The RACGP’s Queensland chair has spoken out about his “grave concern” that the state’s pharmacy trial will contribute to antimicrobial resistance
But the doctor group is simply fear-mongering, says Trent Twomey, Queensland branch president of the Pharmacy Guild – and the PSA’s national president Chris Freeman says the RACGP is diminishing the role of pharmacists.
Dr Bruce Willett, Queensland Chair of the RACGP, has called for the Queensland trial – which would see pharmacist prescribing and dispensing of an antibiotic to treat acute UTIs, under a protocol – to be put on hold while national reviews around the level of antibiotics in the community are conducted.
The RACGP contends that the Queensland government is exposing the community to one of the biggest global health risks, antibiotic resistant infections, via the trial.
“The science is clear and backed by the United Nations, European Union and the World Health Organization just to name a few,” said Dr Willett.
“If we do not reduce the amount of antibiotics used we pose huge risks to our future generations.
“As doctors, we are seriously concerned about the growing rate of infections that are antibiotic resistant. Already, one in five UTIs is resistant to the medication this trial is proposing to use,” Dr Willett said.
“If a patient’s UTI is resistant to the antibiotic they are using, they can be left with an untreated condition, and potentially become susceptible to a superbug.
“Superbugs are a huge threat to our health system because they have built up resistance to antibiotics leaving us with no effective treatment available.
“To make things even worse, diagnosing a UTI is not a straightforward matter that can be diagnosed in a pharmacy setting. Many sexually transmitted infections and more serious conditions like diabetes and cancer can masquerade as a UTI, so this trial poses a significant risk to patients’ health.”
The RACGP says that the trial is bucking global health advice to reduce the level of antibiotics in the community.
“Doctors across the country, including GPs, are collectively reducing unnecessary antibiotic prescribing due to the identified global health risks,” said Dr Willett. “We know we don’t always get it right and we’re seeking to prescribe less.
“Introducing more and less experienced prescribers will only exacerbate the current challenges we have with overprescribing.
“We must see the brakes put on this trial until the Australia’s Antimicrobial Resistance Strategy 2020 and Beyond has been handed down by the Australian Governments Departments of Health and Agriculture.”
The Pharmacy Guild’s Trent Twomey said that international evidence simply does not show that pharmacists are handing out antibiotics any more than doctors.
“I think this is fear-mongering, pure and simple,” he told the AJP. “I think it is completely devoid of fact. It’s alarmist, and the doctor lobby should be ashamed of themselves.
“This is not about increased use of antibiotics at all. This is about increased access.
“This is not requiring a pharmacist to do anything more than they’re already trained to do in other developed countries around the world.”
He said that the evidence from North America and Europe shows instead that “a pharmacist is far more conservative in their prescription of medicines, especially antibiotics, than their GP counterparts”.
“This is about ensuring that the Australian Therapeutic Guidelines are upheld by properly trained health professionals, through whatever setting the consumer chooses,” he said.
“This is not about a lower level of care. It’s about the same high level of care consumers can expect from their GP, now being expected from their local pharmacist. And we congratulate not only the Queensland Government, but the Queensland Parliament as a whole on this trial, which enjoys bipartisan support.”
A spokesperson for the national Guild said the Queensland trial will provide Queensland patients with safe and convenient access to medicines as required, under appropriate protocols which will ensure collaboration with the patient’s other health professionals including their doctor.
“This a major step forward for patient care and sensible use of the community asset that is represented by highly-trained pharmacists distributed across the State in the most accessible health infrastructure of all – community pharmacies,” they said.
“The RACGP’s claims that the trial could increase antibiotic resistance seem somewhat disingenuous given that doctors over-prescribing antibiotics has led to the current concerns.
“Pharmacists, as the medicines experts, are well placed to ensure prescribing for the conditions allowed under the trial (contraceptive pill and for antibiotics for urinary tract infections) is targeted and effective.”
Pharmaceutical Society national president Dr Chris Freeman said that the PSA is disappointed that the RACGP has again chosen to diminish the role of pharmacists as trusted and patient-centred health professionals.
He said that it is essential for all health professionals to work together for the benefit of patients, and that the pharmacy profession as a whole intends to do continue to do so.
He said that it supports collaborative prescribing of medicines by pharmacists to improve Australians’ access to safe and effective healthcare and will work with the Queensland Government to ensure that any prescribing trial is performed in a way that protects patient safety.
“We must also recognise and acknowledge that pharmacists already prescribe medicines. It is neither fair, nor professional of the RACGP to dismiss the vital role pharmacists play in our healthcare system,” Dr Freeman said.
“Pharmacists already make clinical assessment and diagnoses within their scope of practice and prescribe lower-risk medicines. The Pharmacist Only Medicines schedule, which allows a pharmacist to assess the clinical needs of the patient, make an assessment, communicate and discuss that assessment with the patient and allows them (based on the risk of the medicine) to supply that medicine as well. In this context based on the risk profile of the medicine, pharmacists do both – prescribe and dispense.
“This vital primary care function of triage and referral, may result in the pharmacist referring the patient to a general practitioner for additional assessment, without the provision of a medication and with no out of pocket expense to the patient.
“As we have raised previously, the RACGP should be well aware that Australia’s healthcare system rates poorly on access and equity, an issue Australian pharmacists are all too familiar with, given the rising out of pockets costs that are prevalent in accessing general practice and general practitioners.
“These factors, in addition to the alarming incidence of medication-related harm, the availability and access to pharmacist care and our medicines’ expertise all add to the need for pharmacists to be able to do more in our health system, including prescribing, just as dentists, midwives, nurse practitioners, optometrists and podiatrists are able to.
“PSA has argued that collaborative prescribing should be designed so that the pharmacist and the medical practitioner support each other. They are complementary roles that would be designed to actually address the safety concerns of patients in an already fragmented care system.
“The pharmacy profession remains committed to working with medical practitioners, other health professionals and consumers to foster relationships and models of care that will greater benefit all Australians.”
The RACGP’s comments are only the latest opposing the Queensland pharmacy trial: RACGP national president Dr Harry Nespolon is on record claiming that the trial will help create “super bugs,” while the AMA recently moved to call on the Queensland Government to stop the trial immediately.
They also come at a time when doctor organisations in Western Australia are strongly opposing the recommendations made in a State Government review into pharmacy, which included considering enabling pharmacists to practise to their full scope.
Trent Twomey said that this response in Western Australia was “again, the doctor lobby foaming at the mouth”.
“I think their alarmist response is completely devoid of fact, and they’re doing themselves an injustice,” he said.