Backlash after CWH ‘undermines’ local GPs

A Tasmanian doctor’s surgery has decided to step back from working with local Chemist Warehouses after the discount giant began marketing its partnership with a national telehealth service

Dr Donald Rose, a partner at the Summerdale Medical Centre in Launceston, said that when the COVID-19 pandemic hit, the practice needed to find a workaround to get its own telehealth scripts to pharmacies, trying to reduce the amount of foot traffic it received.

Summerdale faxed and emailed scripts to the patients’ preferred pharmacies, as well as mailing them, but “there was often a delay in getting the hard copies – they were getting lost in the mail, or they weren’t arriving,” Dr Rose told the AJP.

“So we started to deliver. A receptionist spent a couple of hours a day delivering all the prescriptions. It was the only way to solve it, and it worked very, very well. The pharmacies were getting a prescription within a day of us writing it.”

But patients who used one of the five local Chemist Warehouse pharmacies to have these scripts filled began to offer the GP surgery feedback, he said.

“The response from Chemist Warehouse was to use an opportunity to market telehealth to our patients.”

As promoted in mainstream media and on its website, Chemist Warehouse has partnered with the telehealth service Instant Consult.

Dr Rose said that when patients went to the Chemist Warehouse pharmacies to get their medicines dispensed, they were given flyers promoting the telehealth service.

“That wasn’t the response we would have liked,” said Dr Rose.

“It was ludicrous. One of our receptionists, wearing her uniform, dropped prescriptions to the Chemist Warehouse and they gave her a flyer!

“The way we look at it, they rely on us – we’re spoon-feeding them our prescriptions to solve the problem, to try and get the prescriptions to them – we thought we were doing a service, as part of the cooperative way we like to work.”

Summerdale began to communicate to patients that it would take a step backwards from the way it had been working with the local Chemist Warehouses during the pandemic.

However Dr Rose said this move was not a boycott.

“It has been brought to our attention that the Chemist Warehouse franchise has partnered with a national telehealth service and is actively marketing the service to residents of the City of Launceston, and of more concern to patients that attend our practice by handing them a flyer for this service when dispensing prescriptions we have prescribed,” the GP surgery wrote on Facebook.

“This type of practice undermines our work as local general practitioners as well as risking the patients care as this service cannot arrange face to face consultations.

“Due to Chemist Warehouse’s actions by undermining local general practices through this partnership, we have made the decision, along with many other local GPs, to no longer support their business model.

“This means we are unable to provide faxing, posting or delivery of prescriptions to Chemist Warehouse. We will still do the prescription but it will need to be collected from our surgery. This also pertains to Webster packs.

“We will continue to fax, post and deliver prescriptions to all other pharmacies in the northern region. We ask our patients to consider supporting local businesses. Your local GP is a local business.”

Dr Rose stressed that the doctors’ concerns lie with Chemist Warehouse at a corporate level, and with the non-local telehealth service model, rather than the two franchisees who operate the five local Chemist Warehouse outlets.

These franchisees have agreed to take down posters and stop handing out flyers promoting telehealth, he said, though the discount giant’s mass media marketing continues, which means that the surgery will continue its stance on not supporting Chemist Warehouse outlets.

“The corporate office somewhere didn’t appreciate the damage it would do, to try and market telehealth in opposition to local GPs,” he said.

“They [The local Chemist Warehouse pharmacists] were just doing what they had to do as part of the franchisee agreement they probably had.

“They’re just the meat in the sandwich, and we don’t want to target them.”

He also said that GPs in general, as well as those at the Summerdale Medical Centre, have strong concerns about the telehealth model.

He said that “pop-up” telehealth services, or those which always operate this way – rather than doctors working under the traditional model who have had to scramble to adapt due to the COVID-19 pandemic – cannot replace a relationship with a usual GP and these consultations often result in patients being sent to emergency departments because the telehealth GP cannot help them.

He said it was disappointing that some GPs chose to work in these “kitchen-based” pop-ups, which do not have overheads like rent or wages for support staff.

However he said health authorities cannot address the problem because telehealth consultations are needed in the current environment to protect GPs – particularly vulnerable GPs, such as those who are older, pregnant or who have underlying conditions – from potentially contracting COVID-19.

“You have to have these rules written as they are to protect older doctors – but they’re not for corporates to make money from providing easy things like repeat scripts,” he said.

“It’s disappointing that doctors work for them and they can’t hope to provide a quality service.

“Patients trust their pharmacists – and if a pharmacist endorses telehealth, the patient thinks it must be all right.”

He said that promoting an interstate telehealth GP service as equivalent to having a local GP is “a complete wrong message”.

“We all want telehealth to continue, but it needs to be fine-tuned.”

The national president of the Royal Australian College of General Practitioners, Dr Harry Nespolon, tweeted his support for the Summerdale Medical Centre.

“Telehealth corporate pop ups are bad news for patient care and pharmacies should not promote consults with interstate doctors over local GPs,” he wrote.

A spokesperson for the Pharmacy Guild said: “The facilitation of telehealth has served patients well during the COVID-19 emergency, but the fact remains that the best form of care is face-to-face contact with a health professional”.

“It is not in patients’ interests to promote telehealth as the norm where contact with a local doctor or pharmacist is available.”

In the meantime, Dr Rose said that he has been told more GPs are now considering pulling back from a closer relationship with pharmacies which actively promote interstate telehealth services.

He said that trust between GPs and pharmacies was vital, particularly during the peak of the COVID-19 pandemic, and again should a second wave of infection occur.

“If we didn’t work together, the whole thing wouldn’t work,” he said, saying that the Summerdale Medical Centre has an excellent relationship with local pharmacies, and that he appreciates that pharmacists were as much “under the pump” as GPs.

“We were faxing prescriptions to pharmacies, and they don’t get paid [at the time] until they get a hard copy. That requires enormous trust, and it’s why we started to deliver.”

But marketing a telehealth service meant that “the relationship of helping each other was broken”.

Chemist Warehouse has declined to comment.

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  1. Karalyn Huxhagen

    While there has been a need for telehealth in the crisis we have all promoted using the services provided by your local GP as much as possible. I have become concerned as we move along in months that the same patients are coming in with Rxs from one of the on line services. for example I have a lass who has had three Sertraline rxs written by an on line service. They do not do repeats but each month she texts the service and a Rx appears for her in my in box. One as an emergency is fine but a month after month Rx with no actual dialogue with a GP concerns me greatly. Who is the watchdog of the management of her mental heath? What will PDL and a court of law say if this young lass commits suicide and my dispensing hx shows that she had months of ‘on line’ Rxs with no intervention? I am concerned for her and I am concerned for me as I am now the only guardian of her health and I am working pretty blind. she is in and out like a fly as she is busy. This medtod of obtaining a Rx suits her really fine so she is not going to chat about the consequences of no oversight by a GP.

    The squiggle on the bottom of her Rxs also concerns me as it is a bump in a straight line. very dodgy and a different Docctors name at the top each time.

  2. Reg Kinder

    For years many doctors in my area have recommended patients to go to CWH to get cheap prescriptions, they knew the price and actively told their patients.

    I find this remarkable. Not very professional.

  3. Maureen

    I have used the instant consult myself, as I had just recently moved and couldn’t get time off work to see a doctor. Also, most of my experiences at doctors clinics I have had to wait at least 30 minutes after my scheduled appointment to be seen. So I did a consult during my lunch break and from the very first consult I was advised to find a regular GP. But they got the ball rolling in terms of sending me to get tests done and starting me on antibiotics.

    So this instant consult is just for emergencies from my understanding, and the doctors on this platform do not encourage the tele-health service as a substitute to a regular local GP. So I wouldn’t be so quick to judge anyone. There is a need for emergency services without the need to flood emergency departments in hospitals, which take minimum 2 hours to be seen if your lucky or if you tell them your in severe pain.

    • Paul Sapardanis

      How can you start antibiotics based on a telehealth consult? Corporate clinics will pop anywhere and service everywhere and when things get too hard they’ll kick the can down the road. The AMA and RACGP need to be very careful about this continuing beyond the pandemic

      • Maureen

        I was asked to wait for my results, but my symptoms worsened and it was Sunday. I arranged for an appointment with my local GP the next day.
        You are right in terms of medical bodies and legislation around this to be tightened and monitored.
        Honestly, I think this could be a government space, so that it does not get into the corporate side of competition in the market. So if there is some kind of framework around this, I believe it can be a really good alternative to receiving emergency care in a hospital for things that we don’t need to be there for or if we have urgently ran out of a script of a continuing medication and not in a familiar area.

  4. I am surprised how a doctor sitting interstate or anywhere in the world consult online, issue and fax endone rx to a patient living next door to pharmacy, while a pharmacist cannot even give panadeine after consulting the patient face to face. While a nurse practitioner can prescribe majority of the medicines, there is no sign of pharmacist practitioner despite 10 years debate on this term or title. Like nurse practitioner, we should have pharmacist practitioners who must be able to work independently from the Guild and pharmacy owners to avoid any conflict of interest as it is the main reason by Doctors organisations.

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