Doc wrong on codeine, conflict and capabilities: Guild


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A key pharmacy stakeholder has condemned comments from the AMA WA’s new president, saying they are inaccurate and harmful to professional collaboration

Pharmacy Guild WA branch director Matt Tweedie was responding to comments by Dr Andrew Miller on ABC Radio, in which the doctor said AMA views were “not put forward” in a recent review.

The AMA’s Western Australian branch elected Dr Miller, a specialist anaesthetist and company director, as president in early July, around the same time the state’s community pharmacy review was published.

The review into community pharmacy looked at several issues, including scope of practice and ownership, and made recommendations including that WA should monitor national developments and discussions relating to non-medical prescribing for pharmacists.

It also recommended enabling greater access to vaccination via trained pharmacists.

Dr Miller slammed the review at the time, and has now gone on ABC Perth Radio’s Breakfast program to criticise the review’s recommendations and the community pharmacy sector.

Host Nadia Mitsopoulos asked Dr Miller why the AMA would not relent on the issue.

Dr Miller responded that an increased scope of practice was being recommended by “the big business interests in pharmacy,” before Ms Mitsopoulos pointed out that the review was not authored by pharmacy interests.

The review “was authored by the Chief Pharmacist and it was 65 submissions where the vast majority were from pharmacy owners,” Dr Miller said.

“Our views in the review were not put forward, which are that pharmacists are not trained to diagnose. That’s what your GP’s there for.

“And pharmacists also have a conflict of interest in prescribing.

 “We’ve just seen last week a study come out of Queensland: 400 pharmacies which had mystery shoppers showing that more than half the time they are selling unnecessary things, and prescribing unnecessarily the over the counter medications in that setting.”

Dr Miller may have been referring to a QUT study published last week which found that using standardised patients in scenarios of requests for help with emergency hormonal contraception or conjunctivitis, 57.6% of pharmacies followed dispensing behaviour compliant with the protocol, while 31.3% involved some form of overtreatment or overselling of medication. The study involved 205 Brisbane pharmacies.

“So we have severe concerns about diagnostic capabilities, and about prescribing, particularly moving into things like antibiotics, or opiate medications, and this is the reason codeine had to be taken out of pharmacy,” Dr Miller said.

He said that the AMA “100%” supported non-dispensing pharmacists and employee pharmacists, and suggested that there was little interest in wider scope of practice among members of the profession.

“And I don’t think that they’re wanting to buy into this ‘let’s become GPs, writing sick certificates and scripts,’ I think that it’s the big business interests, and that’s what we’re against.

“Those pharmacists are not conflicted, they’re not making money out of selling you a prescription or all of the other stuff, which frankly is our other problem: there’s lots of stuff that’s being sold to our patients in pharmacies which is worthless, in our view.”

The Guild’s Mr Tweedie said there were factual errors in Dr Miller’s comments, including that the Review did include input from the AMA as well as the RACGP and was not produced by “big business” or pharmacy owners.

“We remind him that the WA review into pharmacy ownership works hand in hand with the Sustainable Health Review,” he told the AJP.

“Both were commissioned by the current Government, and called for input from all stakeholders. The AMA, RACGP, Pharmacy Guild and PSA – all these peak bodies that are part of the health system – put forward their submissions.

“If you don’t like the outcome of the review, then perhaps re-examine your own submission.”

He said the AMA appeared chagrined that its “isolationist” reviews were not reflected in the pharmacy review’s recommendations.

Mr Tweedie suggested that the AMA could “focus inwards on what they can do as an organisation to help their own people and patients, rather than deriding, criticising, harping and being shrill about an organisation that he seems to know little about”.

He also condemned the comment about the codeine upschedule.

“We suggest that Dr Miller go back and re-examine why that was done, and inform himself before making comment.”

He noted that – as pointed out by Ms Mitsopoulos, who said that when the review was discussed on the program, most listeners supported the review’s recommendations – Australians in general embraced the concept of wider scope of practice for pharmacists.

“We are confident, and we remain confident, that the public values the service of pharmacists and pharmacies, and uses them on a daily basis, with over one million consultations a year in WA alone, resulting in a high level of satisfaction.

“The position that the Guild is taking is that we hope one day people like Dr Miller will get on board and start working with people, rather than on an ad hoc basis opportunistically continuing to deride and insult fellow health professionals.

“We call on Dr Miller to cease his groundless attacks on a fellow health profession, and get on the page and help us achieve the sustainable, high-quality health service that all Australians deserve.”

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