Another prominent GP has accused pharmacists of pushing beyond their scope of practice in a bid to make more money

AMA vice president Dr Chris Zappala has penned a piece in the AMA’s Australian Medicine publication, in which he says doctors should become “more determined in defending the critical importance of a medical-led model of care”.

He also outlined a case for doctors dispensing medications.

Initiatives such as the Victorian Government’s funding of the MMR vaccines in pharmacies, as well as the “truly perplexing” Pain MedsChecks, will “push the patient out of GP-centred care i.e. away from the trained and experienced professional able to genuinely help,” writes Dr Zappala.

“At $100 a pop for potentially ill-advised direction from a pharmacist who lacks detailed anatomy or pathology knowledge or any greater sense of medicine or what else might be wrong with a patient seems awfully expensive compared to the cost of any engaged, family GP who costs less and is able to achieve a better, holistic outcome,” he writes.

“The desire for pharmacists (and others) to push beyond trained scope of practice straying dangerously into medical territory is conceivably a strategy of self-defined job redefinition in order to improve market share and profit, given how aggressive the pharmacy retail market has become.

“The conflict that all pharmacists face when offering ‘medical advice’ to patients needs highlighting.

“When a doctor writes a script (or not) there is no change in the consultation fee. By contrast, whenever a pharmacist/retailer persuades a shopper to buy something as a result of their advice, they make more money.”

Dr Zappala writes that if doctors dispensed medications, only covering the cost of the dispensing, “there would be less cost to the patient and system, and no perverse profit incentive as exists for the pharmacist”.

This would be the ultimate in efficiency and convenience, he says.

“I can hear the usurpers citing benefits from drug companies to doctors as a prescribing incentive. This is nonsense… Non-educational benefits from industry to doctors is non-existent. My plumber can give me notepaper and a pen with company details, but a drug company cannot.”

Meanwhile pharmacies receive “representation and benefits from drug companies to stock certain items in their stores and promote certain products,” he says.

“Any retail shop owner obviously makes more money if they can persuade shoppers to purchase, for a pharmacy this might occur as a result of providing ‘medical advice’.”

Collaboration is a euphemism for role substitution, he writes.

“What usurper groups manage to gain, they should be solely and proportionately responsible for – they cannot take the cream but leave the real work and responsibility to doctors given the training and experiential requirements of future generations of doctors.”

He called on the Pharmacy Guild to “put profits aside” and help ease pharmacists into general practice.