The Royal Australian College of General Practitioners (RACGP) has warned the New South Wales Government in the strongest possible terms to abandon its plan to dramatically expand the scope of pharmacists state-wide.
Earlier this year, the RACGP and other medical bodies resigned from the North Queensland Pharmacy Scope of Practice Pilot steering committee amidst serious concerns regarding patient safety. The slightly watered down pilot in Queensland will allow pharmacists to prescribe medications for many common conditions without any GP supervision or consultation.
Now news has emerged today the NSW Government is following suit. Pharmacists will be able to prescribe antibiotics, the contraceptive pill and repeat scripts for conditions such as high blood pressure, with patients paying a private fee to the local pharmacist who will prescribe and dispense drugs on the spot.
The college understands the first stage of the reform will be announced tomorrow, with pharmacists able to administer a wider range of vaccinations. The next stage will involve a year-long trial similar to the Queensland experiment where pharmacists will be able to prescribe medication for antibiotics for urinary tract infections (UTIs). The final stage will allow trained pharmacists to prescribe medications for a range of conditions such as gastro, nausea and vomiting, allergies, shingles, dermatitis, psoriasis, acne, and hormonal contraception
RACGP President Adj. Professor Karen Price urged the NSW Government to put patient safety ahead of pharmacy owner profits.
"Stop this madness before it's too late, this is a recipe for disaster plain and simple." she said.
"Healthcare is about more than just writing prescriptions and sending people out the door on their way. This alarming NSW scheme promises to be little more than a dangerous script writing service that puts patient safety in jeopardy.
"I strongly urge the state's leaders to resist the lure of the powerful Pharmacy Guild lobby group and look at what has happened in Queensland and overseas when greater power is handed to pharmacists. For example, incidents have emerged from Queensland's Urinary Tract Infection Pharmacy Pilot, which should make policy-makers second guess expanding pharmacy scope of practice.
"GPs have reported many concerning incidents including a patient in their 50s prescribed antibiotics for a presumed UTI who turned out to have a 15-centimetre pelvic mass. There was also another patient in their 60s with a recurrent UTI being prescribed the antibiotic trimethoprim despite know resistance to the drug. Keep in mind too these are just some of the cases we know about. Meanwhile, in the United Kingdom the British pharmacists' own defence union warned of incidents of unsafe practice that have emerged with the rise of independent pharmacist prescribers.
"What particularly concerns me is that if this plan goes ahead patient care will be fragmented, resulting in reduced patient safety and reduced health outcomes. This isn't a solution for patients, this is a solution for the pharmacy lobby. Continuity of care with a GP is so important, particularly for those patients with multiple, chronic conditions that need careful follow-up and management. Under this NSW scheme GPs will be flying dark because we will have no idea what the pharmacist is prescribing and vice versa. I cannot stress enough how dangerous that is, especially for those patients on multiple medications for serious health concerns.
"If the NSW Government is to proceed with his pilot or something similar, the focus should be on pharmacists working as part of a team in the hospital or medical practice setting with doctors and other healthcare workers, rather than operating in an unsupervised retail space. In fact, we have previously pushed for team-based models of care, including general practice-based pharmacists.
"One of the justifications for this plan in NSW, as well as in Queensland, is that there is a shortage of GPs. Some communities in NSW do have a shortage of GPs and this is a problem occurring in many parts of Australia, particularly in rural and remote areas. It's something the Royal Australian College of GPs is all too aware of, and that is why we have been fighting so hard for increased investment in general practice care so that no patients are left behind.
"Additionally, recent workforce data also shows there are significant shortages of pharmacists, so handing more responsibility to them doesn't make sense. At the end of the day, proposals like this are short sighted and dangerous. Rather than handing over responsibility to the pharmacy sector as part of a band aid solution for rural and remote healthcare we need government to look at long term solutions for the GP workforce nation-wide."
RACGP NSW Chair Associate Professor Charlotte Hespe said the pilot was terrible news for patients across NSW.
"This expansion of pharmacy responsibilities will put people at risk and must be stopped," she said.
"Consider how this scheme will hit the hip pocket of patients too. Patients, including those who are up against it financially during a time of rising cost of living, will be slugged a private fee for consultations and keep in mind that there will be no reimbursements under the Pharmaceutical Benefit Scheme.
"Under this plan, as with Queensland, I doubt there will be sufficient training and supervision for the pharmacists. In Queensland, pharmacists will be able diagnose and treat patients from a variety of backgrounds, some with serious health concerns, after completing a 120-hour prescribing course. Even if NSW pharmacists are given more onerous training responsibilities, this does not come anywhere close to being equivalent to the training GPs do. A GP like myself has usually well over 10-years of extensive training and that not only includes the rigours of completing a medical degree but also the vocational training that follows, including in hospitals and GP clinics.
"I hope the Government also considers the conflict of interest at play too. Under this scheme, the pharmacist will not only be diagnosing a range of health conditions and writing scripts, but then also selling patients medications based on what they have diagnosed. We have seen overseas what happens – in the UK to take one example, when pharmacists were allowed to prescribe antibiotic eye drops to patients, the number of prescriptions miraculously rose almost straight away.
"I urge the New South Wales Government – stop plan in its tracks now before it is too late. Put patient safety ahead of greedy pharmacy owner profits. Every patient deserves the best possible care from a GP they know and trust, and there is just no substitute for a well-trained doctor."
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