoriasis, shingles, smoking cessation, and obesity management.
 
It will also allow for the structured prescribing as part of a chronic disease management program for a cardiovascular disease risk reduction program for type 2 diabetes, hypertension and dyslipidaemia, and the Obstructive Pulmonary Disease Monitoring Program.
 
In total, participating pharmacists will be able to prescribe 150 different Schedule 4 drugs.
 
Queensland Health (QH), which again declined to answer newsGP’s questions regarding the pilot, has said the program is designed to take pressure off struggling general practices.
 
But Mackay-born GP Dr Stephanie Dawson-Smith, who currently works in Brisbane, said it presents a number of problems and she is worried that patients will receive a ‘second-rate version of care’.
 
‘It’s really disappointing that this has become the solution instead of providing adequate funding for patients to access appropriate care,’ she told newsGP.
 
‘It does take years after [GPs have] done the university coursework – and even during university we’re doing years’ worth of placements – and even after that we still needed supervision as interns before we were ready to make these big decisions about patient care accurately.
 
pharmacy-pilot-article-1.jpg
Dr Stephanie Dawson-Smith believes the pilot will make pharmacists’ jobs ‘exponentially more complicated’.

‘People with incredibly complex care really deserve absolutely top-shelf primary care and really well coordinated care, so it’s just so disappointing that this program is seen as a solution.’
 
Nationwide trend
Despite the opposition from medical groups and local GPs, it appears the pilot will still go ahead.
 
In March, the first cohort of 175 pharmacists began their training and are due to finish the course by December, while a second cohort started in July.
 
The progression also comes as pharmacist prescribing powers continue to grow in other parts of the country.
 
In Tasmania, a trial will begin next year to allow the state’s pharmacists to prescribe medications to people in rural areas and aged care homes, while in Western Australia, pharmacists can now treat uncomplicated urinary tract infections (UTIs).
 
NSW has also established a pharmacy prescribing trial involving UTIs and oral contraception, as has  Victoria, which this week revealed that pharmacists will be able to reissue repeat prescriptions of oral contraceptives, and treat minor skin conditions and ‘uncomplicated UTIs’, after completing just 2–7 hours of training.
 
AHPAS Advisory Board of Peers Chair Dr Gino Pecoraro believes the North Queensland pilot will continue, whether individual groups agree with the program or not.
 
It is why the Brisbane-based obstetrician and gynaecologist – who once described pharmacy prescribing as a ‘disturbing trend that may herald the further degradation of quality healthcare in the future’ – supports his organisation’s involvement.
 
‘The decision has been made by government that this is happening, so what’s gone before is virtually immaterial,’ he told newsGP.
 
‘What we’re trying to do is say “look, if this is going to happen, how do we make that happen so it’s the safest it can be?”
 
‘The people we believe are in the best position to do that are the GPs that have gone through an extensive medical school training and then specialty GP training, so that they can deliver that information and mentor these people with expanded scope of practice so that they’re properly trained.’
 
An information resource for participating pharmacists suggests training for the first cohort will conclude on 1 December, while the QH website states that the pilot should commence in the latter half of 2023, running through to May 2025.
 
But as the program edges closer to going live, Dr Dawson-Smith said any assessment needs to be rigorous, as a matter of public safety.
 
‘We’re just about to make things exponentially more complicated for the pharmacist and I really think this is going to be very dangerous for patients,’ she said.
 
‘This pilot will be very difficult to redeem.
 
‘I think we should explore other ways to be able to utilise the incredible skills that pharmacists have, but this pilot isn’t the answer.’
 
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Rural GP   20/09/2023 10:54:47 AM

In our local area ( coastal NSW) the UTI trial was introduced without consultation The pharmacist informed me that I was part of the trial, even if I did not agree, because by law they had to notify me when they prescribed an antibiotic. I have no choice but to be in the trial. This might be the "very supportive approach " the guild is referring to.
I have explained to our pharmacist, that there is no role for pharmacist prescribing, nor is there lack of access to Drs/antibiotics in our little community. This is expedient care : not best care, and it is motivated to win votes and appease the pharmacists for the 60 day rule. Where there is lack of access to GP's, harder to make this case , I know.


Dr Christine Barstad   21/09/2023 12:40:33 AM

It is of the utmost importance that we change our language around pharmacists "treating UTIs". They are inappropriately treating Dysuria with antibiotics. They are not in a position to make a definitive diagnosis of a UTI.


Dr Prem   21/09/2023 9:33:42 AM

This risks straining my cordial relationships with my local pharmacists, in case they approach me for mentorship. I would certainly decline, mainly due to time pressure and the medico legal issues surrounding this issue. Unfortunately , I would be guilty until proven otherwise!