UTI pharmacy prescribing goes nationwide

Patients in every state and territory across Australia can now bypass a GP and have their suspected urinary tract infection (UTI) diagnosed and treated by a pharmacist.
 
The Northern Territory went live with its pharmacy prescribing program on Monday, the last area to roll out the initiative for uncomplicated UTIs and expand its pharmacists’ scope of practice.
 
More than 6000 community pharmacies across Australia now have to opportunity to provide additional services as pharmacist prescribing continues to rapidly grow.
 
But RACGP President Dr Nicole Higgins has slammed the trend, saying it is wasting money, putting patients into emergency departments, and leading Australia to fail in its antibiotic stewardship.
 
‘Realistically, we’re going to see people walking through a retail shop of perfumes, vitamins and washing detergent to go and get a prescription that they may or may not need, for a symptom they think could be a urinary tract infection – that’s just not good medicine,’ she told newsGP.
 
‘Imagine walking into the pharmacy, you feel unwell, you’ve got to pick up your script, and someone asks, “do you want Inner Health Plus with that?”.
 
‘We’re going to have uncontrolled use of antibiotics being dispensed by non-medically trained health professionals because people are paying for the consultation and expect something in return.
 
‘We need to step back and ask what this is all about.’
 
NT Health Minister Steve Edgington said the program is designed to alleviate pressure on primary care services and emergency departments, as well as be more convenient for patients.
 
‘These initiatives encourage pharmacists to play an active role in increasing patient access to care while reducing the burden on other health services,’ he said.
 
But while Minister Edgington assured the public that these conditions could be ‘safely managed in pharmacies’, Dr Higgins said the realities of the program and its impact on patient health, safety, and privacy are already being felt.
 
‘I was in the pharmacy recently and there was a woman in scrubs in front of me and it was widely announced to the rest of the busy pharmacy that she was on escitalopram,’ she said.
 
‘She is a health professional and in a small town and her medical history has just been broadcast.
 
‘It goes against the World Health Organization’s recommendations and every piece of evidence that we have for safe practice.’
 
The expansion comes at the same time as NT health bureaucrats consider adding several additional conditions to the NT program over the next year, including shingles, eczema, mild psoriasis, asthma, cardiovascular disease risk reduction, smoking cessation, and the oral contraceptive pill.
 
In what the RACGP has previously called a ‘race to the bottom of healthcare’, almost every state and territory has now allowed its pharmacists to treat all or some of these additional conditions without the involvement of a GP.
 
The nationwide expansion comes despite a recent review of clinical protocols for community pharmacist‑led management of UTIs finding most are of poor quality, and just four were deemed high-quality.
 
Moving forward, Dr Higgins fears things will only get worse.
 
‘I expect what will happen from here is that the Pharmacy Guild will be pitching for MBS access to deliver more and more services that they don’t have the training or the capacity to deliver,’ she said.
 
‘I respect my local pharmacists as really important healthcare team members, but if they want to be doctors, come and do the medical training.’
 
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Northern Territory pharmacy prescribing urinary tract infection UTI