The Royal Australian College of General Practitioners (RACGP) has doubled down on warnings that the North Queensland Pharmacy Scope of Practice Pilot will fragment care and lead to poorer patient health outcomes.
It comes following the RACGP and other medical bodies resigning from the pilot’s steering committee amidst serious concerns regarding patient safety.
The controversial pilot, the first of its kind anywhere in Australia, will allow pharmacists to diagnose 23 conditions, including asthma, type 2 diabetes, and even heart failure, without any consultations with a GP or other medical specialist. Pharmacists will be able to prescribe and dispense up to 150 different S4 drugs, which are drugs that are prescription only and need to be taken strictly according to the instructions.
RACGP spokesperson and Brisbane-based GP Dr Krystyna de Lange, also a former pharmacist, said that the pilot was a disaster waiting to happen.
“This pilot will allow pharmacists to diagnose, treat and prescribe for very serious health conditions outside of a healthcare team and completely unsupervised,” she said.
“We aren’t just talking about relatively minor medical ailments; this pilot will allow pharmacists to manage patients with type 2 diabetes and serious heart conditions.
“If your only tool is a hammer, every solution is a nail. So, what we have here is the Pharmacy Guild successfully lobbying to put in place a pilot that will put financial gains ahead of the welfare of patients. This is a great win for the pharmacy lobby and a terrible outcome for healthcare in the north of the state.”
Dr de Lange said that the pilot was riddled with risks.
“The most alarming aspect is that pharmacists will not have had the proper medical training to manage these health problems,” she said.
“All GPs, regardless of where they live and work, undergo a minimum of 10-years training. That includes not only medical school but also vocational specialist training, where we learn under supervision how to diagnose and treat patients to prepare us for independent practice.
“It is proposed that pharmacists will – completely unsupervised – diagnose, treat and prescribe for serious conditions after undertaking a course equivalent to around three weeks full time training. After that, they will have the license to manage health conditions which, if not handled carefully, can prove fatal.
“I cannot overstate how dangerous this is. Quality primary care is founded in continuity and a collaborative, team-based approach. Some patients, who would normally consult with their GP, will instead see a pharmacist and that will lead to a fragmentation of care.
“The GP won’t be aware of what the pharmacist is doing and vice versa, so we will struggle to achieve that continuity of care, which is so vital - especially for people with complex health needs including multiple chronic conditions. The left hand won’t know what the right hand is up to, and I strongly believe that this will lead to adverse health outcomes.
“This pilot is happening in north Queensland where there is a high proportion of First Nations people. As a GP with a special interest in Aboriginal and Torres Strait Islander health who works at an Indigenous Health Service, I find this particularly troubling. It’s a reality that many of these patients do have complex health needs that require careful monitoring and follow-up. This pilot is the worst possible outcome for them because instead of promoting collaboration and teamwork, their care will be fragmented and compromised.
“Some communities in north Queensland, and in many corners of Australia, have a shortage of GPs. That is a problem the Royal Australian College of GPs is all too aware of, and we are working with national and state and territory governments to ensure a better distribution of specialist GPs across the country. However, role and task substitution won’t address workforce shortages and maldistribution problems and this pilot will have detrimental health outcomes.
“All of this comes on top of the Urinary Tract Infection Pharmacy Pilot - Queensland, which has been extended without any evidence being released concerning patient health outcomes.
“This pilot, which allows pharmacists to prescribe antibiotics for suspected UTIs, is very concerning because the symptoms of a UTI are common to several other very serious health issues, including bladder cancer, which poses the risk of misdiagnosis. We also fear it will undermine the efforts of GPs and other prescribers to combat antimicrobial resistance, which is caused in part by the over-use of antibiotics.”
Dr de Lange said that the pharmacy lobby’s win was a loss for patient health and wellbeing.
“The Pharmacy Guild has scored a huge ‘win’ for their pharmacy owner members, but at what cost?” she asked.
“We withdrew our representative from the pilot’s advisory committee in protest. Initially, we thought that having a seat at the table might allow us to influence change; however, the more we learned the more it became apparent that this trial would compromise patient care.
“It’s vital to recognise that there is a massive conflict of interest here. Pharmacists will not only be diagnosing conditions, but then also selling patients medications based on that very diagnosis. Roles in diagnosing and dispensing have always been separated for this very reason. In Britain, when pharmacists were allowed to prescribe antibiotic eye drops, there was a doubling in the number of prescriptions issued.
“Enough is enough, we need to haul in the pharmacy lobby and take stock of what is happening. Recently, it was revealed that the Pharmacy Guild donated nationally almost $300,000 to the Liberal and National parties and Labor in 2020/21. In the lead up to the last federal election, that figure was more than three quarters of a million dollars.
“Political donations like this are perceived by many as a conflict of interest and should never influence public health decisions when they relate to patient safety.
“The Royal Australian College of GPs will keep up the fight because there is too much at stake. This trial should be stopped in its tracks before any harm is done and governments everywhere should be wary of exactly what kind of deals the pharmacy lobby is trying to get them to sign up to and how they will impact patient care.”