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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