The Royal Australian College of General Practitioners (RACGP) has welcomed the Victorian Government's planned investment in the general practice training pipeline but warned that expanding the scope of pharmacy will put patient safety and wellbeing at risk.
It comes following the Government announcing a $19 million 12-month pilot to expand the role for pharmacists to treat minor illnesses like common skin conditions and administer travel vaccinations and more public health vaccinations as well as treating urinary tract infections (UTIs) and reissuing prescriptions for contraceptives. Pharmacists will be paid $20 for each consultation with all fees paid by the Government.
It was also announced that the Government will invest $32 million in incentivising future doctors to become GPs via $30,000 top-up payments for first-year trainee GPs to ensure they don't take a significant pay cut. The Government will also cover the costs of their exams in their first year, investing $10,000 per trainee.
RACGP Victoria Chair Dr Anita Munoz welcomed the training pipeline announcement.
"It's great news the Victorian Government has heeded our calls and invested in the general practice training pipeline," she said.
"Any boost to the GP workforce is welcome. One of the problems we have holding back the GP workforce is that pay and leave benefits are not transferred as GP trainees rotate through different training positions. The Victorian Government is not only listening to the RACGP but acting to secure the future of the general practice workforce so that no patients anywhere are left behind.
"By covering the shortfall in income from leaving hospital work we can encourage more future doctors to give general practice training a red-hot go. Covering the costs of sitting exams is also a really worthwhile initiative that will make a real difference and something that the RACGP applauds. These are positive steps forward and I encourage other states and territories to follow Victoria's lead.
"However, it is disappointing to hear decision-makers oversimplify and minimise the important function of the GP in consultations involving repeat prescriptions of the contraceptive pill, travel medicine discussions or diagnosing a urinary tract infection. When a GP consults with a patient we don't simply hand over a script because patient care is much more complex than that - we provide whole person care.
"GPs will assess if the contraceptive pill is still the most suitable or appropriate choice before issuing repeat prescriptions. In terms of UTIs, many GPs encounter women who think that they have a UTI, but it turns out to be a sexually transmitted infection. The herpes virus, chlamydia and gonorrhoea can all cause pain when urinating and can seem like a UTI but without a proper assessment, you simply cannot be sure. Pharmacists don't have the training and expertise to make these calls and pregnancy, cancer, genital infections, and undiagnosed diabetes can also cause similar symptoms to a UTI. Unlike pharmacists, a GP will take a full history, perform dipstick urine testing and physical examinations as well as pathology urine testing as needed.
"I also want to point out that GP workforce challenges are not a justification for extending the powers of pharmacists. There are communities in my home state of Victoria facing a shortage of GPs and the RACGP is advocating strongly for increased investment in general practice care to fix that. That is the solution that is needed, not a band-aid plan of giving pharmacists more responsibilities including the prescribing of antibiotics. Further, we know from workforce data that there are significant shortages of pharmacists, so handing more responsibility to them is not a sound option. Governments should resist the power of the pharmacy owner lobby and instead look at long term solutions for the future of the GP workforce."
RACGP President Adj. Professor Karen Price echoed Dr Munoz's statements.
"Some of this is positive news, because more must be done to boost the GP workforce so that all patients can access the care they need when they need it," she said.
"Less than 14% of future doctors are choosing general practice as their speciality of choice and that must change. I welcome today's announcement and hope that more future doctors look to a career in general practice. From my own personal experience, I can tell you that it is a rich and rewarding career, you are valued by your community and get to know your patients and see them as they move through different stages of their life."
The RACGP President also warned, however, that empowering pharmacists to perform functions such as prescribing antibiotics for UTIs was a step in the wrong direction.
"As we near the end of World Antimicrobial Awareness Week it's timely to once again warn government that expanding the number of antibiotic prescribers is a bad idea," she said.
"It may be considered convenient, but you need to consider just what the Government is signing up to. You only need to look to Queensland, where a Urinary Tract Infection Pharmacy Pilot was made permanent earlier this year. GPs in Queensland 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. Overseas 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.
"It is clear that introducing pharmacist prescribers in Victoria and other jurisdictions will see a rise in antimicrobial resistance because that is exactly what has happened overseas. In New Zealand and the United Kingdom increased trimethoprim resistance has resulted from inappropriate prescribing and use of antibiotics. This antibiotic was over-prescribed and now doesn't work for one-in-three women due to resistant bacteria. Governments should be halting pharmacist prescribing rather than expanding the scope of pharmacists."
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