‘An old and tired us vs them mentality.’

tug of war

The Guild has hit back at “misleading” claims by doctors about the risk of superbugs and the Board’s stance on pharmacist prescribing

On 29 January, state president of the Australian Medical Association Dr Dilip Dhupelia wrote to Queensland’s Members of Parliament, to urge them to talk to Health Minister Steven Miles about stopping the Queensland Pharmacist Prescribing pilot.

Dr Dhupelia’s concerns included the lack of doctor voices on the Steering Advisory Committee, after doctor groups including the AMA and RACGP pulled out; the Pharmacy Board’s decision on pharmacist prescribing models it would consider; and the UK experience.

Trent Twomey, state president of the Pharmacy Guild, has now also written to Members of Parliament to correct “misleading statements and misleading information from the AMA-Queensland”.

He wrote that even during a busy time for health stakeholders – a third case of the novel coronavirus in Queensland was confirmed on Tuesday night – Dr Dhupelia’s assertions “cannot go unanswered”.

“Unfortunately, when you strip out all the emotion, the AMAQ’s ongoing political campaign against advances in primary health care is not driven by patient need or service but an old and tired us vs them mentality [his italics] which is preventing patients from receiving world class primary health care where and when they need it.”

He says that AMAQ has “deliberately” sought to conflate two issues: the Queensland Parliament’s bipartisan endorsement of a pilot of pharmacist-led management of uncomplicated UTIs in women who are not pregnant; and the relevant committee’s recommendation that the oral contraceptive pill be made available over-the counter after an initial script from a doctor or sexual health nurse.

He points out that the two issues are not linked and “are being worked through with the Queensland Department of Health as two separate, but equally important advances in women’s health”.

Mr Twomey notes that the UTI pilot will follow the model used in international jurisdictions such as the UK, New Zealand and parts of Canada, where pharmacists have the ability to provide scripts for several common ailments.

He stresses that as detailed in the recommendation from the 2018 Inquiry into the Establishment of a Pharmacy Council and Transfer of Pharmacy Ownership in Queensland, such prescribing would first see participating pharmacists receive appropriate training.

They would also be expected to follow “strong risk management frameworks”.

He writes to MPs that the fear of pharmacists contributing to the development of “superbugs” by undermining antimicrobial stewardship – a view expressed by doctors representing the RACGP as well as the AMA – are “unfounded opinions”.

“As medicines experts, the role and input of pharmacists in antimicrobial stewardship programs is very well established, the Australian Commission on Safety and Quality in Healthcare have highlighted the pharmacist’s key role in antimicrobial stewardship in hospitals, aged care facilities and the community.

“International evidence from Canada and New Zealand highlights that pharmacists demonstrate high levels of compliance with antibiotic prescribing guidelines in the management of UTIs – further supporting the role that pharmacists can play in providing safe and timely access to therapeutically appropriate treatments for uncomplicated UTIs.”

The AMA Queensland has also propagated “misinformation and misrepresentation of the Pharmacy Board of Australia Pharmacist Prescribing Position Statement,” he writes.

The Board said in October 2019 that it would not consider a model of autonomous prescribing by pharmacists.

“The Pharmacy Board highlighted that significant issues remain with any model of pharmacist prescribing including evidence of need, conflicts of interest, and the importance of separating the prescribing and supply of medicines – all issues raised previously by the AMA,” Dr Dhupelia wrote to MPs late last month.

Mr Twomey notes that “It is of key importance to note the UTI trial falls under the model of structured prescribing, NOT autonomous prescribing”.

He cites the position statement: “The Board’s position statement outlines, ‘Under the National Law, the Board has no regulatory barriers in place for pharmacists to prescribe via a structured prescribing arrangement or under supervision within a collaborative prescribing arrangement. The Boards view is that autonomous prescribing by pharmacists requires additional regulation via an endorsement for scheduled medicines’.”

Mr Twomey also takes aim at Dr Dhupelia’s comments regarding UK pharmacy prescribers, saying these issues have been “grossly misrepresented and assertions of patient harm been taken out of context”.

The Pharmacists’ Defence Association in the UK reported in November 2019 that it had observed that there had been several incidents of unsafe practice coming to light, as the number of independent prescribers working in GP practices rose.

It issued a circular to members in which it warned pharmacists to use significant amounts of caution when prescribing a medicine for the first time, and highlighting other high-risk scenarios.

“Advice from the Pharmacists’ Defence Association in the UK was a reminder to UK pharmacist prescribers (who work in GP practices) to exercise appropriate caution when prescribing in high-risk scenarios,” Mr Twomey wrote to state MPs.

“I would expect nothing less from a professional body dedicated to excellence and care to remind their members of their responsibilities.”

He again stressed that the UTI trial would not include pharmacist dispensing of the OCP, saying the AMAQ had “raised baseless concerns regarding pharmacist provision of the contraceptive pill alongside the UTI trial in a deliberate attempt to mislead stakeholders by conflating these two separate issues.”

The final Committee report had recommended that the state Health Department develop options to provide low-risk emergency and repeat scripts, using the OCP as an example, subject to a risk minimisation framework.

“AMAQ also referenced emergency supply provisions of three days and continued dispensing provisions for specific molecules under the Health (Drugs and Poisons) Regulation 1996, however they fail to outline the inadequacy of three days’ supply in continuity of care with the contraceptive pill and the 40% of women who are ineligible for the continued dispensing provision because it excludes women who take a non-PBS subsidised (private) contraceptive pill,” Mr Twomey writes.

“The Inquiry report drew attention to this inequality of contraceptive pill access for women.

“The comments that the AMAQ levied at Queensland Health regarding the scope of practice for non-medical prescribers appear similarly unsubstantiated and if you’re concerned I’d implore you to seek appropriate advice from the Department in relation to these matters, to sort fact from fiction.

“It’s severely disappointing that the AMAQ would seek to use unfounded fear and scare tactics to further their own interests ahead of the advancement of women’s health in Queensland.”

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