Doctors have reiterated claims that pharmacist prescribing is like “Russian Roulette,” accusing the Queensland Government of promoting cut-price health care at pharmacies
The Australian Medical Association’s Queensland branch has responded to an article published by the AJP, authored by industry analyst Bruce Annabel and retail consultant and strategist Malcolm Scrymgeour, by stating that the Queensland Government is “feeding an industry-wide drive by pharmacists to cash in on patients at the expense of health care”.
Australian Medical Association (AMA) Queensland Councillor Dr Marco Giuseppin said the article, Profit Accelerators, revealed a money-making agenda on the part of the entire pharmacy industry.
“This reveals the real intention behind the pharmacy industry’s lobbying of the State Government to allow it to provide extra services such as vaccinations and prescribing medications without a doctor’s prescription,” Dr Giuseppin said.
“Instead of protecting patient care over profits, the State Government is dishing up discounted health care to Queenslanders at pharmacies in an irresponsible cost-cutting exercise.
“AMA Queensland has repeatedly voiced concerns about a conflict of interest in allowing commercial businesses to provide medical treatments, as well as the risk of pharmacists diagnosing medical conditions,” he said.
“It’s akin to playing Russian roulette with people’s health.”
Dr Giuseppin singled out a section of the article in which the authors noted that opioid replacement services could be profitable, as well as a section referencing the Queensland Government’s recent decision to expand the range of vaccinations available in the sector.
“Health Minister Steven Miles has recently made changes that allows Queensland pharmacies to offer nine different types of immunisations, compared with three or four in every other state or territory,” Dr Giuseppin.
“Queensland is also the only state or territory to approve a trial allowing pharmacists to diagnose patients and prescribe antibiotics as well as some other medications.
“It’s unnecessary and irresponsible public health care.”
The AMAQ’s response also states that the article recommends pharmacists “target the vulnerable and elderly through Dose Administration Aids,” and that offering professional programs such as diabetes, sleep disorder and mental health services fragments care and leads to poor health outcomes.
“The State Government needs to prioritise patient care rather than allow pharmacies to use patients as cash cows,” he said.
The AJP spoke to longstanding contributor Bruce Annabel, who expressed disappointment at the AMAQ’s response and noted that, “We are promoting, not pharmacists just flogging stuff for the hell of flogging stuff – we’re talking about pharmacists delivering health services, principally”.
Mr Annabel said that the expansion of vaccination services in pharmacy had led to a “deluge” of patients seeking vaccination in the sector, particularly for influenza during the COVID-19 pandemic.
“It’s an all-time record, which says that patients do like the service, and probably appreciate the convenience of being able to book an appointment with the pharmacist fairly easily,” he told the AJP.
He said that medication management services such as DAAs “are all about helping improve patient compliance and adherence – what’s wrong with that? It’s a service for which people get paid”.
“There is nothing in there that has anything to do with purely making money,” Mr Annabel said. “It’s all about providing professional services to patients in the interest of improving health – maybe that’s what they’re upset about.
“Pharmacy is beginning to make that transition to a more professional style, utilising the training and skill sets that pharmacists have as the medication management experts.
“You can’t deliver quality, consistent, professional services to pharmacy patients unless you’re running a quality business – and that includes that the business must make a profit to survive and to service working capital demands such a stock and paying landlords,” said Mr Annabel.
“The things we’re talking about here are all professional services which are patient health-related. So is the AMA saying these things should be done for nothing while the employer has to pay the pharmacist to do the job, pay the rent and maintain the premises?”
He pointed out that the pharmacy channel’s operating costs and systems are very different from those of other, larger retailers.
“The moving parts in a pharmacy are quite extensive, when you think about the staffing, the training, the fitout costs of a pharmacy, the stock you need to keep, manage and reorder, the services you need to provide to your patients – all of these are extremely significant and radically different to how a general practice operates. Managing it well, in order to be able to deliver a quality, consistent health care offer, is a lot more complicated.”
He said that the AMAQ’s remarks were disappointing in part because at grass-roots level, GPs and pharmacists work so well together.
“In my experience, my clients work extremely well with GPs in their local areas – the spirit is strong, the collaboration is strong and the focus of all this, from the pharmacist and the GP, is patients health.
“I think that’s something that needs to be perhaps understood by the AMA, because they perceive the pharmacist as stealing their turf, and flu vaccination might be one of those.
“But apart from that pharmacists are sticking to their areas of dispensing, giving advice on the medication, medication management and adherence, and helping patients.
“They have a very big primary health care role, and if it wasn’t for that, general practices would be flooded and wouldn’t be able to cope.”
Meanwhile an article in The Australian commented on a “brawl” between pharmacies and GPs over continued dispensing.
“Chemists are using the coronavirus health crisis to push for a permanent increase in their power to issue customers with scripts for medications without a prescription, trigging a fresh stoush with doctors over their scope of their authority,” writes health editor Natasha Robinson.
This article cites the Pharmacy Guild’s submission to the bushfires Royal Commission in which it lauds related continued dispensing arrangements as a success.
RACGP national president Dr Harry Nespolon was quoted saying that the RACGP felt this was a “serious risk to patient health and wellbeing”.
“This is yet another example of the retail pharmacy sector seeking to put financial gains ahead of patient care and safety, and taking advantage of temporary arrangements designed for emergency situations … There is no place for these arrangements on an ongoing basis,” Dr Nespolon told Ms Robinson.
Mr Annabel said that “It is in the patient’s interest; if you can’t get hold of a doctor if you need a prescription, particularly one that’s life-saving, of course you need it”.