Pharmacy jabs a ‘slippery slope,’ says GP

pharmacy jabs: vaccine on blue

A prominent doctor has attacked pharmacist vaccinations and the “slippery slope” of health services in community pharmacy

He says that the health sector needs to examine adverse effects on the general practice model, conflicts of interest in the pharmacy industry and issues with the Queensland vaccination trials.

Dr Edwin Kruys, chair of RACGP Queensland and member of the AMA Queensland Council of General Practice, wrote in AMA QLD’s Doctor Q that the Queensland pilots “have resulted in new legislation with little consideration given to the broader health impacts”. The article also appeared on his blog, Doctor’s Bag.

“This move is paving the way for an expansion into other pharmacy-based health services, which have been successfully delivered in general practice for decades,” he writes.

“It is also threatening the medical home model, which the federal government ostensibly supports.”

Dr Kruys has taken aim at pharmacists several times in the past.

He says that there is little evidence that delivering vaccinations and other health services via pharmacists will improve efficiency, safety or quality of care for patients, though he admits there is a “convenience factor”.

“People need to ask how commercial interests have been allowed to be placed before health benefits to the Queensland population,” he writes, before slamming the QPIP trial data as “superficial, selective and shows elements of observer bias”.

He says claims of managing people who had not been vaccinated “are neither verified, nor explained”.

Dr Kruys also says that there is an inherent conflict of interest in pharmacists delivering GP services, including vaccinations, citing the need for separation of prescribing and dispensing.

Pharmacy Guild of Australia, Queensland Branch president Tim Logan told the AJP today that Dr Kruys’ blog offers no real new points of discussion.

“If somebody is both prescribing and dispensing on all occasions, you wouldn’t have that second pair of eyes on the process to catch errors – but that’s not what we’re talking about with vaccination,” Logan says.

“We’re dealing with a one-off situation here, not a carte blanche for pharmacists to prescribe. The same goes for minor ailments – is it somehow a problem if we recommend an S3 medication, that we’re recommending and then selling it?

“I think for finite issues such as minor ailments, or the provision of a very safe vaccine that should be widely used, it’s not an issue.

“If you’re dealing with toxic drugs and complicated medicines regimes and busy practitioners seeing lots of people and handling lots of medicines, it would be a huge issue then, but I think Dr Kruys is really stretching the argument to suggest that this represents a safety issue, given the low toxicity and high degree of safety of the medicine.”

Dr Kruys also highlights fragmentation of care and missed opportunities for GPs to engage with patients in his blog.

“Pharmacists are ready to roll out more ‘enhanced pharmacy support services’ in the near future,” Dr Kruys writes.

“The impact of patients presenting to pharmacies instead of general practice will result in more fragmentation of care, missed opportunities for screening and preventive health care, unnecessary and non-evidence based care, and possibly increased risk and wasted health resources. It also clashes with the innovative national medical home model.”

But Logan points out that even in general practice, a lot of the time it’s not the GP giving the vaccine.

“He talks about the fragmentation of care as if every occasion of GP care was a full investment, when certainly from my point of view anecdotally is that there’s a lot of six minute medicine,” he says.

“You can’t possibly hope to cover all the screening and monitoring processes that he alleges will be missed if many people go to pharmacy for vaccines and minor health ailments.

“And by the way, why don’t you insist on the same standard with all the corporate medical suppliers around the place? Why’s it only pharmacy that’s the devil incarnate?

“He talks about pharmacy being self-interested – obviously we want to earn a living but wouldn’t you say the same about medical practitioners worried about their market being reduced?”

Logan says that if everybody participated in ehealth records, fragmentation of care would be significantly reduced.

He says that ultimately it profits society more for GPs to work with pharmacists, citing a presentation at the Australian Pharmacy Professional conference earlier this year by US expert Dr Paul Grundy, who demonstrated the benefits provided by a model which encouraged GPs to do so.

“He said the only way to herd cats is to move their food,” Logan says. “And he said that it was interesting that in a medical system where doctors were remunerated on vaccination rates whether or not they performed them themselves, all of a sudden, pharmacist vaccination wasn’t an issue.

“I think that’s germane.”

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  1. Peter Crothers

    Classic splitting and projection psychic defence mechanism that, sadly, we see so much from the docs. Splitting: Subconsciously I feel bad about myself/my own group so in order to feel better I will subconsciously pretend my group is wonderful and altruistic, and others like pharmacists are evil and “commercial”. Projection: I will take the things about myself that cause me conflict – like being “commercial” and having subconscious fears about the medical home concept – and project them onto the people I perceive as a threat, in this case pharmacists. Therefore pharmacists doing anything that a GP can do is a slippery slope. This sort of response is easily dismissed. Patients simply adore the reality of pharmacy ‘flu vaccinations and there will be no going back. Pharmacists taking on extra roles in health/wellness/illness care that benefit patients and are convenient and of good quality will actually strengthen patient-centricity and help build the medical home as a vibrant 21st century working model and – if responded to sensibly – will allow GPs to move on from much of the drudgery of their current work and focus on where their skills are really needed – in coordinating the care of the most complex and needy patients. It is wins all round in the long run

  2. Anthony Tassone

    Unfortunately this is not the first time this author has chosen to make such disparaging remarks about pharmacists and pharmacy’s role in primary care. Th

    Such commentators continue to position themselves as speaking on behalf of the patient – but don’t listen to the patient and consumer.

    Repeated surveys of consumers find that they; trust pharmacists, like visiting pharmacies, are generally satisfied with the service, would welcome the pharmacist doing more in an expanded role (including vaccination) provided that; they were appropriately trained, the service is actually delivered by the pharmacist, it was conducted in an appropriate private consultation area and that their GP was kept in the loop (so that their health professionals in their health care team can be ‘on the same page’).

    These were generally some of the findings of a survey of 500+ consumers by the Consumer Health Forum (CHF) last year (link to release below along with links to the full report);

    GuildCare software helps enable community pharmacies to adhere to their obligations under state and territory regulations to document vaccination services – and also further to that, have inter-professional collaboration and correspondence with other health professionals in the patient’s care.

    Anthony Tassone

    President, Pharmacy Guild of Australia (Victoria Branch)

  3. Darren

    He’s right – it IS a slippery slope – but doctors, not for pharmacists. The more the government paymasters and the public realise that a lot of what doctors do, can be done by others, just as well, and for a lot less money, the faster the doctors will slip down the slope, from the lofty financial pinnacle, and easy workloads, they are often now on.

    • John Rees

      Nurses give vaccines in a room at minesites

  4. William

    If this doctor doesn’t like combining prescribing and dispensing, then he will be wanting to ensure that all doctors have to write scripts for all vaccines they currently prescribe, dispense & administer themselves – can’t be too careful now, can we doctor?

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