Pharmacy under fire


angry woman

One doctor has accused the PSA of being “asleep at the wheel” in 7CPA negotiations, while another has declared that the Guild “enjoys a magical path of political favour”

A number of doctors have slammed pharmacy for calls to retain continued dispensing and what the AMA calls “role substitution,” in particular the Queensland trial of pharmacists prescribing antibiotics for simple UTIs.

Speaking to Morgan Liotta at RACGP publication newsGP, Dr Evan Ackermann, immediate past Chair of the RACGP Expert Committee ­– Quality Care, said that “Both the Guild and the PSA have a long history of medication policy misjudgements… codeine, opioids, increased dispensing quantities – so that no one rates their health policy opinions that much anymore”.

“The PSA was asleep at the wheel at the recent negotiations, and achieved nothing for their members in any funding or professional development sense,” he said.
 
“They fell over backwards for the business demands of the Pharmacy Guild.”

Dr Ackermann was commenting on the fact that double script lengths were not implemented despite repeated calls for it from doctor groups.

He also commented on PSA’s recent call to make temporary continued dispensing arrangements, introduced this year as a response to the bushfire and COVID-19 crises, permanent. The arrangements were extended for three months last week.

He said that such arrangements “allow consumers to continually acquire their PBS-subsidised medicines without obtaining a valid prescription from their GP”.
 
“Continued monitoring is a core quality issue for any chronic disease. It is a very short-sighted strategy to effectively stop or sidestep reviews by the responsible prescriber.
 
“Pharmacists want to usurp this role, but in reality they have no experience and little insight into a prescribers’ therapeutic rationale, chronic disease management, or management in the context of multimorbidity.”

In the same article Professor Mark Morgan, current Chair of the REC–QC, said that a permanent scheme would require transparency and the release of details.

“We have to remember that community pharmacists are working in a retail environment – patients are customers,” he said.

“It is hard to disappoint customers, so there will be a great temptation to bend the rules.”

He said he was worried that pharmacists could inadvertently recommence medicines which the doctor had stopped prescribing, and that he was disappointed that double dispensing had not been implemented.

Adviser to and immediate past president of the PSA Shane Jackson said on Twitter that the article contained the “largest amount of self-interested drivel that I’ve seen for a longtime,” prompting an exchange with Dr Andrew Miller, recently re-elected president of the AMA’s WA branch and another frequent critic of the pharmacy sector.

 

Dr Miller took aim at the Queensland UTI trial as well as pharmacist vaccination, as well as the PSA and Guild themselves, saying that, “Your platform is wobbly cos we see you and the rent seeking political donating Guild running as allies”.

In response to another comment by pharmacist Sam Keitaanpaa, he said that for 20 years “GPs lose every time & the Guild enjoys the magical path of political favour. AMA forgot to donate…”

 

‘Tainted view’

Associate Professor Chris Freeman, national president of the PSA, responded to the comments in newsGP by calling again for the continued dispensing arrangements to become permanent and expressing disappointment in the attacks on the profession and its stakeholder groups.

“PSA will not get drawn into a back and forth with an individual, sitting on the sidelines with a tainted view on the pharmacy profession,” Dr Freeman told the AJP.

“One sided commentary such as this is doing nothing to progress patient care and are damaging when pharmacists and GPs on the ground are building collaborative relationships.

“The 7CPA agreement supports the vital role of pharmacists in primary care and in delivering better health outcomes for patients.

“PSA worked closely with the Department of Health and Minister for Health over 18 months on this forward-looking 7CPA that will achieve genuine and positive outcomes over the term of the agreement.”

Dr Freeman also underlined the organisation’s stance on continued dispensing, saying the arrangements had allowed 75,000 Australians to benefit from “safe, secure and timely access to medicines when faced with a global pandemic, bushfires and social isolation.

“These Australians may have gone without these medicines, posing real and imminent harm to their health,” he said.

“We need a health system which is agile and able to respond to emergencies like these and we need all health professionals to come together as a team to support each other in caring for the community.

“Pharmacists are experts in medicines – ensuring safe and quality access to medicines – continued dispensing is just one of the many tools pharmacists use as part of a holistic care team.

“PSA has robust standards and guidelines supporting pharmacists to make evidence based and clinically appropriate decisions around continuous dispensing. The continued dispensing program does require regular GP review, a point conveniently missed by the RACGP representatives.

“It is now time to make continued dispensing arrangements permanent.”

Meanwhile AMA Queensland president Dr Chris Perry has written an opinion piece for Hospital and Healthcare in which he criticises “role substitution” in the Queensland trial.

He said pharmacists would be dispensing antibiotics to “all and sundry”.

“I accept that more than 1000 pharmacists have now ‘qualified’ to diagnose and treat urinary tract infections after a short intensive online training module of 6–8 hours,” he wrote.

“Still, the pharmacist cannot take an appropriate history in a chemist shop, cannot correlate symptoms with the patient’s unavailable medical history, cannot order a micro-urine test to confirm there is an infection and what the bacteria is sensitive to, and they cannot access the results of previous tests.

“They cannot examine for symptoms of pelvic and bladder cancer which may be similar to infection, and of course the pharmacist will be able to recommend value adding products from their bursting shelves — all of which are not covered by a healthcare card.

“There will be further fragmentation of health care, potentially more drug allergic reactions without the patient’s history being readily available and many patients not knowing their history.

“There will be more inappropriate antibiotic use with consequent increased antibiotic resistance.”

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3 Comments

  1. Mimimomo
    07/07/2020

    “We have to remember that community pharmacists are working in a retail environment – patients are customers,” he said.

    “It is hard to disappoint customers, so there will be a great temptation to bend the rules.”

    That is so true!!

  2. Dr Evan Ackermann
    07/07/2020

    Frankly I do think the front-line pharmacists deserve better.

    The 7th CPA failed to deliver what is needed most, improved remuneration models for frontline pharmacists and validity of community pharmacy as a profession and a trusted voice on health issues.
    Frontline pharmacists are compelled to increase their label-sticking, perform medication management services and “programs” which they know (and evidence says) does not work – for dollars that go to the business not them. The Guild wins again. Pharmacy programs are a backdoor payment to owners.

    This was $1.2Billion that the PSA could have lobbied for a better deal for front line pharmacists – but the PSA is asleep at the wheel. You would think there may have been reference to different funding models for pharmacists rather than channeling everything through community pharmacy business owners.
    The PSA contribution did not amount to much other than – The “Commonwealth intends to provide funding to the PSA during the Term to be directed to achieving the objective of further promoting the standards of professionalism in the pharmacy profession. Sort of says there is a problem with professionalism in Community Pharmacy that the PSA cannot resolve without government funding!”
    I normally reserve pharmacy criticism to the Guild – but this time front line pharmacists were sold out by both the Guild and the PSA.

  3. actnowpharmacists
    30/07/2020

    “It is hard to disappoint customers, so there will be a great temptation (for pharmacist) to bend the rules.”

    I disagree with the blanket statement. The same goes for GP’s as well. Its classic mud slinging that somehow GP’s are the only torchbearers when it comes to ethics and professionalism. There have been documented cases in the past where GP failed to provide adequate care for lack of time (or wanting to see more patients as they stretch their limit).

    On one hand Pharmacists are considered “Experts” in medicines and are “Expected” to be able to deduce plethora of information re customer’s history, concurrent medications, pregnancy status and what not by simply having a look at a single prescription presented in the pharmacy. They are expected to catch an error made by GP. But at the same time GPs don’t want them to really excel in providing that level of clinical care and oversight because obviously that means diversion of the funds and may involve some turf overlapping.

    “Front line pharmacists were sold out by both the Guild and the PSA.” Absolutely. Front line pharmacists are coping it on the chin having to balance their obligations as Pharmacists , living under a cloud of constant threat of being sacked for being too slow (read too thorough) and trying to please Pharmacy Owners who seems to be more interested in the number game. No matter how good a pharmacist you are, how good your clinical knowledge is, at the end of the day you can be replaced by a newly registered pharmacist who can work for low wage and can dispense faster.

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