The Royal Australian College of General Practitioners (RACGP) is warning that expanding pharmacy prescribing powers to treat urinary tract infections (UTIs) in South Australia will compromise patient safety and wellbeing.
It comes following President Dr Nicole Higgins and RACGP South Australian Chair Dr Sian Goodson speaking at the Parliamentary Select Committee on Access to Urinary Tract Infection Treatment. The College's submission (see no. 23) outlines why expanding pharmacy powers is not the right call.
RACGP President Dr Nicole urged the state's leaders to heed GP warnings.
"Patient safety must come first," she said.
"Ask any GP and they will tell you - there is no such thing as an 'uncomplicated' UTI. GPs and practice teams value the vital role that pharmacists perform, and we are right behind pharmacy and general practice working hand in glove. However, GPs complete over a decade of training and undertake years of supervised training to manage patients and treat conditions such as UTIs. Whilst pharmacists are expertly trained to perform their functions, they are not trained to make a diagnosis.
"We must be very careful not to fragment care and risk the long-term well-being of any patient. If the left hand doesn't know what the right hand is doing it can put people in jeopardy, and that is exactly what can happen if pharmacists and GPs are both performing jobs such as prescribing antibiotics. I note too that a crowded retail setting is not a suitable environment to have sensitive conversations about a condition such as a UTI. There is no consult room, and we know from the Queensland experience that patients had to discuss their sexual history in earshot of other customers."
Dr Goodson backed the President's calls.
"There is a real risk of bad health outcomes," she said.
"Some may point to the Queensland Government's decision to make permanent their pharmacy UTI scheme, which allows pharmacists to prescribe antibiotics for 'uncomplicated' UTIs, as evidence that this approach works. They do so at their own peril. In that state, we know of several very concerning instances including a patient who had chlamydia being prescribed antibiotics for a UTI and then also upsold products including cranberry tablets. Another patient who was handed antibiotics for a presumed UTI turned out to have a 15-centimetre pelvic mass and there was also someone with a recurrent UTI given the antibiotic trimethoprim despite known resistance to the drug.
"Keep in mind – these are just the cases we know about. The Queensland pilot was not a proper clinical research trial conducted by an independent expert evaluating public health outcomes. Rather, patients were surveyed by the pharmacist who provided the service and there was no recording of whether there was a reduction in hospital presentations for UTI complications. Only 32% of women who received a service were followed up by pharmacists, so we don't really know how many of them fared after their visit to the pharmacy.
"The report also alarmingly highlighted that half of pharmacist respondents found charging a $19.95 service fee difficult when they did not supply the antibiotic to treat the UTI. So, it's clear that there is a very real risk of overprescribing. The reason we have always separated prescribing and dispensing is to avoid any potential conflict of interest. So, we certainly don't want any model where pharmacists diagnose and prescribe for a condition, such a UTI, and then sell the very drugs required to treat that health issue. Let's stick with what we know works best – GPs diagnosing and prescribing and pharmacists dispensing."
The RACGP SA Chair also warned of other unintended consequences of expanding the remit of pharmacy.
"At a time when we must do everything possible to combat antimicrobial resistance, there has never been a worse time to expand the number of antibiotic prescribers," she said.
"Evidence abounds, including a 2021 Australian study which showed a significant increase in topical chloramphenicol prescribing after it was rescheduled to pharmacist only in 2010. This is just another reason why expanding antibiotic prescribing is such a bad idea, we should be limiting such prescribing to instances where it is absolutely necessary and only under the supervision of a GP who has the requisite training and expertise."
