GP ‘horror’ at pharmacy ED proposal

Leading GPs have slammed a PSA proposal, with one saying managing non-urgent Emergency presentations in pharmacy is not “just a fun, income-generating exercise”

Last week, the Pharmaceutical Society’s NSW Branch released its 2021-22 Budget Submission, which made recommendations in “five key areas” including vaccination, harm minimisation and embedding in state-funded aged care facilities.

The PSA also recommended that the NSW Government allocate $7.5 million to facilitate and fund re-direction of non-urgent emergency presentations to community pharmacists.

The PSA noted that in 2018-2019, there were 8.4 million presentations to Australian public hospital emergency departments. Of these, 2,976,532 emergency department presentations were in NSW, with 335,836 (11%) of these being considered as non-urgent.

PSA NSW Branch President Chelsea Felkai said at the time that, “There is strong evidence that the clinical advice provided by community pharmacists regarding symptoms of minor illness results in the same health outcomes as if the patient went to see their GP or attended the emergency department,” she said.

“Pharmacists can manage non-urgent conditions or low urgency conditions, provide the right level of care and mitigate funding and system inefficiencies as patients access professional support for conditions that can be self-managed or require referral.”

But doctors have responded to the recommendation with strong criticism.

RACGP NSW and ACT Faculty Chair Associate Professor Charlotte Hespe has told newsGP reporter Matt Woodley that she is “horrified” at the idea.

“Why on earth would you take on all the risks of being the GP triaging?” she told the RACGP’s publication.

“Do they not understand all the actual clinical risks of that sort of work? That assessment of a basic headache is not just saying, ‘Go and take a couple of Panadol’?
“Our job is to be able to adequately assess that it is a headache that can be treated with paracetamol, versus one that needs to be more thoroughly investigated. It isn’t just a fun, income generating exercise.”

Chelsea Felkai

Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care agreed.

“It might seem that pattern recognition for frequently occurring minor ailments means that these presentations can be managed through protocols that include safety netting and a low threshold for advising medical review, but I believe the consultation process is much more complicated,” he told Mr Woodley.

“For example, the minor ailment might be a ticket of entry to open opportunities for a patient to discuss underlying mental health issue. Or what appears to be a simple tension headache might be caused by any one of a number of rare conditions that are only likely to be contemplated by a healthcare provider with a great depth and breadth of medical training.”

He also compared the educational levels of GPs and pharmacists, saying that “training for pharmacists is also comprehensive but with a major focus on the effective use of medications only”.

The GPs said they were also worried about fragmentation of care, privacy and record-keeping.

Ms Felkai responded by telling the AJP that the PSA’s suggestions pointed towards a collaborative model, and noting that pharmacy already has a significant track record in minor ailments.

“I’ve never been to an emergency department where I was triaged by a GP,” she said.

“Minor ailments are managed in community pharmacy everyday – this is not new – and the patient is triaged or referred accordingly – which may be to a patient’s GP or the emergency department for more serious conditions.”

She noted that, “Not all of these conditions are complex clinical conditions, and pharmacists are trained to recognise when a patient needs referral for more complex clinical conditions”.

“Triaging for minor conditions in the primary care setting would reduce a heavy burden that falls on the emergency department, and would see more patients attend their GPs through referrals by their pharmacist,” she said.

“The policy takes into consideration all areas of NSW, where patients may need to travel a significant distance to the nearest hospital and emergency department or where they may not be able to access a GP.

“We very much see this as a collaboration with all primary care providers,” said Ms Felkai.

“Pharmacists and GPs should absolutely collaborate to ensure patients receive the right level of care at the right time and the right cost. This proposal highlights a role that pharmacists are already doing, including consulting with and referring patients to their GP when necessary.

“The article indicates that ‘Often the comparator for minor ailment services is emergency department attendance, which is necessarily an expensive service set up to manage severe acute presentations and emergencies’.

“This is exactly the point, and is not necessary for these non-urgent conditions.”

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