‘Taking shortcuts with your health is simply not worth it.’


The AMA Queensland says that pharmacists should not have a wider scope of practice due to conflict of interest and lack of training

In its submission to the Queensland Parliamentary Inquiry into the pharmacy sector, the Australian Medical Association’s state branch has said that it agrees with the Pharmacy Guild on one point: that separation of prescribing and dispensing provides a safety mechanism.

But it disagrees that pharmacists should be permitted to prescribe medicines for some ailments, it says, as this would mean “this safety mechanism would be put at risk and exposes the pharmacist to an inherent conflict of interest”.

“If the scope of pharmacists or pharmacy assistants was to be extended, it is the view of AMA Queensland that it would be impossible for pharmacists to manage this conflict of interest in a way that would be acceptable to most parties.

“Beyond this inherent conflict of interest, there is also the concern that pharmacists may use the opportunity to upsell to patients. Upselling often involves the selling of products that have few, if any, proven health benefits.

“Our general practitioner members have offered many examples of upselling experienced by their patients, such as a pharmacist recommending Inner Health Plus when dispensing antibiotics or Glucosamine when the patient has their arthritis medication dispensed.

“Others have provided examples of when pharmacists have persuaded patients not to fill a script and use an over the counter medicine instead, without input from the original prescribing doctor.”

The AMAQ also says that GPs are “highly trained medical professionals” with on average 14 years’ training, compared to four for pharmacists.

“Pharmacists are not trained to diagnose, examine and investigate with pathology and radiology. GPs are,” the submission states. “There is already ample evidence which shows that men are less likely to visit their GP than women.

“AMA Queensland is concerned that allowing pharmacists to become prescribers would see both men and women lose out on vital consultations with their GP as they opt for convenience over better health outcomes.”

Such convenience is “potentially dangerous,” it says, stating that expanding pharmacist scope of practice runs “directly contrary to the best available evidence about how care should be delivered: long term continuity of care with the same doctor in a therapeutic relationship based on mutual trust and respect”.

“Taking shortcuts with your health is simply not worth it.”

The AMAQ also says that there is “no convincing evidence” to demonstrate the safety of non-medical prescribing in the UK.

“However, there is compelling evidence of better outcomes where pharmacists and GPs work together in a collaborative model for the betterment of the patient, as part of the non-prescribing and non-dispensing pharmacist model.”

The submission says that at a time when Queensland coroners are calling for a real time prescription monitoring system to ensure the control of medicines scheduled S4 and above to reduce deaths, it is “inappropriate to potentially make it even easier for people to obtain drugs by allowing pharmacists… to prescribe and dispense them”.

The AMAQ also provided a joint submission with the RACGP in which the two bodies argued that the more prescribers, the greater the chance of misadventure, “particularly if a pharmacist is generating the prescription in a time poor retail environment”.

It also stated that it agrees with the Federal AMA’s position that broader ownership of pharmacy businesses should be permitted.

“The current ownership restrictions prevent the development of healthcare models that could benefit patient care. For example, co-located medical practitioners and pharmacists would facilitate coordinated and enhanced care for patients, as well as increase convenience for patients,” it says.

“Under current regulations, this model is only possible under very limited circumstances.”

In the introduction to the AMAQ’s submission, its president Dilip Dhupelia echoed his previous comments to the media about the inquiry.

“Pharmacists do not have the education, training or skills to independently formulate medical diagnoses, independently interpret diagnostic tests, prescribe medication, issue repeat prescriptions, or decide on the admission of patients to, and discharge from, hospital,” he wrote.

“The move to expand the scope of practice for pharmacists away from collaborative care relationships puts patient safety at risk, exposes staff to medico-legal risk and rather than providing efficiencies in health care delivery, may prove to be costlier overall.”

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5 Comments

  1. Ex-Pharmacist
    06/08/2018

    AMAQ president Dilip Dhupelia: “The move to expand the scope of practice for pharmacists away from collaborative care relationships puts patient safety at risk [and] exposes staff to medico-legal risk …”

    Pharmacy students & employee community pharmacists, take careful note.
    You probably think having prescribing rights is a big step forward for you and the pharmacy profession.
    Think about it.
    Add this not-insignificant responsibility to your already long list of current tasks & responsibilities.
    Who gets the benefit? The patient? Possibly, but that is arguable.
    What about you? Absolutely not. Just another damn thing you have to do, that the PHARMACY OWNER will get paid for! PSA / Shane Jackson is leading the push, will be interesting to see how much the Guild push this.

    What if you ‘prescribe’ something that causes harm? YOU get sued. Imagine what this will do to pharmacist indemnity insurance. Do you have any idea what Doctors pay for indemnity insurance? Start by adding a 0 to your current insurance and keep going up.

    Just another example of ‘Employee pharmacist LOSE, Pharmacy owner WIN’.

    • Jarrod McMaugh
      06/08/2018

      Out of interest, what role do you see pharmacists prescribers performing.

      Clearly you see it happening in community pharmacy.

      Is this the only/most likely place it will occur, in your opinion?

    • Michael Khoo
      08/08/2018

      I’m not sure about the Ex Pharmacist above, but how I see it It is not about the so called Owner vs Employee, I am concerned that the tried and true “separation of powers” between prescribers, dispensers and suppliers will be no more.

      I would prefer my prescriptions dispensed by someone who has no pecuniary or professional interest in the prescribing, and I would be very disturbed if the prescriber had a pecuniary interest in the supply or dispensing.

      I would prefer, indeed, expect, my own medication to be assessed by two independent professional minds.

      I see a prescribing pharmacist preforming a similar role to a prescribing nurse, not being able to both prescribe and dispense for the same patient, and being paid by the MBS for the act of prescribing should any claim be made. The possession of an MBS approval ( per practitioner ) and a PBS approval (per Pharmacy) should be mutually exclusive.

      What I want to avoid is driving past a pharmacy and seeing the sign “( Are these ) Australia’s Cheapest Prescriptions!?!” Such practices have already devalued and degraded attempts by Community Pharmacy to expand clinical services such as vaccinations and meds checks.

  2. Jarrod McMaugh
    07/08/2018

    It’s always interesting reading these submissions, because they teach you how to determine what a person or group’s core issue is, by picking apart the inconsistencies.

    You’ll note that AMAQ calls for no prescribing rights for pharmacists, due to pharmacists being incapable of dealing with the conflict of interest. This ignores the fact that we prescribe S3 and S2 medications now. It also ignores the fact that if pharmacists were unable to balance the conflict of interest inherent in ALL professional interactions (ie congitive, not just product-based) then pharmacists would be selling low-dose aspirin to every person who walks in the door….. high-margin/low cost universally accepted….. if we truly caved in to conflict of interest this would be how we’d all get rich! Amazing how that doesn’t happen; must be due to the professionalism of pharmacists.

    You’ll also note a few paragraphs later (with breathtaking irony or hypocrisy… or both) that AMAQ calls for open ownership of pharmacies so that their members can own them – ostensibly so they can be integrated into one business “for the benefit of patients”. The unspoken implication here is that a doctor who owns a pharmacy can easily overcome conflict of interest, yet a pharmacist just couldn’t conceivably do so.

    Given that Bastian Seidel has specifically highlighted that GPs are known to reject new patients who are complex due to the poor return on investment they provide to their business (https://ajp.com.au/news/gps-refuse-care-due-to-cost/), it begs the question – how is it that proven instances of capitulation to CoI from one profession aren’t ringing alarm bells, while accusations (without any evidence) of systemic capitulation to conflict of interest by another profession is quietly accepted with sage nodding as if it is inherently true?

    Clearly, the motivation for this submission is nothing to do with best outcomes for patients – it’s not possible to make these two opposing arguments from that point of view. These arguments can only be made in the same document if the motivation behind them is to financially protect doctors from competition, while opening up new pathways for income at the same time – There’s no shame in this, just be open and frank about it.

    A final point on conflict of interest – every professional who makes a recommendation to a client that ends in a financial benefit for profession is subject to a conflict of interest. This doesn’t need to be a physical product, yet many people (including pharmacists) seem to think that this is a greater conflict of interest than a cognitive product; or if the client pays rather than medicare.

    All conflicts of interest are the same, and are inherent to a professional interaction. As an illustrative example, ask yourself why a GP would prescribe an antibiotic to a child with a viral infection at the insistence of the parent when they know this will be ineffective? Because the GP wants them to keep coming back… and therein lies a conflict of interest. Why turn away complex patients who take more time for the same medicare rebate? Because the surgery business performs better with simple quick patients, and the interests of the business are put in front of the patient.

    Next time you hear someone say that pharmacists have a conflict of interest just because we sell physical products, remind them of these facts. These are demonstrable cases of succumbing to CoI on a SYSTEMIC level.

  3. B Lee
    07/08/2018

    “Our general practitioner members have offered many examples of upselling experienced by their patients, such as a pharmacist recommending Inner Health Plus when dispensing antibiotics or Glucosamine when the patient has their arthritis medication dispensed.

    “Others have provided examples of when pharmacists have persuaded patients not to fill a script and use an over the counter medicine instead, without input from the original prescribing doctor.”

    The AMAQ also says that GPs are “highly trained medical professionals” with on average 14 years’ training, compared to four for pharmacists.”

    This line surprises me that it is actually quoted from a doctor. Doctors are not always right which is the pure fact and sometimes pharmacists are the ones who have to correct the misdiagnosis. Also, sometimes doctor’s prescription is not the only answer. Sometimes they even make the condition worse or not even give a relief. That is when over the counter medication can help over prescriptions. Besides, most GPs do not give enough advice or rather none when prescribing medications, especially new one. Eg heaps of HMG-Coa reductase inhibitors getting prescribed without adequate lifestyle advice and education. When asked patients if any advice given from the doctor, most said no.

    Rather than criticizing about other health care professionals on what they do and try to do, why not to review how medical practitioners actually practice, prescribe and diagnose? Funnily, their misdiagnosis is too frequent and below the standard, sometimes I think how the heck they manage to become a doctor. Diagnosing bacterial conjunctivitis with viral when it was clearly bacterial, prescribing antibiotics when clearly not needed (phoned dr and said I am reluctant for their condition and antibiotic resistance but dr insisted), writing a prescription without actually examining etc naming a few. Some pharmacists can be really bad but doctors are not the one to say it, because they can be as bad or even worse.

    It’s patient health that I am only and most interested in and doctors and other health care professionals should too. Why not only focus on it?? As much as I hate GPs who are busy criticizing others about their lack of competence while can’t see their own, I also hate owners such as Guild and PSA who are only interested in their businesses than employee pharmacists who are actually doing the job or patients. We need each other to maximize the treatment outcome and to correct each other in case if we do wrong. We need to stick to that.

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