A high-profile GP has accused the Guild of being a “disruptive factor in healthcare” over the codeine debate

RACGP Queensland chair Dr Edwin Kruys has written on his Doctor’s Bag blog that the Guild was undermining the codeine upschedule process, “putting patients at risk”.

“It is concerning that those who have been given responsibility to look after the health of Australians take decisions influenced by commercial interests instead of sound evidence and common sense,” he writes.

In a section titled, “Wheeling and dealing,” Dr Kruys accuses the Guild of behaving one way in public – that is, utilising Government funding to develop resources and education to help the sector transition to prescription-only low-dose codeine – and another “behind the scenes”.

He said that the way the Guild approached NSW Nationals leader John Barilaro, who called for a reversal or compromise on the upschedule, was “clever”.

“They picked a pharmacy in a town with no doctor, invited Barilaro, took a picture with him and issued a press release thanking the Deputy Premier for his support of the Guild’s ‘common sense’ proposal to allow pharmacists to continue to supply codeine, stating: ‘What are patients with headache, toothache or period pain meant to do in Harden when there is no doctor within a hundred kilometres for a week at a time? The AMA has no answer’,” Dr Kruys wrote.

He singled out a clause in the letter from State and Territory Health Ministers (bar the SA Minister) to Federal Health Minister Greg Hunt, in which they wrote, “some people managing chronic conditions with codeine medications will deteriorate as they abandon medication due to the out-of-pocket costs associated with accessing GPs for their prescription”.

“If it is true that people in regional areas are indeed ‘managing chronic conditions with codeine medications’ bought from a pharmacy than that is of course a concern as codeine should not be used for this purpose,” Dr Kruys wrote.

“The State Health Ministers seem to implicate in the letter that it is preferable to treat chronic conditions by self medicating with over the counter codeine purchased from pharmacies instead of going to a doctor to get appropriate treatment.”

Yet Guild president George Tambassis said in a media release over the weekend, following mainstream media reports on the letter, that the Guild and PSA were not seeking to overturn the TGA decision and that “prescription – except when” would pertain to the temporary treatment of acute pain only.

Commercial influence?

Dr Kruys writes that “cash for access” to politicians is “unethical”.

He cites a report in The Australian which pointed out that the Guild was one of seven Labor donors who had “cash-for-access” meetings recently with Queensland Health Minister Cameron Dick.

“Concerns have been raised for a while now that the Pharmacy Guild is able to influence healthcare decisions based on commercial principles instead of sound evidence,” he writes.

“The Guild regularly negotiates a massive agreement with the Australian Government to the value of $19 billion for dispensing PBS medicines. This begs the question how ethical it is that the Guild, at the same time, transfers money into the bank accounts of the political parties it is negotiating with.”

Dr Kruys says that the Guild’s preferred solution – which he identifies as “prescription – except when” with real-time monitoring via MedsASSIST – is “weak”.

This is because “codeine is not safe and there is unambiguous international evidence of harm and misuse” and “there are also serious problems with MedsASSIST.

“It is not an independent tool but owned by the Guild. Not all pharmacies use it so it is easy to get around for those who use codeine for the wrong purposes,” he writes.

“The Guild continues to accuse others that they have done nothing to monitor the use of drugs of dependence.

“This is also incorrect as many groups, including the AMA, RACGP and coroners have repeatedly asked for an effective national real-time prescription monitoring system, accessible by doctors and pharmacists.

“The Pharmacy Guild of Australia is increasingly becoming a disruptive factor in healthcare,” Dr Kruys writes.

“Protection of their significant commercial interests drives behaviour that is not always in the interest of the health of Australians. Feedback or criticism is met with aggressive counter punches. Working with the community pharmacy sector is becoming difficult for other health groups.

“I am not accusing anyone of backdoor deals but this whole codeine saga is not a good look.”

A spokesperson for the Pharmacy Guild responded to the blog by telling the AJP that “The biggest problem in relation to codeine harm stems from prescription medicines and the absence of means to curb doctor shopping—about which doctor groups do nothing, say nothing and pay nothing.

“Unlike the Pharmacy Guild which developed and funded MedsASSIST real time recording.”

Guild Victorian Branch president Anthony Tassone responded to Dr Kruys’ Twitter promotion of his blog by pointing out that the Guild developed MedsASSIST at its own cost, and that it does not charge for the use of the decision-making tool despite “significant” running costs.

“It’s not a ‘commercial’ solution, it’s a clinical tool,” Mr Tassone wrote.

 

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