Pharmacy trial slammed as ‘business model’


doctor wearing boxing glove

Another leading GP has slammed Queensland’s limited pharmacy prescribing trial, calling for a national approach

In mid-April, the Queensland Government announced a statewide trial whereby pharmacists would be able to provide short-term treatment for acute UTIs, as well as repeats for the oral contraceptive pill.

The move was soon slammed by the RACGP, Queensland branch of the AMA, the national president of the AMA, and other doctors.

Now, Chair of the RACGP Board and RACGP NSW and ACT Associate Professor Charlotte Hespe has told newsGP that the Queensland trial is “piecemeal”.

“Queensland is being the disruptor,” she said.

“There’s no problem with disruption in healthcare if it means a better system for our patients but, unfortunately, I don’t see that increasing the pharmacy scope of practice is in any way designed to improve patient care.
 
“It is a business model.”

She commended NSW Health Minister Brad Hazzard for rejecting a similar trial in NSW.

“We’re happy that they’ve taken the advice of the RACGP to go down this path,” she told newsGP.
 
“We’ve been strongly advocating at all times that we don’t see it is in the best interests of patient care to divide the provision of primary healthcare services into pharmacy.
 
“I’m fully supportive of the role of pharmacy in primary care, and fully acknowledge the vital role pharmacists play in medication management and decreasing the significant number of preventable hospitalisations due to medication errors. But we need to strongly understand the need to stay in the scope of practice.”

Prescribing does not “fit” in pharmacy, she said, calling for support for pharmacists to work in GP practices.

“I am not anti-pharmacist. Let’s get pharmacists doing what it is in their scope of practice and get government to fund that, instead of argy-bargy over what is already done well.”

Professor Peter Carroll, president of the PSA’s NSW Branch, told the AJP at the time Mr Hazzard rejected the NSW proposal that it would be a patient-centric logical step which could significantly help women with acute UTIs while they wait to access a GP.

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10 Comments

  1. Dr Phil 42
    09/05/2019

    My 92 year old mother was told by her big GP practice they didn’t have any flu jabs at the moment – and all those news articles made her worry. So she went to the pharmacy and they sold her a quadruvalent vaccine. She is 92! So not only didn’t the pharmacist tell her tell her to get the older person vaccine, nor did he offer to supply one, he sold her what he had at hand! The pharmacist when contacted denies this and he insists he told her, even though my brother (not a doctor) was with her at the time.

    I was in favour of pharmacies selling the flu vaccine because they are supposed to give measured advice and use their judgement if it is appropriate. It was clearly not appropriate. Help us all when pharmacists can start prescribing even wider, like the Queensland experiment for pharmacy prescribing of antibiotics for urinary tract infections. What was that about an antibiotic resistance crisis? At least the GP isn’t looking at making a profit if they prescribe or don’t prescribe.

  2. Andrew
    10/05/2019

    Under the current model any service expansion will always challenged by the conflict of interest issue.

    It’s a reasonable concern and a huge limitation in expanding the usefulness of pharmacists.

    • Jarrod McMaugh
      10/05/2019

      Is it a reasonable concern?

      The very nature of professional practice means that a practitioner (regardless of the profession or industry) will have a conflict between their personal interests, their business interests, and the interests of their client.

      The issue isn’t whether a CoI exists (it must exist, by definition).

      The issue is whether there is a capitulation to this CoI.

      The majority of comments leveled at the pharmacy profession are based on the ability of people to identify the CoI that we encounter every day… but very few people can actually point to a profession-wide capitulation to these CoIs.

      Yes there are instances, and Dr Phil highlights one below, but this occurs in **every** profession (for instance, prescriptions provided to people because they expect a prescription, not because there is a clinical need….. advice to invest in this particular share or Superannuation based on referral fees, etc).

      The automatic accusation of “Conflict of Interest” against pharmacists is generally unwarranted, not helpful, and belies the high level of professional practice and trust that exists in the pharmacy workforce.

      • Andrew
        10/05/2019

        Whether it’s a “reasonable” objection or not isn’t really relevant or objectively measurable so let’s set that aside for a moment.

        One of the reasons we don’t let doctors dispense is because of the the conflict of interest. Pharmacists prescribe through the S2/S3 channels; recommending products from which they profit to patients with whom they consult. The hypothetical perfectly-ethical pharmacist could not deny the CoI inherent in this relationship and it would never be allowed to exist in any other industry and if detected, quickly addressed (as in banking).

        It will always be the albatross around the neck of retail pharmacy.

        • Forget the conflict of interest argument. This is debatable. Pharmacists in general do act ethically and put patients interests first. Same can be said with Surgeons recommending unnecessary surgery etc.

          What isn’t debatable is the disparity in skills and expertise.

          • Andrew
            10/05/2019

            >>>What isn’t debatable is the disparity in skills and expertise.

            Yep, I didn’t want digress in my response but that’s part of it too. I’m a AACP of >10 years and would not feel comfortable Dx/prescribing some of the drugs proposed for Appendix-M or down-scheduling – UTI’s in particular.

        • Jarrod McMaugh
          10/05/2019

          Two points on which you are incorrect.

          Separation of prescribing and supply is by convention, and it is not about “letting” doctors dispense, since doctors are able to dispense now in various formats.

          The separation of prescribing and dispensing is by convention, to allow a second opinion to be involved in the determination of whether a medication is appropriate. It is not about CoI, although this may contribute in some circumstances. It is a common misconception.

          It is also erroneous to believe that pharmacists have a special CoI based on the sale of a physical product, while other clinicians do not have a CoI based on the supply of a cognitive product.

          Doctors, for instance, sell cognitive services, which creates a value in their reputation… which in turn creates a lever for CoI. There are many instances of people being provided with these services in a manner than benefit the clinician more than the client.

          Importantly, the existence of CoI is not the same as capitulation to a CoI. This is the very nature of professional practice in all settings.

          I would make the argument that the high visibility of the potential for CoI for a pharmacist is a strength, while the inability of most people – including clinicians themselves – to be able to identify their own risk for CoI is a very strong risk for inappropriate interventions.

          • Andrew
            10/05/2019

            Bless, semantics.

            My point is that the intellectual argument and your opinion ain’t worth much when the overwhelming view by those that matter is that there IS a conflict of interest and that it PROBABLY IS resulting in poorer health outcomes.

            Whether it’s objectively true or not is irrelevant, it’s a weapon used very effectively against pharmacy and has seriously prevented any kind of innovation or development in pharmacy services for decades.

          • Jarrod McMaugh
            10/05/2019

            Really?

            That sounds a lot like opinion that doesn’t bear up against advances in pharmacy practice over the last 10, 20, 30 years….

          • Andrew
            13/05/2019

            Jarrod if you’ve managed to make a business where the bulk of your income ISN’T from “licking and sticking” or basic OTC stuff I’d love to hear
            what it is and how you did it.

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