RACGP opposes push to expand pharmacist scope in Queensland

Doug Hendrie

23/07/2018 3:48:25 PM

The RACGP is firmly opposing efforts in Queensland to allow pharmacists to become prescribers, warning that the move risks public health.

Who can prescribe?
Who can prescribe?

In its submission to the Queensland government’s inquiry into the pharmacy sector, the Pharmacy Guild of Australia has called for extending pharmacists’ scope to include independent prescribing, dispensing repeat prescriptions, treating minor ailments, National Immunisation Program vaccinations and point-of-care testing.
But the RACGP made its concerns around public health clear in its own submission.
‘Pharmacists add value when providing services related to the safe, effective and efficient use of medicines. The increasing push to expand the scope of pharmacy beyond this puts patients at risk of poorly coordinated care and wastes valuable health resources,’ the college submission states.
‘The more prescribers, the more risks for errors. Medication misadventure is one of the leading causes of hospital admission. Multiple prescribers and the involvement of less qualified prescribers will inevitably risk patient safety and increase mortality and morbidity. A particular concern is the prospect that these pharmacy prescriptions would be provided to the most vulnerable patients in our society, and those with chronic diseases.
‘For a large number of patients, interactions with community pharmacy are episodic and ad hoc. A pharmacist does not have comprehensive knowledge of a patient’s history or the appropriate medical training on which to draw in order to provide safe and high quality medical care, spanning triage, diagnosis and treatment.’
RACGP Queensland Chair Dr Bruce Willett told newsGP the college had no concerns with pharmacists working collaboratively in a GP practice or hospital, but that patient safety and trust must be the primary concern.
‘We must avoid making the system less safe, to profit a few pharmacists looking to increase their script numbers,’ Dr Willett said.
‘GPs, as specialists in patients’ medical histories, are uniquely placed to be able to deliver high quality care to Australians through a thorough understanding of their patients’ overall health.
‘While the RACGP welcomes and recognises the important contribution of other healthcare providers to patient care, international and Australian experience has repeatedly shown GPs are the most appropriate profession to be at the core of a patient’s healthcare experience.
However, he said he had no concern with allowing pharmacists to dispense all repeat prescriptions at once.
‘Convenience could be better improved by allowing pharmacists to dispense all the repeats at once, as is done in other countries, rather than one month at a time’, he said.
Dr Willett said a patient receiving health advice or screening in a retail pharmacy would miss out on important health services provided by a GP.
‘Limited repeats on medications such as oral contraceptives and cardiovascular disease medicines ensure patients can continue to be monitored by their GP while receiving treatments and medications, ensuring the right medication is prescribed at the right time,’ Dr Willett said.
‘For example, through prescribing contraceptives during an appointment, GPs are able to review if the right method is being used through a review of symptoms, ensuring side effects do not have dangerous consequences. Removing this opportunity for a GP-patient consultation also takes away from ensuring vital tests such as cervical screenings and STI [sexually transmitted infections] tests are completed and women have a full picture on the potential use of options such as long acting reversible contraceptives [LARCs],’ he said.
The RACGP submission states that pharmacists do not have the appropriate diagnostic skills to identify all potential health issues arising from a consultation, and that pharmacy-based preventive care programs will lead to service duplication, fragmented care and poorer health outcomes.
The Australian Medical Association Queensland submission mirrors many of these concerns, stating that the organisation ‘does not believe that there is a compelling, evidence based argument for increasing the scope of practice for pharmacists and pharmacy assistants … [we] cannot support any measures which would facilitate pharmacists becoming prescribers.’

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Dr Arshad Merchant   24/07/2018 6:43:03 AM

I totally support the RACGP stand. I have seen patient getting repeat Oral Contraceptive from the pharmacist to improve their acne when it was stop due to severe migraine. Another example is Of pharmacies start selling the flu immunization in March 2018, way before the public health recommendation of starting in Late May 2018... Another profit seeking behaviour
With recent codeine scenario, between November 2017 & February 2018, large amount of OTC stocks of codeine been sold for profit without any responsibility. I propose a national inquiry and audit of all pharmacies about this inappropriate behaviour.
My recommendation is to seperate pharmacies from business side ie no pharmacies be allowed to sell or promote any OTC medicine without signing a formal script. In this way, we will know the true understanding of this legitimate danger

Rm   24/07/2018 6:50:36 AM

There is an ability to provide 11 repeats for those patients with a care plan in place in many instances. This can be utilised for those patients when a yearly review is all that is required. Pharmacists have an expanded role only when out of their own profit driven environment and when placed in GP surgeries.

Felix   24/07/2018 7:20:30 AM

Prescribing is not a privilege.
Prescribing rights should only be given to those who have the knowledge of the disease , able to diagnose and monitor response, based on a professional relationship. This is the core of medical practice.

Susan knights   24/07/2018 8:06:45 AM

Why don’t we suggest that gp’s can dispense medications and that pharmacists are not required such as in Malaysia. And after hours in our own hospitals Eg for pain relief medications and antibiotics

Dr George Alhorani   24/07/2018 8:37:20 AM

Why not allow doctors to dispense medications to patients. We have excellent knowledge of medications, we are responsible for any medications we prescribe, we need to tell patient how to use them, possible side effects, we check for interaction with other medications. So we are more capable to dispense, aren’t we ?!!
Pharmacy Guild is trying to take over our role, it’s happening slowly but surely, pharmacy Guild is stronger than AMA & RACGP to influence the government to give them more authorities to take over our work!
I think pharmacists if they like our job that much, they should of study medicine instead!!!
Lately Chloramphenicol eye drops are not efficient anymore, because it’s allowed to be prescribed over the counter, overused, misused. Resistance to it developed already.
Our College & AMA who represent us should say (enough is enough ).

Dr Hassabi   25/07/2018 6:22:18 AM

I totally support RACGP stand.
Simple examples for trivial disorders let alone more complicated ones:
-Seeing patients who have been given ear wax drops with other reasons for their hearing impairment (Does a pharmacist have clinical knowledge, skills and experience of hearing disorders and otoscopy?!!!)
-Seeing patients who have used Chlorsig eye drops for red eye presentations other than bacterial conjunctivitis (Could a pharmacist potentially miss acute Glaucoma?!!!)

Dr Peter J Strickland FRACGP   27/07/2018 3:06:34 PM

The RACGP have to take active action here with the public. Dealing with government means dealing with public servants, and they only deal with budgets and dollars, and not clinical decisions. A push should now be made to have a basic pharmacy in GPs surgeries, and save the patient bundles of money by supplying some pharmacy items at cost price, or at least being able to charge minimum margins by bulk buying by having a RACGP contract for members.

Disappointed   18/09/2018 2:07:39 AM

As a Pharmacist i must clear up a few misconceptions. We also see misprescribing daily - antibiotics for viral infections cos go doesnt want to loose patient, spironolactone for oedema in pregnancy, pregabalin for a gardening injury that went away without taking it, cozying up to drug reps, not telling patients to stop their simvastatin while on clarithromycin. Profit motives such as not taking complex patients cos more work and time for same money as non complex patient, sending through incomplete and one worded clinical summaries in return for govt funding for "collaboration". Asking patients to go back to collect amended rx when we pick up a mistake so that medicare card can be swiped again. Rushing patients out the door with rx. I had one patient tell me "he just looked at me and gave me keflex". Its a problem encountered in a health system that rewards quantity over quality. Number of medicare card swipes wins. There is plenty of opportunity for unethical behaviour in gp practices but most gps do the right thing. Similarly as there are plenty of opp for unethical behaviour in pharmacies, most pharmacists do the right thing. If you are concerned about profit motive it is the pharmacy guild to blame and not the pharmacist. Most of us also detest the profit hungry guild. Pharmacists are incredibly under-utilised and we would like to play a larger role in collaborative health care and move into the future such as in the UK and Canada. Not like malaysia lol!

Dissapointed   18/09/2018 2:15:10 AM

Also, as more and more new medications are being approved and the ageing population is presenting with more complex medication regimes, it would be unwise to continue a system created decades ago where doctors had to deal with much less and are now struggling to keep up with new advances. It would be better for patient health to have a system in which all health professionals were maximally utilised as we see in other countries. With the introduction of Myhealth record the fears of fragmemtation of care thats used to often may be alleiviated.