As the Queensland pharmacy prescribing trial draws nearer, the president of AMA Queensland has again attempted to stop it going ahead
Dr Dilip Dhupelia, the state’s branch president, has written to all Queensland Members of Parliament on behalf of the AMA Queensland’s Council and its members, as well as “for the safety of Queenslanders”.
“I seek your support to stop the preparations for a trial allowing pharmacists to dispense the oral contraceptive pill (OCP) and antibiotics for urinary tract infections (UTI) without the need for a prescription and for the Health Minister to stop expanding the scope of practice for non-medical practitioners, where it does not comply with the AMA’s 10 minimum standards of prescribing,” Dr Dhupelia wrote.
This is the latest in a series of attempts by groups representing doctors to halt the trial – which was recommended as a result of the 2018 Inquiry into the Establishment of a Pharmacy Council and Transfer of Pharmacy Ownership in Queensland.
A starting date has not yet been finalised for the trial, as exact protocols are still being worked out.
Now, Dr Dhupelia has highlighted to state MPs that the AMA has several concerns including that the AMAQ, RACGP and the Australian College of Rural and Remote Medicine will not be part of the reference group responsible for the trial.
He noted that these groups all indicated their opposition to the trial by letting the Health Minister know in writing that they had withdrawn from the group.
Trent Twomey, president of the Queensland branch of the Pharmacy Guild, pointed out that groups representing doctors had chosen not to have direct input into the trial.
“All major doctor groups and unions, were given the opportunity to have their say on the trial framework and were, until recently, part of the consortium which is managing the trial,” he said.
“The trial consortium includes the four University Pharmacy Schools in Queensland, researchers, the Guild and the Pharmaceutical Society of Australia as well as patient advocacy groups all dedicated to excellent medicine management and patient safety.
“It’s sad that the AMAQ has decided not to lend its voice to the development of this trial.”
“Pharmacy prescribing is a threat to antibiotic stewardship,” Dr Dhupelia told MPs.
He wrote that since state Health Minister Steven Miles said in April 2019 that he supported a trial allowing pharmacists to prescribe and dispense the OCP and antibiotics for UTIs, there have been “significant updates”.
These updates include the publication of the Federal AMA’s position statement on the 10 minimum standards of prescribing in August 2019, and the October 2019 decision by the Pharmacy Board of Australia that it did not plan to consider a model of autonomous prescribing by pharmacists.
“The Pharmacy Board highlighted that significant issues remain with any model of pharmacist prescribing including evidence of need, conflicts of interest, and the importance of separating the prescribing and supply of medicines – all issues raised previously by the AMA,” Dr Dhupelia wrote.
He also cited an article appearing in the UK’s Journal of the Pharmacists’ Defence Association, “whre pharmacy practitioners based in the United Kingdom were linked to a number of serious incidents and cases where deaths were reported”.
“The PDA raised the issue of competency of pharmacists to prescribe and the serious harm to patients causes untold distress to patients, their families and to the pharmacists involved.”
He also cites opinion pieces published in mainstream and doctor media, and writes that legislation is already in place to ensure continued supply of medication by pharmacists without prescription in emergency situations.
“AMA Queensland has repeatedly advised the Department of Health that attending a GP for a script allows the GP to offer other therapeutic advice at the same time,” Dr Dhupelia told MPs.
“The evidence is clear. The pharmacy prescribing trial represents a threat to public safety and quality of care, which will result in poorer health outcomes for Queenslanders.”
He urged MPs to encourage Mr Miles to stop preparations for the trial, as well as for a trial of physiotherapy prescribing in emergency departments.
“The health, safety and quality of care of Queenslanders will be compromised on the basis of the convenience of the pharmacy prescribing trial and the ready access in emergency departments which the physiotherapy prescribing trial represents.”
‘Double the usage,’ claims GP
Meanwhile RACGP Queensland chair Dr Bruce Willett has told the Brisbane Times that allowing the trial would cause antibiotic use to increase.
“We saw with over-the-counter eye antibiotics in Australia as well as the UK. When it became a regular-use item, the usage doubled,” Dr Willett told reporter Stuart Layt.
“We would expect that would happen with urinary tract infection medication as well.
“Meanwhile, the reverse happened when codeine was taken off shelves and became prescription only, the usage halved straight away.
“So there seems to be a clear pattern that a chemist-dispensed item will roughly double the usage.”
He said that other conditions, including STIs, could initially appear like a UTI and in a pharmacy setting, these possibilities could be overlooked.
In response to the AMAQ’s letter to Queensland MPs, the Guild’s Trent Twomey said the group’s stance was a shame.
“Pharmacists are some of the most trusted primary health care professionals in Australia and are highly trained,” he said.
“It’s disappointing that the doctors union would seek to use unfounded fear and scare tactics to further their own interests ahead of the advancement of women’s health.
“As a part of the proposed trial, appropriately trained community pharmacists will be able to provide a limited range of antibiotics to patients who present with low-risk urinary tract infections. This happens safely in New Zealand, the UK and Canada.
“Why should other advanced nations have access to world class primary health care but not Queenslanders – a question the AMAQ can’t answer.”
Mr Twomey said that the Palaszczuk Labor Government should be congratulated for embracing “world’s best primary health care practice”.
“This trial forms part of their innovative health care agenda which is clearly patient focused and pharmacists are keen to play an increasing role as trusted primary health care professionals,” he said.
He noted that the trial has bipartisan support, with Inquiry committee members on both sides of politics unanimously agreeing to the recommendation to allow community pharmacists to provide low-risk scripts.
“Australia is falling behind other OECD countries in terms of accessibility to primary health services,” Mr Twomey warned.
“This trial follows the model of other countries, such as the UK and Canada where community pharmacists are able to provide prescriptions for a number of common ailments.
“Pharmacists complete minimum five years training as well as ongoing, mandatory professional development.
“Pharmacists are medicines experts with training in disease prevention, management and treatment with a focus on patient outcomes. Pharmacists operate within extensive professional, ethical quality and risk management frameworks.
“Governing boards define registration standards, codes, guidelines, policies and scope of practice to which a pharmacist is qualified to operate.”