Pharmacist prescribing will enable ‘super bugs,’ say docs

angry woman

Doctor groups have responded with outrage to the announcement that Queensland will trial limited pharmacist prescribing

Following the recent inquiry into the pharmacy sector in Queensland, the state government has announced a trial allowing pharmacists to prescribe repeats of the oral contraceptive pill, and antibiotics for urinary tract infections.

The RACGP and the AMA have both condemned the plan.

RACGP president Dr Harry Nespolon said that the move was a “misguided solution to a problem that doesn’t exist” and that it fails to acknowledge the health care needs of patients.

Patients may have other health issues which impact on the type and dose of antibiotics used to treat a UTI. Dr Nespolon said that pharmacists do not have the medical training required to safely deliver these health care services.

He said that prescribing contraceptives is an “invaluable” opportunity to assess a patient’s overall and sexual health, a service only GPs can provide.

“While it may sound like a straightforward matter to prescribe medications for contraception and urinary tract infections, the Queensland Government clearly has not taken into account the complexities that can be involved in a patient visiting their GP for a script for antibiotics or the pill,” Dr Nespolon said.

“General practice is so effective in Australia because GPs treat the whole patient, not just a symptom.

“When a woman comes in for a repeat prescription of a pill, I make sure to check her blood pressure and look into any possible any side effects. I provide advice on if a longer term contraceptive may be best, check if she is due for a cervical screening and discuss her long-term fertility plans.

“These are conversations that will simply not happen in a pharmacy.”

Dr Nespolon said allowing pharmacists to prescribe antibiotics for UTIs also drastically increases the risks of community resistance of antibiotics and the creation of ‘super bugs’.

“Antimicrobial resistance is a real community risk, which has seen GPs become the stewards of antibiotic prescribing. Increasing the amount of professionals able to prescribe antibiotics will do nothing but exacerbate this issue,” Dr Nespolon said.

“The Queensland Government is thumbing its nose at antibiotic stewardship.  Even the World Health Organisation sees this as a major health problem. Governments should be trying to decrease the number of prescribers of antibiotics not flippantly increase them.

“When you have a pharmacist dispensing and prescribing rights you remove all of the needed checks and balances on medications, leaving the system open for increased human error or worse, risk of manipulation for business purposes. Ultimately, it is the patient who suffers.

“I call on the Queensland Government to reconsider their decision, before any patient suffers the potential negative effects of this decision.”

The Australian Medical Association’s Queensland branch also weighed in, with state president Dr Dilip Dhupelia calling the decision “irresponsible and reckless”.

“Pharmacists do not have the medical training required to determine the various factors involved in ensuring patient safety when it comes to medication,” he said.

“This is a blatant push by the pharmacy sector and the State Government has condoned the move. Patients are set to be the biggest losers in this transaction.”

Dr Dhupelia said that the reason doctors require a consultation for repeat scripts is “because they are qualified to ask the relevant questions and take account of what things may have changed since the medication was first prescribed”.

“How will a pharmacist determine that the oral contraceptive pill continues to be the most appropriate contraceptive for a specific woman?

“Will a patient’s usual GP even be informed that medication has been dispensed to them without their doctor’s input?”

He called the establishment of a committee to evaluate the trial a “waste of more health dollars”.

“I don’t understand why the State Government is wasting money on such bureaucratic processes, when we already have highly skilled GPs who can do this work.”

He also said that the recommendation that pharmacists rely on the Government’s 13 HEALTH hotline and the My Health Record database for medical advice when unsure about dispensing medications that normally require a doctor’s prescription was “reckless and dangerous”.

“The Government’s 13 HEALTH phone service is a nurse-led hotline with one GP assigned for all of Queensland,” he said. “The Queensland Government’s own website concedes that 13 HEALTH ‘is not a diagnostic service and should not replace medical consultation’.

“And when it comes to relying on patient’s information from My Health Record, that fact that nearly one million Australians have opted out of this database makes it a highly unreliable source of information.”

Dr Dhupelia said the Queensland Government’s move to roll out the trial would require legislative changes and placed the state at odds with the rest of the country that abided by a national governance framework for prescribing standards and training.

He said Queensland doctors had called for a new system where pharmacists worked collaboratively with GPs within GP practices.

“The public health system would save $545 million over four years by having pharmacists working within GP practices but that saving has been ignored,” he said.

“The Health Minister is duty bound to protect patients, not bow to the pharmacy lobby’s greed and make it easier for people to buy drugs without a prescription or seeing a doctor.”

The comments also follow the release of submissions by the AMA and RACGP to the Pharmacy Board’s consultation on pharmacist prescribing, in which both groups slammed the concept.

In this week’s edition of Guild newsletter Forefront, national executive director Pam Price foreshadowed the doctor groups’ reaction to the Queensland trial.

“More in sorrow than in anger, we expect the usual predictable naysaying from certain doctor groups, whose knee-jerk concern for their business model masquerades as concern for patient safety,” Ms Price wrote.

“What we say to them is: recognise the potential patient benefit and convenience this represents within a safe framework, and work with pharmacists to ensure it is implemented in a collaborative and expeditious way. Put patients first, and give patients more control of their own health.

“We are sure most GPs will adopt this positive approach, regardless of what their peak body may say.”

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